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A sociological exploration of workers' compensation fraud and the role of the third parties

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A sociological exploration of workers' compensation fraud and the role of the third parties
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Garcia, Lucinda Beatrice
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English
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ix, 96 leaves : ; 28 cm

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Subjects / Keywords:
Workers' compensation -- United States ( lcsh )
Fraud -- United States ( lcsh )
Third parties (Law) ( lcsh )
Sociological jurisprudence ( lcsh )
Fraud ( fast )
Sociological jurisprudence ( fast )
Third parties (Law) ( fast )
Workers' compensation ( fast )
United States ( fast )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

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Bibliography:
Includes bibliographical references (leaves 93-96).
General Note:
Department of Sociology
Statement of Responsibility:
Lucinda Beatrice Garcia.

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University of Colorado Denver
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Auraria Library
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All applicable rights reserved by the source institution and holding location.
Resource Identifier:
57587646 ( OCLC )
ocm57587646
Classification:
LD1190.L66 2004m G37 ( lcc )

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Full Text
V
A SOCIOLOGICAL EXPLORATION
OF WORKERS COMPENSATION FRAUD
AND THE ROLE OF THE THIRD PARTIES
by
Lucinda Beatrice Garcia
B.A., University of Colorado, Boulder
A thesis submitted to the
University of Colorado at Denver
in partial fulfillment
of the requirements for the degree of
Master of Arts
Sociology
2004


This thesis for the Master of Arts
degree by
Lucinda Beatrice Garcia
has been approved
by
at,
Date


Garcia, Lucinda Beatrice (M.A. Sociology)
A Sociological Exploration of Workers Compensation Fraud
and the Role of the Third Parties
Thesis directed by Assistant Professor Virginia Fink
ABSTRACT
This is a mixed methods research study testing Donald Blacks theory of the
third party by analyzing data that I systematically collected from Pinnacol Assurance
fraud files and in-depth interviews. Phase one of this study encompassed the review
and analysis of fifty-nine State of Colorado Workers Compensation fraud cases for
the time period of 2000-2001. Phase two, consisted of conducting in-depth face-to-
face interviews with attorneys and investigators, who are familiar with the Colorado
Workers Compensation system.
The theory of the third party seeks to understand when and how individuals
intervene in the conflict of others. I specifically studied the roles of the advisers
(attorneys) based on the nature and degree of their intervention within the Workers
Compensation fraud prosecution process. My analysis also included focusing on
similarities and differences amongst the claimants accused of Workers
Compensation fraud based on gender, age, racial/ethnic entity, prior history of fraud,
and occupation.
This abstract accurately represents the content of the candidates thesis. I recommend
its publication.
IV


ACKNOWLEDGEMENT
I would like to express my gratitude to Dr. Virginia Fink for her guidance,
supervision, patience, and mentorship throughout the evolution of my thesis.
Working under her supervision was a confidence-building experience.
I would like to thank Dr. Candan Duran Aydintug and Dr. Richard Anderson, my
committee members, for their time, effort, and constructive feedback on my work.
I also wish to thank the Pinnacol Assurance Special Investigations Unit and Legal
Department, especially Mr. Walter Kirkwood and Ms. Kathy Stumm, for providing
me the data that made this research possible, and for their continuous support.
Lastly, and most importantly, my family deserves credit. The support and guidance I
receive from them helps me chose the best path to take when the road leads in many
different directions. Thank you.


CONTENTS
TABLES.....................................................ix
CHAPTER
1. INTRODUCTION............................................1
2. THEORETICAL PERSPECTIVE.................................3
3. LITERATURE REVIEW.......................................6
4. AIM OF THE STUDY/HYPOTHESIS............................13
5. METHODS................................................14
Data....................................................15
Phase One...............................................17
Operationalization of Variables.........................18
Phase Two...............................................28
Models..................................................31
6. RESULTS................................................33
Frequency Distribution and
Statistics of Central Tendency..........................28
Cross-tabulations.......................................39
Interviews..............................................43
Gender arid Age......................................43
Race.................................................44
vi


Weekly Wage and Occupation..................................45
Workers Compensation History
And Surveillance............................................47
Claimants Legal Representation.............................48
Attorney Status.............................................49
Trial/Plea..................................................51
Sentence and Amount of
Restitution Ordered.........................................52
7. DISCUSSION................................................... 53
8. LIMITATIONS/SUGGESTIONS FOR FURTHER RESEARCH...................59
APPENDIX
A. History of Workers Compensation in Colorado
and History of Pinnacol Assurance........................62
B. Pinnacol Assurances Fraud Prosecution Process..........64
C. Data Consent Form.......................................66
D. Subject Consent Form....................................67
E. Data Collection Index...................................68
F. Attorney Interview Guideline............................69
G. Investigator Interview Guideline........................71
H. Data Coding Scheme......................................74
I. Frequency for Gender....................................79
J. Frequency for Age.......................................80
vu


K. Frequency for Race......................................81
L. Frequency for Weekly Wage...............................82
M. Frequency for Occupation.................................83
N. Frequency for Workers Compensation History.............84
O. Frequency for Surveillance..............................85
P. Frequency for Claimants Representation.................86
Q. Frequency for Status of Claimants Attorney.............87
R. Frequency for Charges/Allegations.......................88
S. Frequency for Trial.....................................89
T. Frequency for Plea......................................90
U. Frequency for Sentence..................................91
V. Frequency for Restitution...............................92
REFERENCES........................................................93
vm


TABLES
Table
6.2.1 Claimants Legal Representation and
Sentence Cross-tabulation..............................................39
6.2.2 Chi-Square Test for Claimants Legal
Representation and Sentence, N=23......................................40
6.2.3 Claimants Legal Representation and
Amount of Ordered Restitution Cross-tabulation.........................41
6.2.4 Chi-Square Test for Claimants Legal
Representation and Amount of Ordered Restitution, N=22.................42
IX


CHAPTER 1
INTRODUCTION
Prior to the establishment of workers compensation law in Colorado, very
little recourse existed for injured workers. Injured workers had the ability to sue their
employer, but it was costly for both parties involved. Thus, as mechanization in
factories and mines brought an increase in work-related injuries during the Industrial
Revolution, the move towards workers compensation became top priority. In
Colorado, Governor George Carlson led the fight to enact legislation. On August 1,
1915, the Colorado Workmens Compensation Act became law (Path to the Summit,
Peak Performance for Colorado Videocassette, 2002). This Act, instituted complex
laws and provisions designed to provide compensation for individuals who incur
workplace injuries. The current workers compensation system provides a no fault
method of compensating injured workers for medical expenses and wage losses due
to on-the-job injuries.
The social scope of this issue is important since, according to the United
States Department of Labor, Bureau of Statistics and Labor; Injuries, Illnesses, and
Fatalities Program, a total of 5.7 million injuries and illnesses were reported in private
industry workplaces during 2000, and 5.2 million were reported in 2001 (U.S.
Department of Labor Web Site, 2004). In addition, a total of 5,920 fatal work injuries
occurred in 2000, and in 2001, 5,915 fatal work injuries occurred, excluding the 2,886
1


work-related fatalities that resulted from the September 11 terrorist attacks (U.S.
Department of Labor Web Site, 2004).
While the vast majority of workers compensation claims are truthful, it has
been estimated that billions of dollars of false claims are submitted each year to
insurers from employees, employers, health care providers, attorneys and others. As
research points out, these false and exaggerated claims have made workers
compensation fraud one of the fastest growing segments of insurance fraud.
In turn, workers compensation fraud is estimated to be the second largest
white-collar crime in the nation, second only to income tax evasion (Hardin,
2004:4). In the State of Colorado, fraud is estimated to cost the workers
compensation system, billions of dollars annually. Employers, employees, insurance
carriers and Colorado consumers pay the cost of fraud in 1) lost jobs and profit, 2)
lower wages and benefits, and 3) higher costs for services and premiums.
Very little research has been conducted in the workers compensation fraud
area, and the little research that is out there fails to focus on the State of Colorado. In
turn, there is a demand for research exploring the workers compensation fraud
prosecution system, specifically the roles of judges, attorneys, and investigators
involved; as well as identifying demographic similarities of individuals accused of
and/or prosecuted for workers compensation fraud.
2


CHAPTER 2
THEORETICAL PERSPECTIVE
The purpose of this study is to specifically test Donald Blacks theory of law,
specifically his theory of the behavior of law and the third party. According to Black
(1998) conflict occurs whenever individuals incite or express a grievance. It occurs
whenever an individual participates in behavior that someone has defined as deviant
or whenever an individual subjects another individual to social control.
Black (1998) indicates that social control occurs throughout the universe,
wherever individuals interact. Social control can occurs unilaterally (by one party
against another), bilaterally (between two parties), and trilaterally (by a third party).
Black (1998) suggests that the possibility of a settlement agent intervening in conflict
varies with the degree of relational distance between the parties in conflict.
Central to Blacks theory of social control, is the argument that the social
structure of a case predicts how a case will be handled. In turn, this case structure
includes the social characteristics of all the parties involved, such as the principals
(the alleged wrongdoer), supporters (lawyers), and third parties (such as the judge or
jury) (Black, 1998). Thus, Black (1998) suggests that the social stature of a case
depends on whether an attorney has been hired, by an alleged wrongdoer, to provide
legal representation. According to Black (1998), the mere social status of an attorney
enhances the stature of a typical criminal wrongdoer, and in turn, provides the alleged
3


wrongdoer with less severe treatment and a less severe sentence. Furthermore, Black
(1998) suggests that wrongdoers, who represent themselves in criminal proceedings
(pro se), are more likely to plead guilty and, based on social characteristics, are less
likely to receive a reduced sentence. Thus, according to Black, attorneys reduce the
severity of courts toward defendants (Black, 1998:69).
Blacks (1998) theory of the third party seeks to understand when and how
individuals intervene in the conflict of others. This theory embraces virtually all
individuals or groups who intervene in any way in an on-going conflict, including
those who are overtly an unabashedly partisan from the outset, such as lawyers.
The theory categorizes third parties into two dimensions based on the nature
and degree of their intervention. These two dimensions are classified between
support and settlement roles. In addition, Donald Blacks (1998) theory of the third
party identifies a total of twelve roles, which include five support roles (informer,
adviser, advocate, ally, and surrogate), as well as five settlement roles (friendly
peacemaker, mediator, arbitrator, judge, and repressive peacemaker).
Informers, such as investigators, are among the various supporters of
individuals in conflict. A matter of fact, informers assist others by providing
information, but do not actually partake in resolving the conflict itself. Informers are,
professionals, who, for a price, invest considerable resources in discovering and
reporting what a client wants to know (Black, 1998). Workers compensation fraud
investigators perform this role by investigating potential fraudulent activity, and
4


reporting evidence and information to the State of Colorados Attorney Generals
Office for prosecution. (See Appendix B, Pinnacol Assurances Fraud Prosecution
Process).
Additionally, advocates, such as attorneys, are another supporter of
individuals in conflict. Advocates publicly assert the cause of the people they
support. They are directly involved in the conflict management between parties, and
occasionally risk their personal reputations to benefit the principals they support.
Within the settlement roles, Black (1998) indicates that judges address the
matter separating the adversaries, make a settlement decision, and if necessary,
enforce the decision.
Historically, in the criminal prosecution process attorneys are usually seen as
advocates, but in the case of workers compensation fraud the roles are not as clear
due to a variety of reasons.
5


