Houston Man Pleads Guilty to Hiding Payroll from Texas Mutual

Texas Mutual Insurance Company reported today that Marvin Solano of Houston pled guilty to workers’ compensation fraud-related charges. A Travis County district court ordered Solano to pay $140,038 to Texas Mutual, pay a fine of $1,000, serve 10 years of deferred adjudication and perform 300 hours of community service.

Solano owned Elamar, Ltd., doing business as Mastercare Gardens. He obtained workers’ compensation coverage through Texas Mutual from February 2006 to May 2008. During that time, he concealed payroll through various family operated companies he controlled.

Because workers’ compensation premium is based, in part, on payroll, this type of scheme results in an employer being charged a lower premium than it actually owes. By hiding payroll, an employer can gain an unfair advantage over competitors.

Preventing Workers’ Comp Fraud

The majority of workers’ comp claims filed in Texas and other states stem from real instances of on-the-job injuries. Unfortunately, the people who cheat the system drive up costs for employers, consumers and insurers.

As a corporate executive once noted, if workers’ comp fraud were a legitimate business in the United States, it would rank among the Fortune 500 companies. Indeed, according to the National Insurance Crime Bureau, workers’ comp fraud totals $7.2 billion a year. The Texas Department of Insurance notes that insurance fraud is the second most profitable crime after drug trafficking.

Fraud is

Fraud is lying for financial gain. Claimant fraud is the most common type of fraud. Claimant fraud happens when workers:

• Fake or exaggerate injuries
• Collect benefits for injuries that were not work-related
• Double-dip, or continue to collect benefits after returning to work
• Engage in activities that are inconsistent with their injuries

Fraud is not

Delayed recovery. Some injured workers take longer than expected to recover and return to work. This is not fraud. Injured workers do not have to return to the job until their treating doctor releases them.

Recreational activities. Injured workers can participate in recreational activities that are consistent with their medical restrictions.

Suspicion without evidence. To prove fraud, a carrier must have evidence that the injured worker knowingly collected benefits he or she was not entitled to. Evidence includes medical records, witness testimony, business records and surveillance video.

Premium Fraud Indictments

A Travis County grand jury recently indicted Premrock Commercial Drywall Ltd. Co., Timothy Castonguay of Arlington and Carlos Aguilar of Ft. Worth on workers’ compensation fraud-related charges.

Castonguay and Aguilar own and operate Premrock Commercial Drywall Ltd. Co., a Dallas- area drywall contractor. The indictments allege that the individuals intentionally misrepresented the payroll of Premrock Commercial Drywall Ltd. Co. between December 26, 2006, and May 14, 2007. The misrepresentation allowed the company to fraudulently obtain lower premiums from Texas Mutual.

Workers’ compensation insurance premium is based, in part, on payroll. An employer who intentionally underreports payroll is charged a lower premium than it actually owes. By fraudulently concealing or underreporting payroll, an employer gains an unfair advantage over competitors.

If you’re interested in learning more about the fight against workers’ comp fraud, visit the Fighting Fraud section of our website.  It includes fraud articles, red flags for fraud and copies of our FraudStoppers posters in English and Spanish.

Note: A grand jury indictment is a formal accusation, not a conviction, of criminal conduct.

Recent Premium Fraud Conviction

A Travis County district court recently sentenced Ellynn A. Ogilvie of Houston to five years of probation, 450 community service hours and a $2,000 fine for workers’ compensation fraud-related charges.

Ogilvie, who owned United Crane, Inc. and multiple related companies, was indicted in March 2009 for her role in concealing payroll and employees from Texas Mutual Insurance Company from August 16, 2001 to October 11, 2004.

Because workers’ compensation insurance premium is based, in part, on payroll, this type of scheme results in an employer being charged a lower premium than it actually owes. By hiding payroll, an employer can gain an unfair advantage over competitors.

Texas Mutual previously reported that Gary C. Quintinsky, who was also a participant in the scheme, was sentenced in March and received a two-year prison term for his role.

In 2007, a Travis County jury awarded Texas Mutual more than $5 million in actual damages and $2.5 million in punitive damages in a civil judgment against Quintinsky. The case was the largest premium fraud case in Texas Mutual’s history.