North Carolina Industrial Commission Uncovers Workers’ Compensation Fraudulent Activity in Craven County, North Carolina

The North Carolina Industrial Commission recently charged a woman with workers’ compensation fraud in Craven County, North Carolina.

Ms. Kimberly Ann Sutton has been charged with two counts of workers’ compensation fraud and two counts of obtaining property by false pretense. Fraud investigators found evidence that Ms. Sutton was working at the same time that she was simultaneously receiving workers’ compensation benefits. There was also evidence that she failed to disclose that she was employed by a different employer. This was in direct violation of N.C. Gen. Stat. § 14-100.

There was also evidence that Ms. Sutton made misrepresentations on two North Carolina Industrial Commission Form 90’s. A Form 90 is a report of earnings form that an employer can elect to send to a claimant to ensure that the claimant is not receiving income and workers’ compensation benefits. In this current matter, Ms. Sutton illegally received $64,040.65 in benefits as a result of the misrepresentations made on the Form 90’s. Her actions violated N.C. Gen. Stat. § 97-88.2.

Ms. Sutton was served with warrants by the New Bern Police Department.

The North Carolina Industrial Commission has a separate Fraud Investigative Unit whose mission is to ensure compliance with the rules and regulations of the North Carolina Workers’ Compensation Act. The Unit also investigates suspected criminal violations of the Act. The Unit is comprised of several fraud investigators who handle all criminal complaints that are filed with the Industrial Commission.

Suspected fraud activity is frequent within the field of workers’ compensation. Attorneys and carriers alike have likely had at least one claim where there was suspicion for fraudulent activity.  Unfortunately, gathering enough evidence to prove that workers’ compensation fraud is occurring tends to be very difficult. Most often, employers and unrelated third parties need to be involved to in order to provide proof, which is not always a realistic request. However, thanks to the work of the fraud investigators, some fraudulent activities are caught and prosecuted.

The Unit has several different methods available to report a suspected workers’ compensation fraud claim in North Carolina. Ways to contact investigators include:

Attn: Sam Constance

1233 Mail Service Center

Raleigh, NC 27699

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