CHAPTER 3
LITERATURE REVIEW
White-Collar Crime
In the world of criminal justice research, there has been relatively little
attention paid to white-collar crime. The number of research studies on white-collar
crime pales in comparison with the many studies on the commission and control of
violent crimes and property crimes.
The term "white-collar crime" was coined in 1939 during a speech given by
Edwin Sutherland to the American Sociological Society. In this speech, Sutherland
defined the term, white-collar crime as, crime committed by a person of
respectability and high social status in the course of his occupation (White Collar
Crime FYI Web Site, 2004). Within this area of white-collar crime, Sutherland
became interested in examining how upper class, white-collar offenders, were being
processed within the judicial system. In the scope of his research, Sutherland noted
that these criminal offenders were not being processed by criminal courts. Rather,
these upper class, white-collar offenses, were being processed as civil violations, and
being handled as administrative law and processed through administrative agencies.
Sutherlands research brought attention to corporate deviance and upper-world
6


criminality, because these offenders were not being considered criminals nor were
they included in studies and theories of criminal behavior (Reid, 1997).
Sutherlands definition, limiting white-collar crimes to occupational crimes of
the upper class, created great debate. However, sociologists and criminologists have
expanded Sutherlands definition of white-collar crime. For example, Reiss and
Biderman define white-collar crime as violations of law that include the use of a
violators power, influence, or trust for the purpose of illegal gain (Reid, 1997).
Edelhertz defines white-collar crime, as an illegal act committed by nonphysical
means and by concealment or guilt to obtain money or property (Reid, 1997).
Although there has been some debate as to what qualifies as a white-collar
crime, the term today generally encompasses a variety of nonviolent crimes usually
committed in commercial situations for financial gain (Legal Information Institute
Web Site, 2004). White-collar crime is construed to involve deception of a victim and
generally occurs where an individuals job, power, or personal influence provide the
access and opportunity to abuse lawful procedures for unlawful gain.
Categorization of White-Collar Crimes
Many criminal acts may be classified as white-collar crimes. Some of these
acts are committed primarily by individuals acting alone, through the participation of
more than one person, or by corporations. These acts include, but are not limited to,
7


various types of fraud, such as embezzlement, bribery, insider fraud, government
fraud, counterfeiting, etc.
The scope of this study focuses on one type of white-collar crime, insurance
fraud, specifically workers compensation insurance fraud. Insurance fraud consists
of false claims made to an insurance company, so that individuals can collect benefits
or additional benefits. (The definition of workers compensation, workers
compensation fraud, and the various types of workers compensation fraud are
described later in this chapter.)
White Collar Crime Resolutions
Unlike violent crimes, white collar crimes, do not necessarily cause injury to
identifiable persons. Instead, white-collar crime causes loss to society. For example,
violent crime has an immediate and observable impact on its victim, which raises the
ire of the public. In contrast, white-collar crime frequently goes undetected and is
more difficult to investigate. However, white-collar crimes can create the greater
havoc. The victim of an assault will recover, however, the impact of a fraud can last a
lifetime.
White-collar crime is rarely prosecuted; when prosecuted and if a conviction
is obtained, penalties tend to be extremely light (Friedrichs, 2001). The penalties for
white-collar offenses include fines, home detention, community confinement, costs of
prosecution, forfeitures, restitution, supervised release, and imprisonment. However,
8


sanctions can be lessened if the defendant takes responsibility for the crime and enters
a guilty plea.
Workers Compensation Background
Workers compensation is an insurance, paid for by employers/insurance
policyholders, that provides financial benefits and medical care to employees who
become injured or ill as a result of their work.
Most states, including Colorado, require 100 percent payment of medical
expenses for employees injured on the job, as well as providing disability benefits,
and up to two-thirds of wage loss benefits while the employee is unable to work.
Workers Compensation Fraud
As defined by the Texas Workers Compensation Commission, workers
compensation fraud occurs, when a person knowingly or intentionally conceals,
misrepresents, and makes a false statement to deny or obtain workers compensation
benefits (Texas Workers Compensation Commission Web Site, 2004). In the
United States, dramatic increases in workers' compensation premiums, throughout the
late 1980s and early 1990s, are believed to have been fueled by fraudulent workers
who were abusing the workers compensation system. During this time period, the
American Insurance Association (AIA) estimated fraud losses at about $3 billion per
year, the National Insurance Crime Bureau doubled the AIA's estimate to $6 billion,
9


and one insurance company president put the cost of workers' compensation fraud at
$30 billion a year (Labor Research Association Web Site, 2004).
These large amounts sparked the need for legislative and state reform. Since
that time, it is estimated that more than half of the states have passed legislation on
workers' compensation fraud, and/or currently have active workers' compensation
insurance fraud units.
It is important to note that, workers compensation fraud currently has
multiple forms and is practiced by a variety of fraudulent individuals. Employer fraud
is committed by an employer/insurance policyholder who misrepresents dynamics
used to determine their workers compensation premium, such as understating
employee payroll or misclassifying their business type. In addition, this type of fraud
can also be perpetrated by policyholders (employers) who discourage and/or prevent
their injured employees from submitting and pursuing workers compensation claims.
Health care provider fraud occurs when providers inflate their bills for services, bill
for treatment or services of nonwork-related injuries, and prescribe or refer treatment
unrelated to the injury. Finally, claimant fraud occurs when an employee falsely
claims (lies) about a work-related injury or exaggerates the extent of an injury to
intentionally collect workers compensation benefits. These employees are often
receiving disability benefits while working a second job or performing activities
beyond what their claim allows.
10


Workers Compensation Research Agencies
Specific institutions, such as the Workers Compensation Research Institute
(WCRI) and National Counsel on Compensation Insurance (NCCI) conduct research
specifically designed to study trends in the workers compensation market with
regards to legislation, policy rates, and gains and losses. The Workers
Compensation Research Institute (WCRI) is an independent, not-for-profit research
organization providing high-quality, objective information about public policy issues
involving workers compensation systems (Workers Compensation Research
Institute Web Site, 2004). Founded in late 1983, WCRI was organized to conduct
studies and obtain data involving workers compensation systems. The Workers
Compensation Research Institutes services consist of studying individual state
systems, studying legislative changes, and presenting workers compensation findings
to legislators, companies, etc. After much research into WCRI studies, I was unable
to locate any information related to workers compensation fraud.
In addition, the National Counsel on Compensation Insurance (NCCI),
operates as a not-for-profit rating, statistical and data management services
organization (National Counsel on Compensation Insurance Web Site, 2004).
Founded in 1919, NCCI was established as a systematic mechanism designed to
create a more uniform approach to workers compensation. Thus, NCCIs products
and assistance are designed to aid insurers, legislators, and other stakeholders in
making decisions regarding the economic functioning of the workers compensation
11


system. Pinnacol Assurance utilizes NCCI as a central organization in determining
insurance costs, and evaluating trends that could possibly affect the State of
Colorados workers compensation market.
12


CHAPTER 4
AIM OF THE
STUDY/HYPOTHESIS
The purpose of this research project is to sociologically explore the dynamics
of workers compensation fraud by exploring the roles various third parties play in
the fraud prosecution process. One thing is obvious, however, that the availability of
workers compensation fraud literature depicts an area that has not been widely or
thoroughly researched. The questions I address are these: Based on demographic
characteristics, what types of individuals are more prone to commit or be accused of
workers compensation fraud? How does the workers compensation legal and
investigative community defme a high status attorney? Does the claimants legal
representation play a role in the workers compensation fraud prosecution process and
overall sentence? If the claimant is represented, does the status of their attorney play
a role in the final outcome? In turn, I hypothesize that if a claimant is represented by
an attorney, in workers compensation legal proceedings, the claimant will receive a
lesser sentence than if they were to represent themselves and remain pro se.
13


CHAPTER 5
METHODS
Although many researchers have advocated the use of a single methodology, I
chose to use mixed methods research to conduct this study. Mixed methods research
consists of collecting and analyzing both quantitative and qualitative data in a single
study or multiple studies (Creswell, 2003). The crucial aspect in justifying mixed
methods research is that both single methodology approaches, qualitative and
quantitative, have strengths and weaknesses. However, combining the two methods
produces improved instrumentation for data collection and sharpens the researchers
understanding of findings (Creswell, 2003).
Recently the mixed methods approach has found application in various social
and behavioral science disciplines. As Creswell (2003) indicates, in conducting mixed
methods research, different types of mixed methods research designs can be
employed. All these designs incorporate features such as implementation, priority
given to quantitative and qualitative data collection, and the integration of both types
of data.
My mixed method analysis was conducted, in two phases, using a sequential
explanatory design. By using this strategy, greater priority is given to the
quantitative data, and the two methods are integrated during the interpretation phase
of the study (Creswell, 2003:215). In this study, phase one consists of a quantitative
14


analysis of workers compensation fraud data followed by phase two, a qualitative
segment, utilizing in-depth participant interviews to assist in explaining and
interpreting my quantitative findings.
Data
In phase one of this study, I obtained my sample from Pinnacol Assurance
2000 and 2001 workers compensation fraud files. This sample consisted of fifty-nine
Pinnacol Assurance claimants who were accused of or committed workers
compensation fraud during this time period. In turn, this sample includes cases that
were either prosecuted or declined prosecution by the State of Colorado Attorney
Generals Office, cases that were never referred to the Attorney Generals Office by
Pinnacol Assurance, cases that are pending trial and cases that are still under
investigation or have charges pending. A major strength of using this desired sample
is that I collected the data myself. To date, there is no known data set on this topic, so
this allowed me to personally collect the data relevant to this particular study, and not
rely on a secondary data set.
Phase two of this study, consisted of conducting in-depth, open-ended
interviews of workers compensation attorneys and investigators. The purpose of
these interviews was to allow the participants to depict their experiences and insights
into the workers compensation arena and fraud prosecution process. Therefore, a
major strength of conducting these interviews in an open-ended format is that it
15


allows the participants the ability to guide the conversation with their experiences and
thereby become active contributors to the research process; it also allowed for the
incorporation of some of their suggestions and feedback on the topic.
I began the data gathering process for this study during the summer 2002
semester and I continued through spring 2004 semester. My initial process consisted
of thoroughly reviewing the State of Colorados workers compensation history, laws
and procedures, as well as searching for any literature or materials related to my
topic. In turn, I obtained approval for this study and interview guidelines from the
University of Colorado at Denver, Human Subjects Committee, and obtained
authority from the Special Investigative Unit Manager for Pinnacol Assurance to
review and access these fifty-nine files (See Appendix C: Data Consent Form). The
Special Investigative Unit Manager was aware of the realm of this study and what the
data would be used for. Even though these data are not easily accessed, this
information is public record and can be accessed by following the proper legal
procedure of requesting public citizen information at the criminal division of the
clerks office at the respected county/district court where the case was prosecuted.
Prior to conducting this study, ethical considerations were taken into account.
It is important to note, that due to the nature of this study, specific situations may
arise that could pose potential risks to the claimants. The claimants, in phase one of
my study, could experience psychological repercussions, such as potential
stigmatization if they ever obtained access to my Masters thesis or subsequent
16


publications. It is highly unlikely, but the claimant may notice that my data consist of
workers compensation fraud prosecutions and declined prosecutions during the time
period in which they were accused. In turn, this may subject them to feel socially
stigmatized by thinking that others will be able to identify them.
However, no potential legal risks could pose a threat to the participants in
either phase of this study. In phase one of this study, under the term of double
jeopardy, the claimants, in my data set, cannot be tried twice for the same offense
(prohibited by the 5th Amendment of the U.S. Constitution). In phase two of this
study, participant interviews could not subject the participants to any form of legal
repercussions, because the attorneys will merely be giving their legal opinions and
experiences, and the investigators will also be giving their investigative opinions and
experiences.
Phase One
In phase one of this study, I did not conduct interviews on the claimants, but
did obtain all necessary information from the Pinnacol Assurance 2000 and 2001
fraud files. These fraud files contained information about each participant, such as
age, gender, and race, as well as information about their employer (policyholder), a
copy of the investigation report and court/legal documents, subjects DMV record,
and any information relevant to the particular case. A coding scheme was developed
for part one of the study. This coding scheme gave each fraud file (claimant) an
identification number. In addition, I developed a data collection index which contains
17


a record of the participants name, their identification number, their race/ethnicity,
their employers name, their attorneys name, the judge who presided over their case,
their charges and their convictions (See Appendix E: Data Collection Index). The
data collection indexes are kept in a private file. The duration of the fraud file review
ranged from twenty minutes to four hours per case. These time variances were a
result of disorganized fraud files, multiple fraud files, and/or the need for investigator
assistance and clarification. I reviewed between eight to ten cases per month, but if
the claim was still under investigation or if the claimant had charges or a trial
pending, I was required to go back and review these cases for updated information.
Operationalization of Variables
I determined the gender of the claimants based on the Department of Motor
Vehicle (DMV) records provided in the fraud files. In a couple instances, a DMV
record failed to be located in the file, so I directly asked the investigator assigned to
the case the gender of the claimant. For purposes of data analysis, I coded #l-for
male and #2- for female, and #9-for missing data.
The age of the claimants accused of workers compensation fraud is an
important variable in my research. The claimants age is substantial in determining a
median age of individuals submitting workers compensation claims, and more
importantly, a median age of individuals being prosecuted for workers compensation
fraud. I obtained the claimants date of births from the investigator reports located in
18


