Opinion
No. 12–P–310.
2013-03-4
COMMONWEALTH v. Daniel WILSON.
By the Court (RAPOZA, C.J. KATZMANN & CARHART, JJ.).
MEMORANDUM AND ORDER PURSUANT TO RULE 1:28
The defendant appeals from his conviction of one count of workers' compensation fraud. On appeal, he argues that the workers' compensation statute requires detrimental reliance on a false statement made in furtherance of a workers' compensation claim. He also argues that the failure of the Commonwealth to prove detrimental reliance rendered the evidence presented at trial insufficient to sustain his conviction. We affirm.
Background. In August, 2006, the defendant was employed as a heavy equipment mechanic by Southworth–Milton, Inc. (Milton CAT), which is a power equipment and construction vehicle business. On August 15, the defendant informed Milton CAT that he injured his shoulder while working. Milton CAT subsequently reported the defendant's injury to its insurance carrier, Sentry Insurance (Sentry).
Jodie Driscoll, a senior claims representative for Sentry, handled the defendant's claim. She testified as follows: that the defendant's injury was initially “medicals” and that Sentry began paying the defendant's medical bills so that the claim could “move[ ] along”; that on April 12, 2007, the defendant had shoulder surgery, at which time he began to receive temporary total disability benefits from Sentry; and that Sentry considered the defendant “totally disabled from the date of surgery until [it] received documentation that he could work.”
Milton CAT had a $350,000 deductible with Sentry, which meant that Sentry acted primarily as a claims administrator until that deductible was reached.
On August 2, 2007, the defendant underwent an independent medical evaluation so that Sentry could determine whether to adjust or maintain his benefits. Dr. Kenneth Polivy examined the defendant and reported: “At the present time [the defendant] is not working.” Dr. Polivy testified that it was customary to ask whether a patient was working; he believed he asked that question and that the defendant clearly understood it to mean whether he was working anywhere, not just at Milton CAT. On August 20, 2007, the defendant completed an employee earning report at the behest of Sentry—he verified that he had “not received earning for any period in which [he] was entitled to receive Workers' Compensation Benefits.” On September 4, 2007, the defendant underwent a second independent medical examination by Dr. Vincent R. Giustolisi. Dr. Guistolisi testified that the defendant stated that he was not currently working.
Driscoll testified that she reviewed the defendant's earning report. She also testified that she relied on the defendant's statements made during the medical examinations, as well as the doctors' reports, to determine whether to modify his benefits.
On cross-examination, Driscoll testified that, as of July 27, 2007, she knew that the defendant was self-employed and working.
Between April 12, and August 20, 2007, Sentry paid the defendant $857 per week. As of April 4, 2007, however, the defendant was performing heavy machine maintenance for Scott Construction Company (Scott), a general building contractor. Between April 4, and September 11, 2007, the defendant was paid $11,711.17 by Scott.
The following bills, with their dates and amount, were submitted by the defendant to Scott: 4/6/07 for $4104.70; 4/9/07 for $757.77; 5/25/07 for $1227.60; 6/27/07 for $3047.62; 6/27/07 & 6/28/07 for $1141.40; and 9/11/07 for $1432.08.
At the end of trial, the defendant moved for a required finding of not guilty. The judge denied the motion and instructed the jury as to the elements of workers' compensation fraud. Specifically, the judge instructed the jury that “[t]he Commonwealth need not prove that the party receiving the statement believed it or relied on it, but it must prove that the statement was made in a workers' compensation proceeding....”
Defense counsel objected to this instruction.
Discussion. On appeal, the defendant argues that G.L. c. 152, § 14(3), requires that Sentry detrimentally rely upon his statements (that he was not working) and that because Sentry knew he was working and paid his benefits regardless, the defendant did not violate the statute. Such an interpretation of the statute is inconsistent with our case law. See Commonwealth v. Williams, 63 Mass.App.Ct. 615, 623 (2005).
In analyzing the sufficiency of the evidence, we review the evidence in the light most favorable to the Commonwealth. Commonwealth v. Latimore, 378 Mass. 671, 677–778 (1978). The Commonwealth presented evidence that the defendant made false statements in pursuing his workers' compensation claim. The fact that at some point Sentry was aware of the falsity of his statements, yet continued to pay the claim, does not absolve the defendant of criminal liability for making the false statements. Applying the familiar Latimore standard, we are persuaded that the Commonwealth presented sufficient evidence to support the jury's verdict.
Judgment affirmed.