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California Self-Insured Restaurant Group Wins Fraud Conviction

The California Restaurant Mutual Benefit Corp. (CRMBC) is holding up a new conviction as success story in its ‘intensified campaign’ against workers’ compensation fraud.

Jeanette Gallo pleaded no contest to one of the two felony counts of insurance fraud in Superior Court, County of Fresno. Gallo, an assistant manager at a Jack in the Box in Fresno, had filed a stress claim in connection with a robbery. It was later discovered that she had played a part in that robbery. Gallo entered the plea on Aug. 31. Sentencing is scheduled for Oct. 19.

The key to the conviction was immediate investigation by restaurant owners Sanjiv Bhagat and Jyoti Madhura after the two identified and investigated red flags they observed with the incident, according to CRMBC. Gallo had arrived early in the morning to open the restaurant in contradiction to company policy, there was ‘unusual behavior on surveillance tapes’ and interviews with employees added to their suspicions, CRMBC states.

That documentation and cooperation with Fresno police lead to the arrest of Gallo and her boyfriend on a grand theft charge. A subsequent follow-up by third party administrator American Claims Management and their special investigations unit lead to the additional charges of insurance fraud.

CRMBC lays claim as state’s largest workers’ compensation self-insured group.

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Written by lordsinsurancelog

September 8, 2011 at 9:29 pm

Posted in Insurance News