the fraud files. In only a few instances did the files lack these birth dates.
Furthermore, I calculated the age of the claimant when they submitted the workers
compensation claim, by subtracting that date from the claimants birth date. In
addition, I calculated the age of the claimant when the claim was referred to the
Office of the Attorney General for potential prosecution, by subtracting that date from
the claimants date of birth. I entered these variables as numerical values for the
purpose of data analysis and coded #77-for missing data/policyholder, #88-for cases
never filed with the Attorney General, and #99-for missing data.
The race of the claimant is substantial in all studies related to criminal
research. I determined the race of the claimants based on their racial identification
on their DMV records. Once again, I ran across the problem of DMV records lacking
from the fraud file, so I was required to seek assistance from the investigator who
conducted the investigation. With regards to my coding scheme, I selected racial
categories based on the United States census categorical coding for 2000. I selected
#l-for White, #2-for Black or African America, #3-for Hispanic or Latino, #4-for
American Indian or Alaska Native, #5-for Asian, #6-for Hawaiian or Pacific Islander,
#7-for other, and #9 for missing data.
The occupation of the claimant is a significant aspect in my research, because
it allows me to analyze if individuals employed in a specific occupational category
are more likely to be accused of or prosecuted for workers compensation fraud. In
turn, I was able to locate each claimants occupation on his or her first report of
19


injury. The claimants first report of injury, is a worksheet filed within 48 hours of a
work-related injury, and lists the occupation of the claimant at the time of injury, the
date and extent of their injury, as well as the claimants average weekly wage. In my
initial analysis, I broke down the claimants occupation into 3 main categories, based
on whether they were employed in a white-collar occupation, a blue-collar
occupation, or if they were a policyholder/employer. I differentiated between blue
and white-collar positions based on whether the claimants occupation required the
use of manual labor. If a claimants profession necessitated manual labor their
occupation was considered blue-collar. If the claimant was employed in a
professional, managerial, or administrative position their occupation was deemed
white collar. In turn, it is important to note that policyholders do fall into the white-
collar occupation schema, because as employers they do hold supervisory/managerial
positions. However, I thought it was important to distinguish policyholders in order
to determine to what extent policyholder fraud is committed. In a later analysis, I did
integrate policyholders (employers) into the white-collar occupational category. I
coded #1 for white collar, #2 for blue collar, #3 for policyholder, #8 for not
applicable, and #9 for missing data.
The average weekly wage of the claimant proved to be an important aspect of
my research. I was interested in examining the amount of money each claimant
makes in a 40-hour workweek to see if low wage earnings served as an impetus for
claimants to defraud the workers compensation system. I obtained the average
20


weekly wage for claimants from their first report of injury. The way in which the
average weekly wage was reported differed from case to case. On the first report of
injury worksheet, the average weekly wage was either accounted for based on a 40-
hour workweek or was reported hourly. In the instance that it was reported hourly, I
calculated the dollar amount to operationalize for a 40-hour workweek. However, in
many of the policyholder fraud claims, the policyholder was accused of or prosecuted
for violating provisions of their workers compensation policy, and not for submitting
a falsified injury claim. In these instances, a first report of injury was never
completed and thus, the policyholders average weekly wage was unavailable. I
entered these variables as numerical values and coded #77-for not
applicable/policyholder, #88-case never filed with the Attorney General, and #99- for
missing data.
I originally set out to establish whether each claimant had a history of
submitting workers compensation claims in the State of Colorado and throughout the
United States. I thought this information was important for my study, because a
continuous submission of workers compensation claims could be a direct linkage to
the mastery of defrauding the workers compensation system. While some of the
investigation reports did indicate whether each claimant had previous workers
compensation claims with other insurance carriers, many reports failed to display this
information. Thus, I searched the Pinnacol Assurance database, by the claimants
social security number or first and last name, to determine whether each claimant had
21


ever submitted or had pending workers compensation claims in which Pinnacol
Assurance was the insurer carrier. Thus, I used only this data for analysis and coded
#1- for no previous workers compensation history, #2-for previous workers
compensation history, #3-for not applicable, #8 for unable to determine, and #9 for
missing data.
I thought it was important to determine what percentage of claimants accused
of or prosecuted for workers compensation fraud have unknowingly been under
surveillance by workers compensation investigators. The investigators report, in
each fraud file, listed the date/s and result/s of each surveillance. With regards to the
coding scheme, I coded #l-for no surveillance conducted, #2-for surveillance was
conducted, #8-for not applicable, and #9-for missing data.
Within the workers compensation arena, attorneys play a significant role in
the litigation process. In this research, I thought it was extremely important to
differentiate between the various types of legal representation that exist within the
prosecution process. To account for the types of claimant representation, I developed
three .specific categories: #l-for pro se (meaning that the claimant does not have
defense representation and has chosen to defend themselves); #2- for public defender
(a lawyer who works for the state representing claimants accused of a crime who
cannot afford to pay); #3-for private attorney (an attorney hired by the claimant to
represent them in legal proceedings). In addition, I coded for #4-for unable to
determine/case still under investigation, #5-for no attomey/file closed prior to
22


Attorney General referral, #6-for not applicable/prosecution declined by the Attorney
General, #7-for no attomey/charges pending and #9-for missing data.
With regards to the respondents representation, I coded for the same three
categories as I did for claimants representation, with one additional category. This
extra category includes, #4-for assistant Attorney General (attorney at the State level
representing the insurance carriers and the State of Colorado). Moreover, I coded for
#5-for unable to determine/case still under investigation, #6-for no attomey/file
closed prior to Attorney General referral, #7-for not applicable/prosecution declined
by Attorney General, #8-for no attomey/charges pending and, #9-for missing data.
In instances where claimants hired private counsel (attorneys) for legal
representation, I determined the status of both the claimants and respondents
attorneys by obtaining each attorneys rating through the Martindale Hubbell website.
Martindale Hubbell has provided the legal community with a broad array of attorney
information for 130 years. An integral part of Martindale-Hubbell's service to the
legal community is the Lawyer Rating system. The Lawyer Rating system evaluates
lawyers and law firms, in the United States and Canada, based upon peer review.
These ratings indicate a lawyer's professional ethics and legal ability, and reflect the
confidential opinions of members of the Bar and Judiciary. Overall, the Martindale-
Hubbell Ratings are composed of two entities: the legal ability ratings and the general
ethnical standards rating. The legal ability ratings are based on the lawyers
professional ability, expertise, and other professional qualifications. The legal ability
23


rating categories are C-Good; B-High; A- Very High. The general ethical standards
rating is V-Very High. When both categories of Ratings are confirmed, a lawyer
receives a CV, BV or AV rating (Martindale Hubbell Web Site, 2003). For the
purpose of my coding scheme, I operationalized the status of claimants and
respondents attorneys by coding #1- for AV (Very High Rating), #2-for BV (High
Rating), #3- for CV (Good Rating), #4-for pro se claimant, #5-for unable to
determine/no Martindale Hubbell rating, #6-for no attomey/file closed prior to
Attorney General referral, #7-for no attomey/charges pending, #8-for not
applicable/prosecution declined by Attorney General, #9-for case still under
investigation and #99-for missing data.
The name of the judge and the status of the judge were important variables in
the onset of my research. However, as I started the data collection process, I realized
that the fraud files lacked the judges names, which ultimately prevented me from
operationalizing for their status. I also realized that in order to obtain this information
I must request public citizen information at the criminal division of the clerks office
at the respected county/district court where the case was prosecuted. Moreover, to
go through this date request process is beyond the scope of this thesis.
The allegation/s and charge/s each claimant was accused of and/or charged for
is substantial to my study on workers compensation fraud. This information is
important in examining what types of fraudulent activities are more frequently
committed. As a result, I operationalized this variable by combining allegations and
24


charges into one category. I noticed while obtaining the data that if an individual was
prosecuted, the allegations and charges brought against them coincided. Thus, the
allegations and charges were the same. For the purpose of this study, I did not to go
into complete detail and distinguish whether these allegations/charges consisted of a
misdemeanor (offenses lower than felonies and generally those punishable by fine or
imprisonment otherwise than in a penitentiary) (Blacks Law Dictionary, 1979:901)
or felony (a crime of a graver or more serious nature than those designated as
misdemeanors (Blacks Law Dictionary, 1979:555). I merely noted the allegations
and the actual charges the claimant was prosecuted for, if prosecuted. In turn, I coded
for the following allegations/charges: #1-theft, #2-false statement, #3-mail fraud, #4-
conspiracy, #5-false claim, #6-forgery, #7-theft & false statement, #8-theft, false
statement & forgery, #9-theft, false statement & other, #10-forgery & other, #11-
charges never filed with the Attorney General, # 12-other, #99-missing data.
The percentage of claimants prosecuted and not prosecuted for workers
compensation fraud is an important aspect of my research. In this section of my data
analysis I accounted for claimants that were prosecuted for workers compensation
fraud and went to trial, those that were prosecuted and never went to trial and finally
those that were declined prosecution, had charges or a trial pending, or were still
under investigation. I obtained this information from the Pinnacol Assurance
workers compensation case status reports for the years of 2000, 2001,2002, and
2002. These reports are updated on a monthly basis by the Special Investigative Unit
25


and illustrate the status of the case, indicate if charges have been filed, and whether a
trial was or is being held on the claim. In turn, I coded #1 -no, #2-yes, #3-no
trial/prosecution declined by the Office of the Attorney General, #4-charges pending,
#5-trial pending, #6-charges never filed/file closed prior to Attorney General referral,
#7-case still under investigation, #8-not applicable, and #9-missing data.
Within a criminal case, a plea is the defendant's statement pleading "guilty"
or "not guilty" in answer to the charges (Lectric Law Library Web Site, 2003). This
statement is made in open court. I obtained the plea information from either the
investigators notes or the restitution order located in the fraud file. The restitution
order summarizes the case including the county in which the trial was held, the plea,
the verdict, and the sentence. In this section of my data analysis, I also accounted for
claimants that were not prosecuted for workers compensation fraud by the Office of
the Attorney General. I coded #l-not guilty plea, #2-guilty plea, #3-no
plea/prosecution declined by the Office of the Attorney General, #4-charges pending,
#5-trial pending, #6-charges never filed/file closed prior to Attorney General referral,
#7-case still under investigation, #8-case settled, #9-not applicable and #99-missing
data.
In criminal proceedings, the sentence is the judgment formally proclaimed by
the court or judge after a conviction, imposing the punishment to be imposed (Blacks
Law Dictionary, 1979:1222). I obtained the sentence information from the restitution
orders located in the fraud file. After analyzing the similarities and differences of
26


each claimants sentence, I developed my coding scheme to account for the
reoccurring trends of punishment I was noticing. Then, I grouped two or three forms
of punishment into single categories. For the purpose of data analysis, I coded #1 -
for restitution, #2-for probation, #3-for restitution and probation, #4-for jail, #5-for
jail and restitution, #6-for jail and probation, #7-for community service, #8-for
community service and restitution, #9-for community service and probation, #10-for
community service, restitution and probation, #11-for jail, community service, and
restitution, #12-for deferred sentence, #13-for Department of Corrections, parole,
probation, and restitution, #14-for no sentence/prosecution declined by Attorney
General, #15-for charges pending, #16-for trial pending, #17-for charges never
filed/file closed prior to Attorney General referral, #18-for case still under
investigation, #19-for other, 20#-for not applicable and #99-for missing data.
Restitution is the amount of money a criminal offender is required to repay
as a condition of their sentence (Blacks Law Dictionary, 1979:1180). In this study,
restitution amounts are only applicable for claimants that have been prosecuted and
sentenced. I obtained the restitution amounts from the restitution orders located in the
fraud files. For the purpose of data analysis, I entered these variables as numerical
values and coded #l-for trial pending, #-2 for charges pending, #3-for charges never
filed/file closed prior to Attorney General referral, #4-for case still under investigator,
#5-for no restitution/prosecution declined by Attorney General, #6-for no restitution
ordered, #8-for not applicable, and #9-for missing data.
27


Phase Two
Prior to conducting phase two of this study, the participants interviewed gave
their approval to partake in this study by signing the required consent forms. This
form illustrated the intent and expectations of the study, and provided the name and
telephone number of the chair of thesis research in case of questions or concerns (See
Appendix D: Subject Consent Form).
By giving each participant a number to serve as an identification code, the
participants information was recorded in Such a manner that no individual attorney or
investigator could be identifiable. I have kept a record of the participants name, their
identification number, their phone number, their address, the date of the interview,
and the duration of the interview in a private file. In addition, the interview notes
only contain identification numbers.
As my secondary method of data collection, I used a convenience sampling
technique in order to obtain participants. I acquired the names of key informants best
suited to participate in this study, from Pinnacol Assurance legal and investigation
department employees. The final sample consisted of four workers compensation
attorneys, two male and two female, and four workers compensation investigators,
two male and two female, who were are all knowledgeable with the State of Colorado
workers compensation laws and procedures. I purposely selected participants
(attorneys) who are licensed to practice law in the State of Colorado, have knowledge
and experience with workers compensation laws and procedures, and fit one the
28


employment criterion of being previously employed as an Administrative Law Judge,
District Attorney, or private counsel. In addition, my criterion for selecting subjects
(investigators) is that they must currently be employed within the workers
compensation investigation arena and they must have experience investigating
workers compensation fraud cases.
Furthermore, I interviewed the participants using a guide consisting of mostly
open-ended interview questions (See Appendixes F & G: Interview Guidelines). I
chose to use open-ended questions in order to encourage free and open responses
from interview participants. My goal was to capture the participants experiences and
insights within the workers compensation fraud arena. In addition, the interview
guidelines aided me in pacing the interviews, and by making them more systematic
and comprehensive. The interviews were conducted in English and all sessions were
audio taped, with the consent of the participant. This allowed me to give my full and
undivided attention to the participants during the interview. The audiotape was also
turned off during the interview if the participants got uncomfortable at any time.
All of the interviews were conducted at Pinnacol Assurance, because of my
accessibility to confidential conference rooms. The first part of the interview
consisted of a series of demographic questions focusing on the participants
educational background, as well as their years of experience as an
attomey/investigator within the workers compensation area. The second part of the
interview consisted of general content questions. In this part of the interview, I asked
29


the participants to describe the role of attorneys, investigators, and judges within the
workers compensation area, and specifically asked them whether they believe the
status of these individuals has an affect on the overall verdict in a case. Moreover, I
specifically asked the subjects to indicate how they would define the status of an
attorney. I asked this question in order to examine if participants definition of status
is based on the demographic and social characteristics of attorneys. In addition, I
asked the subjects to describe whether they believe specific types of individuals,
based on gender, race, age, and income are more prone to commit or be accused of
workers compensation fraud. I observed all of the participants facial expressions,
body posture, affects, visual emotions during the interview and I entered these in my
field notes. After the completion of the interviews, I transcribed the tapes as soon as
possible, verbatim, and typed up all field notes.
The length of the interviews varied from seventeen to forty minutes, and no
follow up interviews were conducted. Based on the participants work and personal
schedules, it took approximately three months to complete the interview process.
I began the data analysis process by reviewing the data I collected from the
fraud files, interview transcripts and field notes. After reviewing the fraud data, I
consulted with the investigator who performed the investigation for clarification on
any questions that arose. In addition, I noted similarities and differences in participant
interview responses to establish new categories in the coding scheme. Next, I began
30


coding data from the fraud files based on the 18 variables established in Appendix C.
(See Appendix F: Data Coding Scheme).
Models
For this study, first I used descriptive statistical techniques. I used a
frequency distribution because it is the simplest method for organizing and describing
categorical (nominal) data. Since I was working with new data, I thought it was
important to utilize frequency distribution to ensure that no data entry errors existed,
and to determine if there was a need to combine any of the categorical variables for
further multivariate analysis. A frequency distribution was important in this study as
a tool for identifying demographic similarities of claimants accused of and/or
prosecuted for workers compensation fraud.
Along with the frequency distribution, for each variable I also reported its
variability, and central tendency of continuous variables. In addition, measuring the
mean, percentage, and range of some of these variables.
While frequencies show the numbers of cases in each level of a categorical
variable, they fail to provide information about the common distribution of two
variables. I used a cross-tabulation procedure for the purpose of identifying
relationships between categorical variables, and to test the significance and
association of these two variables.
31


Within the cross-tabulation procedure, I performed a measurement analysis to
test the statistical significance of my data. I was interested in testing whether
claimants representation, either by private counsel or pro se, played a role in the
claimants overall sentence and amount of ordered restitution. The chi-square test
was used to assess statistical significance. Due to my small sample size, Fishers
exact test was also used to determine statistical significance.
32


CHAPTER 6
RESULTS
Frequency Distribution and
Statistics of Central Tendency
We see from the frequency distribution for gender (see Appendix I) that there
are a total of 59 cases, 58 valid and 1 missing. These results exhibit that males
account for 69% of the population and females account for the remaining 31%.
Thus, these results suggest that, in the time period of 2000-2001, more males were
accused of and/or prosecuted for workers compensation fraud than females.
In the frequency distribution for age (see Appendix J) there are at total of 59
cases, 47 valid and 12 missing. It is important to note, that the age range of claimants
accused of and/or prosecuted for workers compensation fraud is 35, ranging from 21
to 56 years old. In addition, these frequency results exhibit that 40 and 37 year olds
encompassed the highest percentages of individuals accused of and/or prosecuted for
workers compensation fraud. The data depicts that six, 40 year old claimants,
accounted for 12.8% of the population and 5,37 year old claimants, accounted for
another 10.6% of the population. The mean age of claimants accused of and/or
prosecuted for workers compensation fraud is 39.3 and the median age is 39.
Furthermore, for the time period of 2000-2001, these results suggest that individuals
33


in their late 3Os to mid 40s exhibited the highest percentage of those accused of
and/or prosecuted for workers compensation fraud.
In the frequency distribution for race (see Appendix K) there are a total of 59
cases, 58 valid and 1 missing. These results exhibit that Whites account for 74.1% of
the population, Black or African Americans for 5.2%, and Hispanics the remaining
20.7%. Thus, these results suggest that, in the time period of 2000-2001, more Whites
were accused of/and or prosecuted for workers compensation fraud than any other
racial/ethnic category.
We see from the frequency distribution for weekly wage (see Appendix L)
that there are a total of 59 cases, 51 valid and 8 missing. These results illustrate the
average wage claimants, accused of and/or prosecuted for workers compensation
fraud, accrued in a week. It is important to note, that eleven of these cases were
policyholder fraud cases, which ultimately lacked information about their weekly
wage. In turn, the remaining weekly wage range of claimants, accused of and/or
prosecuted for workers compensation fraud, is $937.69, ranging from $120.00 per
week to $1057.69 per week, and the mean weekly wage is $474.15. These results
suggest that, in 2000-2001, the weekly wage claimants, accused of and/or prosecuted
for workers compensation fraud, accrued greatly varied.
In the frequency distribution for occupation (see Appendix M) there are a total
of 59 cases, 53 valid and 6 missing. These results exhibit that eleven claimants,
20.8%, who were accused of and/or prosecuted for workers compensation were
34


employed in white collar positions. In addition, thirty claimants, 56.6%, were
employed in blue collar positions, eleven claimants, 20.8%, were Pinnacol Assurance
policyholders, and one claimant, 1.9%, was a medical provider. Thus, these results
suggest that, in the time period of 2000-2001, individuals employed in or
encompassing blue collar positions exhibited a higher percentage of claimants
accused of and/or prosecuted for workers compensation fraud.
In the frequency distribution for workers compensation history (see
Appendix N) there are a total of 59 cases, with 59 valid. These results depict that
forty-four claimants, 74.6%, did not have a workers compensation history with
Pinnacol Assurance. However, fifteen claimants, 25.4%, had previously submitted
one or more workers compensation claims with Pinnacol Assurance. Thus, these
results suggest that the majority of claimants, accused of and/or prosecuted for
workers compensation fraud, did not have a workers compensation history with
Pinnacol Assurance.
We see from the frequency distribution for surveillance (see Appendix O) that
there are a total of 59 cases, with 59 valid. These results depict that thirty-three
claimants, 55.9%, were unknowingly under surveillance by workers compensation
investigators, and, twenty-six claimants, 44.1%, were never monitored. These results
suggest that, in the time period of 2000-2001, almost half of individuals, accused of
and/or prosecuted for workers compensation fraud, were unknowingly observed by
workers compensation investigators.
35


In the frequency distribution for claimants representation (see Appendix P)
there are a total of 59 cases, 55 valid and 4 missing. These results depict the type of
representation that claimants, who were prosecuted for workers compensation fraud,
selected to represent them in legal matters. Thus, six claimants, 10.9%, opted to
remain Pro Se and represent themselves in legal matters, while one claimant, 1.7%,
was represented by a public defender, and nineteen claimants, 34.5%, hired private
attorneys as their means of representation. Thus, these results suggest that, in the time
period of 2000-2001, a majority of claimants prosecuted for workers compensation
fraud, hired private counsel to represent them in legal proceedings.
In the frequency distribution for status of claimants attorney (see Appendix
Q) there are a total of 59 cases, 55 valid and 4 missing. These results depict the status
of claimants attorneys as rated on the Martindale Hubbell Website. In turn, out of
the twenty claimants who opted for legal representation from a private attorney or
public defender, eight of these attorneys, 14.6%, achieved a status rating of either AY
or BV. In addition, twelve attorneys, 21.8%, were lacking status ratings on the
Martindale Hubbell website. The results suggest that even though only eight
attorneys out of the twenty contained Martindale Hubbell ratings, these attorneys still
obtained high status ratings, very high to high, by their legal peers.
In the frequency distribution for charges/allegations (see Appendix R) there
are a total of 59 cases, with 59 valid. These results depict the charges/allegations of
claimants accused of and/or prosecuted for workers compensation fraud. Out of 59
36


claimants, 52.5% were accused of and/or charged for theft and false statement. In
addition, seven claimants, 11.9%, were accused of and/or charged for false statement,
while 8.5% were accused of and/or charged for conspiracy. The remaining
charges/allegations consisted of theft, forgery, and a combination of all charges.
Thus, these results suggest that a majority of individuals, in 2000-2001, were accused
of and/or charged for theft and false statement infringements.
In the frequency distribution for trial (see Appendix S) there are a total of 59
cases, with 59 valid. These results depict that out of the 30 claimants prosecuted for
workers compensation fraud, only 5.1% opted to have their case heard before a jury.
In addition, another 5.1% are still awaiting trial. These results suggest that a majority
of individuals prosecuted for workers compensation fraud, in 2000-2001, pled guilty
at the preliminary hearings or settled their case, instead of opting for a jury trial.
We see from the frequency distribution for plea (see Appendix T) that there
are a total of 59 cases, 57 valid and 2 missing. These results depict that out of the
cases in which claimants were prosecuted for workers compensation fraud, at least
38.6% of the time, claimants pled guilty at the preliminary hearings or plea-
bargained, and 5.3% pled not guilty. In addition, thirty-two claimants, 54.2%, did not
enter a plea, because they were either never prosecuted, their prosecution was
pending, or their case settled. In turn, these results indicate that a majority of
claimants accused of and/or prosecuted for workers compensation fraud plead guilty
at preliminary hearings or plea bargained.
37


In the frequency distribution for sentence (see Appendix U) we see that there
are a total of 59 cases, with 59 valid. These results depict the legal sentences of
claimants prosecuted for workers compensation fraud. Out of thirty claimants
prosecuted for fraud, only three still have not been sentenced and are awaiting trial. In
turn, out of the remaining twenty-seven claimants, 25.4% obtained a sentence
consisting of community service, restitution, and probation. Another ten claimants,
17.0%, obtained a sentence consisting solely of community service, restitution or
probation or a mixture of two of these sentences. The two most severe sentences
consisted of one claimant, 1.7%, receiving a sentence consisting of serving time in
jail, community service, and restitution, and another claimant, 1.7%, obtaining a
sentence consisting of serving time at Department of Corrections, parole, probation,
and restitution. These results suggest that a majority of claimants prosecuted for
workers compensation fraud, in 2000-2001, received no incarceration time, but were
required to perform community service, pay restitution, and serve probation.
Finally, in the frequency distribution for restitution (see Appendix V) there are
a total of 59 cases, with 59 valid. These results depict the amount of restitution,
claimants sentenced for workers compensation fraud were ordered to pay. It is
important to note, that the range in the amount ordered in restitution is $83,564.00,
ranging from $1,436.00 to $85,000.00. In turn, the mean amount of restitution
ordered is $17,506.22, and only two claimants, 3.4%, were not ordered to pay
restitution. Furthermore, for the time period of 2000-2001, these results suggest that
38


a higher percentage of restitution was ordered between the amounts of $1,000 and
$10,000.
Cross-tabulations
Table 6.1.1
Claimants Legal Representation and
Sentence Cross-tabulation
Claimants Legal Representation
Private Counsel Pro Se Claimant Total
Sentence Restitution, Probation Count and Community Service % within clrep 16 94.1% 5 83.3% 21 91.3%
Dept, of Corrections, Jail, Count Parole, Community Service, % within clrep and Restitution 1 5.9% I 16.7% 2 8.7%
Total Count % within clrep 17 100.0% 6 100.0% 23 100.0%
The purpose of this cross-tabulation, table 6.1.1, was to determine whether the
type of claimants legal representation, either the hiring of private counsel or pro se,
played a role in their final sentence. This cross-tabulation table focuses only on 23
out of the 59 claimants who in fact, were prosecuted for workers compensation
fraud. This analysis excludes the three claimants who are pending trial, and the four
claimants, who lacked information as to how they were represented in these legal
proceedings.
Out of the 17 claimants who obtained private counsel as a means of
representation, 16 claimants, 94.1% received a final sentence consisting of restitution,
probation, or community service or a combination of two or more of these sentences.
39


The one remaining claimant, who was represented by private counsel, obtained a
sentence consisting of Department of Corrections, parole, probation, and restitution.
Thus, out of the 6 claimants who opted to represent themselves and remain pro se, 5
claimants 83.3%, received a final sentence consisting of restitution, probation, or
community service or a combination of two or more of these sentences. The
remaining pro se claimant received a sentence consisting of jail time, community
service, restitution, and probation. These results suggest that the level of
representation for claimants prosecuted for workers compensation fraud, did not
play a direct role in their overall sentence.
Table 6.1.2
Chi-Square Test for Claimants
Legal Representation and Sentence, N=23
Value df Asymp. Sig. (2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided)
Pearson Chi-Square ,650b 1 .420
Continuity Correction .000 1 1.000
Likelihood Ratio .577 1 .447
Fishers Exact Test .462 .462
Linear-by-Linear Association .621 1 .431
N of Valid Cases 23
a.
b.
Computed only for a 2x2 tab!
2 cells (50.0%) have expected count less than 5. The minimum expected count is .52
Table 6.1.2, shows that the chi square is not significant, x (1, N=23) = .65,
p=.42, so the two variables, claimants representation and sentence, are independent.
In addition, Fishers exact test is also not significant, p=.462.
40


Table 6.1.3
Claimants Legal Representation and
Amount of Ordered Restitution Cross-tabulation
Claimants Legal Representation
Private Counsel Pro Se Claimant Total
Restitution Amount 1,000-10,000 Count % within clrep 8 50.0% 4 83.3% 12 54.5%
10,0001+ Count % within clrep 8 50.0% 2 33.3% 10 45.5%
Total Count % within stclatty 16 100.0% 6 100.0% 22 100.0%
The purpose of this cross-tabulation, table 6.1.3, was to determine whether the
type of claimants legal representation, either representation by private counsel or self
representation (pro se), played a role in their amount of ordered restitution. This
cross-tabulation table focuses only on 22 out of the 59 claimants who in fact, were
prosecuted for workers compensation fraud. This analysis excludes the three
claimants who are pending trial, the four claimants who lacked information as to how
they were represented in these legal proceedings, and the one claimant in which no
restitution was ordered.
In turn, out of the twenty-two claimants who obtained private counsel
representation, eight claimants, 50.0% were required to pay between $1,000-$ 10,000
in restitution. Another eight claimants, 50.0% were required to pay $10,000+ in
restitution. Thus, out of the six claimants who opted to represent themselves and
remain pro se, four of them, 83.3%, were required to pay between $1,000-$ 10,000 in
41


restitution, and the remaining two claimants, 33.3%, were required to pay $10,000+.
These results suggest that the level of representation for claimants prosecuted for
workers compensation fraud, did not play a direct role in their overall sentence.
Table 6.1.4
Chi-Square Test for Claimants
Legal Representation and Amount of
Ordered Restitution, N=22
Value df Asymp. Sig. (2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided)
Pearson Chi-Square o CT\ OO 1 .484
Continuity Correction .048 1 .827
Likelihood Ratio .498 1 .481
Fishers Exact Test .646 .417
Linear-by-Linear Association .467 1 .495
N of Valid Cases 22
a. Computed only for a 2x2 table
b. 2 cells (50.0%) have expected count less than 5. The minimum expected count is 2.73.
Table 6.1.4, shows that the chi square is not significant, x (1, N=22) = .49,
p=.48, so the two variables, claimants representation and amount of ordered
restitution, are independent. Fishers exact test is also not significant, p=.646. Thus,
these results do not support my hypothesis. These results suggest that claimants
representation by an attorney, at workers compensation legal proceedings, does not
contribute to the claimant receiving a lesser sentence.
42


Interviews
Gender and Age
All interview participants indicated that males encompass the bulk of workers
compensation claim submittals, and the majority of claimants accused of and/or
prosecuted for workers compensation fraud. One attorney participant indicated that
males make up at least 90% of claimants accused of and/or prosecuted for workers
compensation fraud. Furthermore, male/female gender roles were an occurring
theme as to why males constituted for such a large proportion of the claim submittals,
and claimants accused of and/or prosecuted for workers compensation fraud. Five
participants specifically suggested that males constitute a higher percentage of work-
related injuries and potential fraudulent activity, because they perform more manual
labor than women. An investigator participant explained that, the mans the
provider in the family, so I think what happens is theyre also the ones that are
probably more exposed to higher risk positions (M2S6,2003).
With regards to age, participants overwhelmingly indicated that middle-aged
workers, submit the bulk of workers compensation claims, and account for the
largest proportion of claimants accused of and/or prosecuted for workers
compensation fraud. The participants definition of middle-aged varied. Some
participants indicated that they considered a middle-aged individual to be someone in
their late 30s to early 40s. One investigator participant defined middle-aged as
someone in their mid to late 60s. Finally, one attorney participant indicated that in all
43


the years he/she has worked in the workers compensation fraud area, they have never
experienced a fraudulent claimant over the age of 45.
In all of these participant interviews there was a definite consensus suggesting
that younger individuals rarely submit workers compensation claims, and as a result
a low percentage, of young claimants, will actually be accused of and/or prosecuted
for workers compensation fraud. One attorney participant suggested that young
workers, late teens and early 20s, in general, often refrain from filing workers
compensation claims, because they lack the knowledge and sophistication to file a
claim:
Young workers dont know that workers compensation
Insurance exists, and if they do, they dont know what it
is or what the benefits are. I feel sorry for young workers,
because in many instances their employers take advantage of the
situation (S5E3, 2003).
Race
With regards to the racial/ethnic identity of claimants, five interview
participants implied that Hispanic individuals are the majority of claimants who
submit workers compensation claims, and the bulk of claimants accused of and/or
prosecuted for workers compensation fraud. One investigator participant attributed
this explanation to the large Hispanic population in the State of Colorado. Another
attorney participant proposed that the large percentage of Hispanics, submitting
workers compensation claims and being accused of fraudulent activity, is a result of
44


the influx in seasonal migrant workers. Therefore, suggesting that field work
consists of extensive manual labor, resulting in a large amount of work-related
injuries.
Three participants similarly suggested that every racial/ethnic group
participates in workers compensation fraudulent activity. In addition, these three
participants indicated that, based on their experiences and insights, one racial/ethnic
group is not more likely than another to get accused of and/or prosecuted for workers
compensation fraud. For example,
Ive dealt with all different types of races. I cant say
from my experiences that Ive seen one more prevalent
than the other. I think it involves, or can involve all
different races (H6M2,2003).
Weekly Wage and Occupation
I had expected that the wage claimants accrued in a week would be a factor in
their submittal of workers compensation claims, and their participation in fraudulent
activity. Thus, if a claimant earned a small weekly wage, they would be more likely
than a higher wage earner to defraud the workers compensation system. However,
only one participant indicated that, based on their experiences, the lower wage earner
is more inclined to submit workers compensation claims and partake in fraudulent
activity. As this participant stated, theres less incentive for them to get back to
work (H6M2,2003). In addition, the remaining participants overwhelmingly
suggested that higher wage earners are less likely to submit workers compensation
45


claims, and/or partake in fraudulent activity. Their insights were based on the State
of Colorados Workers Compensation Act. This Act provides injured workers only
2/3 of their average weekly wage, and as participants suggest, results in a larger loss
of income for the higher wage earner. For example,
Workers comp is capped out, so if youre making $1000
a week, your workers comp is capped out at much less than
what youre taking home (M2S6,2003).
With regards to occupation, participant interviews overwhelmingly indicated
that individuals employed in blue-collar occupations, are the majority of claimants
accused of and/or prosecuted for workers compensation fraud. The majority of blue-
collar workers are employed as construction workers, carpenters, and field workers.
One investigator participant implied that individuals employed in white-collar
occupations partake in a smaller amount of workers compensation fraud because,
similar to that of the higher wage earner, the incentive and benefits are lacking.
Within the area of policyholder fraud, four participant interviews yielded information
indicating that policyholder fraud greatly exists, but its a silent crime. As one
investigator participant explained, it runs rampant; nobody wants to say anything
about it. Actually what it is, nobody likes to accuse policyholders of fraud, because
its the bread and butter of the insurance industry (M2S6,2003). Four attorney
participants specified that policyholder fraud is extremely difficult to prosecute,
because currently, the State of Colorados fraud statute lacks enforceable measures.
Thus, there must be concrete evidence proving that a policyholder participated in
46


some type of workers compensation fraudulent activity. Surveillance, witnesses, or
confessions seem to be the main forms of evidence. As one investigator participant
noted, its difficult to obtain this evidence, especially in instances where the
policyholder altered a workers compensation certificate or provided false statements.
How are you going to get this information without a confession (T1K08,2003)?
Workers Compensation History
and Surveillance
Within the participant interviews, I did not specifically ask the participants
whether they believed a history of submitting workers compensation claims was
characteristic of fraudulent claimants. However, one attorney participant freely
mentioned that, he/she believes that a history of submitting workers compensation
claims is definitely typical of fraudulent claimants. According to this participant,
when claimants consistently submit workers compensation claims, they tend to feel
that they have acquired the experience and knowledge to defraud the workers
compensation system.
Participant interviews suggested that many situations arise initiating the need
to have surveillance conducted on potential fraudulent claimants. For instance, in
situations where claimants are receiving disability benefits, and are required to refrain
from any type of employment, specific acts may spark the need for surveillance.
Claimants who consistently miss doctors appointments or arrive at doctors
appointments wearing work clothes may indicate that the claimant is employed. If a
47


claimant is supposed to be at home, resting for a specified time period, and they are
continually getting worse, may also be an indicator that the claimant is working. Two
investigator participants specifically implied that they receive telephone calls from
employers, coworkers, neighbors, or anonymous sources suggesting that a claimant
may be partaking in some sort of fraudulent activity. As one investigator participant
put it, surveillance occurs when anything just doesnt seem right (M2S6,2003).
Claimants Legal Representation
With regards to claimants legal representation, attorney participant interviews
indicated that a majority of claimants prosecuted for workers compensation fraud
select private attorneys to represent them in legal proceedings. Each attorney
participant suggested reasons as to why they believed it was beneficial for claimants
to hire private representation instead of remaining pro se and defending themselves in
legal proceedings. In essence, all of these reasons focused on the lack of experience
and knowledge pro se claimants have within workers compensation and criminal
law, as well as within the workers compensation system. As one attorney participant
put it, this law is complex and if a claimant represents themselves, they may not
know what theyre up against. I think an attorney can better assess a case (E4R4,
2003).
48


Attorney Status
Within all participant interviews, each participant gave their definition of a
high status attorney and, based on their experiences, what role the status of the
claimants attorney plays in the workers compensation fraud prosecution process. It
is important to note that responses to these questions greatly varied between the
attorney and investigator participants. For example, the investigator participants all
based attorney status on material aspects. Similarly, all investigator participants
defined high status attorneys as those who look and play the part. These are the
attorneys that drive nice cars, have exquisite offices, and in many cases, wear the
nicest clothes. One investigator participant indicated that high status attorneys are the
attorneys that are in the media a lot. Basically, these attorneys take the high profile
cases that subject them to media attention or they have television advertisements
marketing their services.
Attorney participants defined a high status attorney based on demographic
characteristics, such as gender and age, as well as years of experience practicing law.
With regards to gender, each attorney participant indicated that gender definitely
determines status within the legal community. According to these participants,
female attorneys are, and have historically been, considered less superior than male
attorneys. For example,
49


Gender assumptions are out there questioning the
ability of female attorneys to thoroughly practice law.
Those assumptions are generally negative, so that
forces female attorneys to work harder to prove
themselves (S5E3, 2003).
All attorney participants stressed that the age of the attorney and years of legal
experience contribute to an attorneys status. Based on participant interviews, it was
indicated that, within the legal community, a bias exists against younger attorneys. As
one attorney participant explained, these younger attorneys do not have the judgment
or the maturity of older, more experienced, attorneys (S5E3,2003). These younger
attorneys seem to lack the experience, respect, and reputation that the attorney
participants believe constitutes a high status attorney. One attorney participant
suggested that attorneys, who possess these high status characteristics, positively
affect the claimants verdict (outcome) in workers compensation proceedings. High
status attorneys often get better results and better settlement offers from the judges.
With regards to race, interestingly, all attorney participants believed that an
attorneys race does not directly affect their status. One attorney participant
specifically indicated:
There are Anglo attorneys who are written off, because
theyre considered to be fools. There are Hispanic
attorneys who are written off, because theyre considered
to be fools. There are African American attorneys who
are written off, because they are considered to be fools.
An attorneys race doesnt play a role, its their excellence
and tenacity (S5E2,2003).
50


An attorneys competence, reputation, and ability to speak multiple languages were
all commonalities indicated to be associated with status.
In turn, only one attorney participant suggested that the educational institution
where the attorney obtained their law degree contributed to status:
Some law schools are harder to get into, and when an
individual graduates from those institutions, it is
automatically assumed that theyre the best. Theres a
notion that theyre brighter, harder workers, and more
exceptional because of the school they went to (S5E3,2003).
The remaining three attorneys all indicated that the institution where the attorneys
obtained their degrees, does not contribute to their status. They believed that this
aspect does not play a daily role in their interactions with other attorneys, nor does it
play a role in the legal proceedings they partake in.
Trial/Plea
All interview participants indicated that, the majority of claimants prosecuted
for workers compensation fraud, typically plead guilty at preliminary hearings or
settle their case instead of opting for a jury trial. One participant, who has been
employed as a workers compensation fraud investigator for 5 years, indicated that
she/he has yet to testify at trial. It was indicated that claimants tend to enter a guilty
plea for fear that they will receive a stiffer penalty if found guilty at a jury trial.
Within the plea-bargaining process, if a claimant plea-bargains, they are aware of the
sentence they will receive prior to pleading guilty. Claimants will know in advance if
51


their sentence consists of incarceration time, community service hours, fines,
restitution, etc. If claimants fail to plead guilty and opt for a jury trial, claimants are
subjected to the provisions of the law. Based on the charges, these provisions could
range from the most minimum sentence to the most possible maximum sentence.
Sentence and Amount of Restitution Ordered
Participants indicated that claimants prosecuted for workers compensation
fraud are rarely incarcerated. Typically, claimants are required to perform community
service hours, pay restitution, and serve probation. As one investigator participant
stated, workers compensation fraud is white-collar crime. Theres no blood, theres
no body (T1K08,2003). Only one interview participant indicated that they know of
one claimant that has received actual jail time. The only reason this claimant
received jail time was because the claimant had prior felonies on their criminal
record. With regards to race, one investigator participant indicated that, based on
his/her experiences, Caucasians are typically required to pay back larger amounts of
restitution.
52


CHAPTER 7
DISCUSSION
Given the importance of the demographic and social similarities of claimants
accused of and/or prosecuted for workers compensation fraud, the frequency
distributions and interview analyses suggest variations in these characteristics.
Both of my results (quantitative and qualitative) shed light on many facets of the
workers compensation fraud prosecution process in the State of Colorado. The
frequency distribution analyses identified the demographic and social characteristics
of individuals accused of and/or prosecuted for workers compensation fraud.
As distinguished in the frequency distribution for gender (see Appendix I) the
data suggest that a higher percentage of males were accused of and/or prosecuted for
workers compensation fraud than females. Based on participant interviews,
participants did suggest that, based on their experiences and insight, males do
encompass the bulk of workers compensation claim submittals, and the majority of
claimants accused of and/or prosecuted for workers compensation fraud.
In the frequency distribution for race (see Appendix K) the results indicate
that White claimants accounted for the highest percentage of individuals accused
of/and or prosecuted for workers compensation fraud. It is important to note, that the
quantitative data results and the experiences and insights of interview participants
differed. First of all, certain participants implied that Hispanic individuals are the
53


majority of claimants submitting workers compensation claims, and the bulk of
claimants accused of and/or prosecuted for workers compensation fraud. Moreover,
others suggest that every racial/ethnic group participates in fraudulent activities, and
one racial/ethnic group is not more likely than another to get accused of and/or
prosecuted for workers compensation fraud.
We see from the frequency distribution for weekly wage (see Appendix L)
that the results indicate that the average wage claimants, accused of and/or prosecuted
for workers compensation fraud, accrue in a week greatly varies. In addition,
participant interviews did not produce much information suggesting that a specific
wage earner is more likely to be accused of and/or prosecuted for workers
compensation fraud. Thus, only one participant commented, suggesting that the
lower wage earner is more inclined to partake in fraudulent acts
The frequency distribution for occupation (see Appendix M) suggest that
individuals employed in blue-collar positions exhibited the highest percentage of
claimants accused of and/or prosecuted for workers compensation fraud. Participant
interviews do support these results, and provide additional insight as to why white-
collar occupations, specifically those of policyholders, are not prosecuted.
We see in the frequency distribution for workers compensation history (see
Appendix N) the results suggest that the majority of claimants accused of and/or
prosecuted for workers compensation fraud did not have a previous workers
compensation history (a submittal of prior claims) with Pinnacol Assurance. Thus, a
54


history of submitting claims, may or may not, be a direct characteristic of individuals
accused of and/or prosecuted for workers compensation fraud. This is difficult to
determine because, due to the scope of this study, I was only able to obtain workers
compensation history from Pinnacol Assurance and not from other insurance
companies in Colorado or throughout the Nation. However, one interview participant
did indicate that, based on their experiences, he/she believes that a history of
submitting claims is a characteristic of fraudulent claimants.
In the frequency distribution for surveillance (see Appendix O) the results
suggest that almost half of individuals accused of and/or prosecuted for workers
compensation fraud were unknowingly observed by workers compensation
investigators. In turn, the participant interviews suggested that many situations arise
initiating the need to have surveillance conducted on potential fraudulent claimants.
The results of the frequency distribution for claimants representation (see
Appendix P) suggest that a majority of claimants prosecuted for workers
compensation fraud selected private attorneys to represent them in legal proceedings.
The participant interviews shed light on the reasons why participants felt, based on
their experiences, that it is more beneficial for claimants to hire private representation
instead of remaining pro se and defending themselves in legal proceedings:
In the frequency distribution for status of claimants attorney (see Appendix
Q) the results suggest that the eight attorneys containing Martindale Hubbell ratings
obtained high status ratings (high to preeminent) by their legal peers. In turn,
55


participant interviews provided information depicting how each participant personally
defines a high status attorney and, based on their experiences, what role the status of
the claimants attorney plays in the workers compensation fraud prosecution process.
Frequency distribution tables reiterated that respondents (i.e, insurance
carriers and the State of Colorado), are represented in workers compensation fraud
legal proceedings by an Assistant Attorney General. While obtaining the workers
compensation fraud data, I was unable to locate the names of Assistant Attorney
Generals who represented Pinnacol Assurance and the State of Colorado in all of
these legal proceedings. Thus, without having their name and information, I was
unable to obtain each Assistant Attorney Generals Martindale Hubbell status rating.
In the frequency distribution for charges/allegations (see Appendix R) the
results suggest that a majority of individuals accused of and/or prosecuted for
workers compensation fraud, were accused of and/or charged for committing theft
and false statement infringements. Moreover, only one interview participant
commented as to why a claimant could be charged for theft and false statements.
The results in frequency distributions for plea and sentence (see Appendixes S
& T) indicate that a majority of individuals prosecuted for workers compensation
fraud pled guilty at preliminary hearings or settled their case instead of opting for a
jury trial. In turn, participant interviews yielded supporting information suggesting
that claimants charged with fraud, typically do plea at preliminary hearings instead of
carrying out the process and resorting to trial.
56


In frequency distributions for sentence and restitution (see Appendixes U &
Y) the results suggest that a majority of claimants prosecuted for workers
compensation fraud received no incarceration time, but were required to perform
community service, pay restitution, and serve probation time. Thus, a higher
percentage of restitution was ordered between the amounts of $1,000 and $10,000.
The participant interviews supported these results by providing information
suggesting that, based on their experiences, participants rarely knew of instances
where claimants, prosecuted for workers compensation fraud, received incarceration
time. In addition, one participant indicated that based on his/her experiences,
Caucasians are typically required to pay back larger amounts of restitution.
In general, the literature indicates that since workers compensation fraud is
considered a white-collar crime, and if a claimant plea-bargains or gets convicted of
fraud, the sentences tend to be extremely light (Friedrichs, 2001). However,
My hypothesis asks whether the legal representation claimants choose to
utilize in workers compensation fraud proceedings affects their final sentence? Do
claimants who are represented by attorneys in workers compensation fraud legal
proceedings, receive a much more lenient sentence than claimants who opt to remain
pro se and represent themselves?
Because claimants legal representation and sentence, as well as, claimants
legal representation and amount of ordered restitution, were not significant in both
cross-tabulations, I will not argue that the type of claimants representation plays a
57


direct role in them receiving a lesser sentence. However, participant interview
analyses do suggest that attorney representation is more beneficial for claimants in
workers compensation fraud legal proceedings, due to the complexity of the law and
an attorneys ability to better assess a case.
58


CHAPTER 8
LIMITATIONS/SUGGESTIONS
FOR FURTHER RESEARCH
The purpose of this study was to research the role of the third party within the
workers compensation fraud prosecution process, specifically the roles of attorneys
and investigators. In addition, this study also explored the demographic
characteristics of claimants, accused of and/or prosecuted for workers compensation
fraud.
In the workers compensation industry, measuring and distinguishing trends in
the workers compensation fraud area has yet to reach any level of precision. The
numbers and data that workers compensation intellects utilize are broadly based on
the rule of reason and common sense. Since this was the first research project of its
kind to explore the State of Colorado workers compensation fraud prosecution
process, the available literature and research focuses mainly oh the evolving
definition of white-collar fraud, as well as the various types of white-collar fraud. It
is important to note that the majority of the information related to insurance fraud, is
specifically focuses on automobile insurance fraud and arson. In turn, it is extremely
difficult to complete a study, in this field, that would be generally conclusive and
above reproach.
59


Among other limitations, the cooperation of the study population, claimants
accused of and/or prosecuted for workers compensation fraud, would be minimal and
inconsistent. It would be extremely difficult to obtain a representative sample size of
these fraudulent claimants who would be willing to partake in interviews or adhere to
a standardized survey. Thus, in order to thoroughly complete a study, in this field, it
would be necessary for the researcher to conduct research and obtain information not
only from one insurance carrier, but multiple agencies. In addition, the researcher, by
requesting public citizen information, should access claimant prosecution data from
the criminal division of the clerks office at the respected county/district court where
the case was prosecuted. This information would yield the researcher with the names
of judges that presided over the case and all necessary outcome data.
Due to the time allotment of my study, I was unable to obtain a representative
sample of workers compensation attorneys and investigators to partake in interviews.
In future studies, it would beneficial to obtain a larger sample of these participants,
and also interview Assistant Attorney Generals, judges, and any other individuals
associated with workers compensation fraud prosecution.
In future studies, the operationalization for attorney status should definitely be
reevaluated. On the onset of this research, I anticipated that the Martindale Hubbell
web site would provide the attorney status ratings for all practicing attorneys.
However, after diving into this research study, a high proportion of attorney status
ratings failed to be located in this database. If the Martindale Hubbell web site is
60


utilized for a future study, the researcher should contact a Martindale Hubbell
representative to inquire reasons as to why the attorney status ratings may be lacking
in their system.
Finally, evaluation research would be useful in exploring the various
demeanors in which insurance carriers respond and manage potential fraudulent
workers compensation claims. This type of research would enable legislators and
insurance carriers to comparatively analyze the various methods and programs other
insurance carriers utilize to combat workers compensation fraud. Thus, providing
legislators and insurance carriers essential information, which would allow them to
assess whether other procedures of battling workers compensation fraud could
potentially benefit their State or insurance company.
61


APPENDIX A
History of Workers Compensation in Colorado
and History of Pinnacol Assurance
Founded in 1915, after the Colorado General Assembly passed the
Workmens Compensation Act, Pinnacol Assurance became the assured source of
Colorado workers compensation insurance. Originally named the State
Compensation Insurance Fund, Pinnacol Assurance, was technically a State agency
under the supervision of Colorados Industrial Commission. Over the years, the State
Compensation Insurance Fund experienced a series of name changes as well as
institutional changes. In 1987, the State Compensation Insurance Fund changed its
name to the State Compensation Insurance Authority. In addition, it became a quasi-
public authority of the State of Colorado, consisting of a governor-appointed board of
directors. In 1990, this quasi-public insurance company came to be known as
Colorado Compensation Insurance Authority (CCIA).
In 1999, CCIA became Pinnacol Assurance, by adopting a name that reflects
the companys Colorado heritage and commitment to being the best and assured
workers compensation carrier. As a nonprofit insurer, Pinnacol Assurance has
established itself as Colorados largest writer of workers compensation by having a
market share of approximately 48 percent (Pinnacol Assurance Web Site 2003).
Thus, due to Pinnacol Assurances background of more than 85 years in Colorado and
62


their current status of being the leading provider of workers compensation insurance
in the state, I obtained, Pinnacol Assurance fraud data, as a basis of my study.
63


APPENDIX B
Pinnacol Assurances Fraud
Prosecution Process
The workers compensation fraud investigation process begins when either an
outside source or an in-house referral suggests that a workers compensation
claimant, policyholder, or medical/legal provider may be partaking in fraudulent
activities. Within Pinnacol Assurance, this tip or lead is assigned to a special
investigator who becomes the sole party responsible for conducting investigation into
the potential fraudulent acts. This investigation consists of conducting interviews
with individuals who may provide information regarding the claimants activities,
such as employers, co-workers, family members, friends, and neighbors. In addition,
investigators are responsible for retrieving motor vehicle records and traffic accident
reports, checking for history of workers compensation claim submittal, and if need
be, assuring that surveillance is conducted by one of Pinnacol Assurances
surveillance vendors. In turn, a final investigation report is completed depicting all
aspects of the investigation.
In turn, if Pinnacol Assurance investigators believe there are elements of
potential claimant fraud, a referral is made to the Colorado State Office of the
Attorney General for prosecution. This referral contains a case packet consisting of
all investigation documentation, all records, a witness list, and all evidence suggesting
claimants fraudulent activity. From this stage, the Attorney Generals Office
64


proceeds with the case, and determines whether the claimant will be prosecuted. If
the claimant is prosecuted, the Office of the Attorney General conducts further
investigation, and appoints an Assistant Attorney General to represent the State of
Colorado, Pinnacol Assurance, and the employer at legal proceedings.
65


APPENDIX C
Data Consent Form
1. The purpose of this study is to gain information regarding Workers Compensation Fraud
prosecutions in the State of Colorado. The main goal of this study is to examine the role of
the third party, specifically the roles of the advisers (attorneys), investigators, and judges
exclusive to each case. This study will be conducted by researching and reviewing Pinnacol
Assurance fraud files of prosecuted claimants for the time period of 2000-2001. This study is
expected to take about six months to complete.
2. There are many benefits that can be expected from this study. This study will provide
information illustrating the impacts and the roles various parties play in file fraud prosecution
process. In addition, it will provide statistical information regarding the physical and
economic similarities amongst the fraudulent claimants for purposes of profiling.
3. Subject confidentiality will be protected with the utmost concern. The researcher (Lucinda
Garcia) will keep all material pertaining to the study in a private locked file. Identity numbers
will be assigned to each subject, so that names and all pertinent information will remain
confidential. The actual fraud files will be kept at Pinnacol Assurance under management by
the Special Investigative Unit.
4. The data from this study will solely be used for educational purposes, including but not
limited to a Masters thesis, educational presentations, and scholarly publications.
5. The undersigned is aware that the researcher (Lucinda Garcia) is an employee of Pinnacol
Assurance, and does agree to allow her access to this data even-in the event of termination or
resignation from Pinnacol Assurance.
6. The undersigned is encouraged to ask the researcher (Lucinda Garcia) any questions about the
study. The questions will be answered as well as possible without jeopardizing the
methodology of the research.
7. Questions about the study should be directed to Lucinda Garcia at (303) 440-1350. Questions
or concerns about the research process should be directed to the Office of Academic Affairs,
CU Denver building, Suite 700. (303) 556-2550.
8. The undersigned will be given a copy of this consent form for their records and will be given
a final copy of the research if desired.
I_______________________________________________,____________________________for Pinnacol
Name Title
Assurance agrees to allow Ms. Garcia to review the entire 2000-2001 fraud files. I also agree by
signing this to all of the terms and conditions written out above.
Name (print)____________________________________Date:_____________________
Signature_______________________________________
This researcher, Lucinda Garcia (303) 440-1350, agrees by signing below to the above consent forms
terms and conditions.
Researchers Signature__________________________Date:_____________________
66


APPENDIX D
Subject Consent Form
1. The purpose of this study is to gain information regarding Workers Compensation Fraud
prosecutions in the State of Colorado. The main goal of this study is to examine the role
of the third party, specifically the roles of the advisers (attorneys), investigators, and
judges exclusive to each case. This study will be conducted by researching and
reviewing Pinnacol Assurance fraud files of prosecuted claimants for the time period of
2000-2001. This study is expected to take about six months to complete.
2. Each subject is requested to take part in at least one interview. This will last for about
one hour, or how ever long it takes to complete the interview. If enough information is
not attained in the first interview, a second one may be requested. Interviews will be
tape-recorded. If at any time the subject wants the recorder turned off, that request will
be honored.
3. It is possible that some subjects may experience some discomfort while discussing then-
views.
4. There are many benefits that can be expected from this study. This study will provide
information illustrating the impacts and the roles various parties play in the fraud
prosecution process. In addition, it will provide statistical information regarding the
physical and economic similarities amongst the fraudulent claimants for purposes of
profiling.
5. Subject confidentiality will be protected with the utmost concern. The researcher
(Lucinda Garcia) will keep all material pertaining to the study in a private locked file.
Identity numbers will be assigned to each subject, so that names and all pertinent
information will remain confidential. The actual fraud file will be kept at Pinnacol
Assurance under management by the Special Investigative Unit.
6. The data from this study will solely be used for educational purposes, including but not
limited to a Masters thesis, educational presentations, and scholarly publications.
7. Each subjects participation is completely voluntary, and the subject may leave the study
at any time that they feel necessary. Withdrawing from the study will not cause any
penalty.
8. The undersigned is encouraged to ask the researcher (Lucinda Garcia) any questions
about the study. The questions will be answered as well as possible without jeopardizing
the methodology of the research.
9. Questions about the study should be directed to Lucinda Garcia at (303) 440-1350.
Questions or concerns about the research process should be directed to the Office of
Academic Affairs, CU Denver building, suite 700. (303) 556-2550.
10. The undersigned will be given a copy of this consent form for their records and will be
given a final copy of the research if desired.
I_______________________________________________, agree to be a research subject of this study of
Workers Compensation fraud. I also agree by signing this to all of the terms and conditions written
out above, knowing my participation is completely voluntary, and I may withdraw my services at any
time with no penalty.
Subjects Name (print)____________________________________Date:________________________
Signature_________________________________________________
This researcher, Lucinda Garcia (303) 440-1350, agrees by signing below to the above consent forms
terms and conditions.
Researchers Signature________________________________________Date:____________________
67


APPENDIX E
Data Collection Index
Identification No.
Claim No.,W.C. No., Policy No.
Gender
Race/Ethnicity:
Date of Birth:
Name of Employer:
Average Weekly Wage:
Occupation:
Claimants Representation:
Martindale Rating:
Respondents Representation:
Martindale Rating:
Previous W.C. Injuries:
Date of Injury:
Nature of Case:
Surveillance Conducted:
Date Referred to Attorney Generals Office:
Allegation/Charges:
Plea (Guilty/Not Guilty):
Trial
County/City Where Trial Held:
Verdict:
68


APPENDIX F
Attorney Interview Guideline
Interviewer:
Interviewee: ID#
Interviewees contact number:
Location of the interview:
Date of the interview:
Time of the start of the interview:
Time of the end of the interview:
PART I: Demographic questions
The object of these following questions is to gain information that is both descriptive and demographic
in nature of the subject and of their knowledge of Workers Compensation law.
Interviewees age:
Interviewees race:
Interviewees gender:
Number of years of school completed:
Where did you earn your degree/degrees:
Number of years experience as an attorney:
Number of years experience as an attorney in the field of Workers Compensation:
PART II: Content questions (preliminary sample)
Please explain the Workers Compensation process in the State of Colorado. For example, a worker
gets injured, what are the next steps? How many hours to they have to submit a claim, etc.? Has this
process changed over time? (Specific laws of importance)
Based on race, gender, and age, do you perceive that certain types of individuals submit more
Workers Compensation claims than others? Im not looking for statistics; Im just interested in your
perception.
Have you done much work in the area of Workers Compensation fraud? If so, explain.
(Have them differentiate between their work experience as a claimants counsel, in-house counsel,
prosecutor, or judge). How has this changed over time?
Do you perceive that a specific type of individual is more prone to committing or being accused of
Workers Compensation fraud?
Male vs. female
Age
Race
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Appendix F (Cont.)
In your experience, do you believe that it is more beneficial for a claimant to hire an attorney to
represent them in legal proceedings or should they remain pro se? (Have them elaborate why they
believe this way)
Once again, in your perspective, what role does the gender of the claimant play within Workers
Compensation legal proceedings? For example, does it play a part in determining the outcome in
hearings (Hearings, Fraud Prosecution Process, etc.).
Based on your beliefs and experiences, how would you define the status of an attorney? For example,
how would you determine that this attorney is a good/notable attorney within the legal community?
Do you perceive that race plays a role, what about sex, what about age? Does the school in which the
attorney graduated contribute to this?
Based on your experience, what role does the status of the claimants attorney play within legal
proceedings?
Do you perceive that if a Claimant is charged with workers compensation fraud that they will receive
a much more lenient sentence if they hire a high status attorney vs. a lower status attorney? What about
a high status attorney vs. pro se? (Have them elaborate)
What role does the gender of the attorneys involved play within Workers Compensation legal
proceedings? Do you believe gender plays a part in determining the outcome in hearings (Hearings,
Fraud Prosecution Process, etc.).
What role does the gender of Judge/Administrative Law Judges play within Workers Compensation
legal proceedings? Do you believe gender plays a part in determining the outcome in hearings
(Hearings, Fraud Prosecution Process, etc.).
On the same lines, does the race of the claimant play a role within Workers Compensation legal
proceedings? Do you believe the race of the claimant plays a part in determining the outcome in
hearings (Hearings, Fraud Prosecution Process, etc.).
How does the race of the attorneys play a role within Workers Compensation legal proceedings? Do
you believe the race of the attorneys plays a part in determining the outcome in hearings (Hearings,
Fraud Prosecution Process, etc.).
What role does social status play in the Workers Compensation legal proceedings? Tell me, based on
your knowledge, do claimants with a higher social status receive much more lenient sentences?
Do you believe there are questions in this interview that I you feel I may have missed or is there any
other pertinent information that you would like to contribute?
70


APPENDIX G
Investigator Interview Guideline
Interviewer:
Interviewee: ID#
Interviewees contact number:
Location of the interview:
Date of the interview:
Time of the start of the interview:
Time of the end of the interview:
PART I: Demographic questions
The object of these following questions is to gain information that is both descriptive and demographic
in nature of the subject and of their knowledge of Workers Compensation law.
Interviewees age:
Interviewees race:
Interviewees gender:
Number of years of school completed:
Where did you earn your degree/degrees:
Number of years experience as an investigator:
Number of years experience as an investigator within Workers Compensation:
PART II: Content questions (preliminary sample)
Please explain the steps that lead to the investigation of a Workers Compensation claim. (Ask if these
are the same steps followed for potential fraud cases). How and by whom are investigations initiated
by? What sparks these investigations? What is your role/duty in conducting these investigations? Etc.
What is the Workers Compensation fraud prosecution process in the State of Colorado. (Example:
Investigator obtains a request to conduct an investigation. The investigator realizes this claim may be
potentially fraudulent, what are the next steps taken?)
Do you perceive that a specific type of individual is more prone to committing or being accused of
Workers Compensation fraud? Explain.
Male vs. female
Age
Race
71


Appendix G (Cont.)
Within this same realm, do you think that individuals occupying certain types of occupations commit
more or are more prone to committing or being accused of Workers Compensation fraud? (Example:
For example, do you see more policyholders committing fraud than laborers, i.e. construction
workers).
What role does the gender of the claimant play within the Workers Compensation fraud prosecution
process? For example, do you perceive that it plays a part in determining the overall verdict of a case?
What role does the gender of the attorneys involved play within Workers Compensation legal
proceedings? Do you perceive that if the claimants attorney is a male that the claimant will receive a
more lenient sentence than if the claimants attorney was a female. Explain.
What role does the gender of Judge/Administrative Law Judges play within the Workers
Compensation fraud prosecution process? Based on your experience and insight, if the Judge is male
and the claimants attorney is female does this play a part in the fraud prosecution process and the final
verdict? What if the Judge is male and the claimants attorney is male? (Give all possible scenarios)
On the same lines, does the race of the claimant play a role within the Workers Compensation fraud
prosecution process? Do you believe the race of the claimant plays a part in determining the overall
verdict of a case? Do individuals occupying a particular race get accused or prosecuted for Workers
Compensation fraud more often than individuals occupying other races?
Based on your perception, does the race of the claimants attorney play a role in the fraud prosecution
process and the final verdict? Explain.
Based on your experience, have you ever noticed or had the inclination that the Judge/Administrative
Law Judge based the verdict of the case solely on race of the claimant? What about the gender of the
claimant? Age?
What role does social status, i.e. wealth (money) play in the Workers Compensation fraud prosecution
process? Based on your perception, do claimants with a higher social status (well-known in the
community, i.e. policyholder, wealthy) receive much more lenient sentences or do you notice that
charges are rarely filed on them?
Based on your perception, are there status differences amongst attorneys? Explain.
Do you think that certain attorneys are hired to represent claimants based on their status? (Explain my
definition of status: famous, known for getting individuals charges dropped or lenient sentences, come
from well-known/prestigious firms, expensive to hire, etc.).
If these statuses do exist, then based on your perception, do you believe that if a claimant is
represented by a high status attorney, then the claimant will receive a lenient sentence?
72


Appendix G (Cont.)
As an Investigator, have you ever felt that one of your cases was denied prosecution by the Attorney
Generals Office based on your race, gender, or age?
As a female/male Investigator, do you feel that you are treated differently than your male/female
counterparts by your immediate supervisor, by others in your department, within the Workers
Compensation Investigation sector?
Do you believe there are questions in this interview that I you feel I may have missed or is there any
other pertinent information that you would like to contribute?
73


APPENDIX H
Data Coding Scheme
ITEM (VARIABLE NAME) CODES AND INSTRUCTIONS
Identification No. (IN) 2 digit numeric variable
Gender (G) 1 digit numeric variable 1- Male 2- Female 9-Missing Data
Date of Birth (DOB) 2 digit character variable ## 77-Missing Data/Policyholder 88-Case Never Filed with Attorney General 99-Missing Data
Race/Ethnicity (RE) 1 digit numeric variable 1- White 2- Black or African American 3- Hispanic 4- American Indian or Alaska Native 5- Asian 6- Hawaiian or Other Pacific Islander 7- Other 9-Missing Data
Occupation (0) 1 digit numeric variable 1- White Collar 2- Blue Collar 8- Not Applicable 9- Missing Data
Average Weekly Wage (AWW) 8 digit character variable jiUUjMjfjM II It II trtttttrTT 77-Not Applicable/Policyholder 88-Not Applicable 99-Missing Data
Previous W.C. Claim (PWCC) 1 digit numeric variable 1- No 2- Yes 3- Not Applicable 8- Unable to Determine 9- Missing Data
Surveillance Conducted (SC) 1 digit numeric variable 1- No 2- Yes 8- Not Applicable 9- Missing Data
74


Appendix H (Cont.)
Claimants Representation (CR) 1 digit numeric variable 1- Pro Se 2- Public Defender 3- Private Attorney 4- Unable to Detennine/Case Still Under Investigation 5- No Attomey/File Closed Prior to Attorney General Referral 6- Not Applicable/Prosecution Declined by Attorney General 7- No Attomey/Charges Pending 9-Missing Data
Status of Claimants Attorney (SCA) 1 digit numeric variable 1- AV (Very High Rating) 2- BV (High Rating) 3- CV (Good Rating) 4- Pro Se Claimant 5- Unable to Determine/No Martindale Hubbell Rating 6- No Attomey/File Closed Prior to Attorney General Referral 7- No Attomey/Charges Pending 8- Not Applicable/Prosecution Declined by Attorney General 9- Case Still Under Investigation 99-Missing Data
Respondents Representation (RR) 1 digit numeric variable 1- Pro Se 2- Public Defender 3- Private Attorney 4- Assistant Attorney General 5- Unable to Determine/Case Still Under Investigation 6- No Attorney File Closed Prior to Attorney General Referral 7- Not Applicable/Prosecution Declined by Attorney General 8- No Attomey/Charges Pending 9- Missing Data
75


Appendix H (Cont.)
Status of Respondents Attorney (SRA) 1 digit numeric variable 1- AV (Very High Rating) 2- BV (High Rating) 3- CV (Good Rating) 4- Pro Se Claimant 5- Unable to Determine/No Martindale Hubbell Rating 6- No Attomey/File Closed Prior to Attorney General Referral 7- No Attomey/Charges Pending 8- Not Applicable/Prosecution Declined by Attorney General 9- Case Still Under Investigation 99-Missing Data
Allegation/Charges (AG) 1 digit numeric variable 1- Theft 2- False Statement 3- Mail Fraud 4- Conspiracy 5- False Claim 6- Forgery 7- Theft & False Statement 8- Theft, False Statement & Forgery 9- Theft, False Statement & Other 10- Forgery & Other 11- Charges Never Filed with Attorney General 12- Other 99-Missing Data
Trial (T) 1 digit numeric variable 1- No 2- Yes 3- No Trial/Prosecution Declined by A.G. 4- Charges Pending 5- Trial Pending 6- Charges Never Filed/File Closed Prior to Attorney General Referral 7- Case Still Under Investigation 8- Not Applicable 9- Missing Data
76


Appendix H (Cont.)
Plea (P) 1 digit numeric variable 1- Not Guilty 2- Guilty 3- No Plea/Prosecution Declined by A.G. 4- Charges Pending 5- Trial Pending 6- Charges Never Filed/File Closed Prior to Attorney General Referral 7- Case Still Under Investigation 8- Case Settled 9- Not Applicable 99-Missing Data
Sentence (S) 1 digit numeric variable 1- Restitution 2- Probation 3- Restitution and Probation 4- Jail 5- Jail and Restitution 6- Jail and Probation 7- Community Service 8- Community Service and Restitution 9- Community Service and Probation 10- Community Service, Restitution and Probation 11- Jail, Community Service, and Restitution 12- Deferred Sentence 13- Dept. of Corrections, Parole, Probation, and Restitution 14- No Sentence/Prosecution Declined by Attorney General 15- Charges Pending 16- Trial Pending 17- Charges Never Filed/File Closed Prior to Attorney General Referral 18- Case Still Under Investigation 19- Other 20- Not Applicable 99-Missing Data
77


Appendix H (Cont.)
Amount of Restitution (AR) 1 digit numeric variable 1- Trial Pending 2- Charges Pending 3- Charges Never Filed/File Closed Prior to Attorney General Referral 4- Case Still Under Investigation 5- No Restitution/Prosecution Declined by Attorney General 6- No Restitution Ordered 8- Not Applicable 9- Missing Data
78


APPENDIX I
Frequency for Gender
Frequency Percent Valid Percent Cumulative Percent
Male 40 67.8 69.0 69.0
Female 18 30.5 31.0 100.0
Total 58 98.3 100.0
Missing 1 1.7
Data 59 100.0
Total
79


21
26
29
31
32
33
34
35
36
37
39
40
41
43
44
46
47
49
50
51
56
Tol
APPENDIX J
Frequency for Age
Frequency Percent Valid Percent Cumulative Percent
1 1.7 1.7 2.1
2 3.4 3.4 6.4
1 1.7 1.7 8.5
3 5.1 5.1 14.9
2 3.4 3.4 19.1
1 1.7 1.7 21.3
3 5.1 5.1 27.7
3 5.1 5.1 34.0
2 3.4 3.4 38.3
5 8.5 8.5 48.9
2 3.4 3.4 53.2
6 10.2 10.2 66.0
1 1.7 1.7 68.1
1 1.7 1.7 70.2
3 5.1 5.1 76.6
1 1.7 1.7 78.7
3 5.1 5.1 85.1
1 1.7 1.7 87.2
3 5.1 5.1 93.6
1 1.7 1.7 95.7
2 3.4 3.4 100.00
47 79.7 79.7
12 20.3 20.3
59 100.0 100.0
80


APPENDIX K
Frequency for Race
Frequency Percent Valid Percent Cumulative Percent
White 43 72.9 74.1 74.1
Black or African American 3 5.1 5.2 79.3
Hispanic 12 20.3 20.7 100.0
Total 58 98.3 100.0
Missing Data 1 1.7
Total 59 100.0
81


APPENDIX L
Frequency for Weekly Wage
Frequency Percent Valid Percent Cumulative Percent
11 18.6 18.6 21.6
Policyholder 1 1.7 1.7 23.5
120.00 2 3.4 3.4 27.5
150.00 1 1.7 1.7 29.4
200.00 1 1.7 1.7 31.4
208.40 1 1.7 1.7 33.3
256.62 1 1.7 1.7 35.3
260.00 1 1.7 1.7 37.3
281.20 1 1.7 1.7 39.2
283.20 2 3.4 3.4 43.1
300.00 1 1.7 1.7 45.1
312.00 3 5.2 5.2 51.0
320.00 1 1.7 1.7 52.9
340.00 1 1.7 1.7 54.9
353.57 1 1.7 1.7 56.9
400.00 1 1.7 1.7 58.8
420.00 1 1.7 1.7 60.8
424.80 2 3.4 3.4 64.7
440.00 1 1.7 1.7 66.7
491.46 1 1.7 1.7 68.6
496.80 1 1.7 1.7 78.6
500.00 2 3.4 3.4 70.6
520.00 1 1.7 1.7 74.5
538.00 1 1.7 1.7 76.5
580.00 1 1.7 1.7 78.4
590.00 1 1.7 1.7 80.4
640.00 1 1.7 1.7 82.4
653.12 1 1.7 1.7 84.3
660.00 1 1.7 1.7 86.3
800.00 1 1.7 1.7 88.2
840.00 1 1.7 1.7 90.2
841.20 1 1.7 1.7 92.2
852.53 1 1.7 1.7 94.1
889.41 1 1.7 1.7 96.1
896.00 1 1.7 1.7 98.0
1057.69 51 86.4 86.4 100.0
Total 8 23.6 23.6
Missing 59 100.0 100.0
82


APPENDIX M
Frequency for Occupation
Frequency Percent Valid Percent Cumulative Percent
White Collar 11 18.6 20.8 20.8
Blue Collar 30 50.8 56.6 77.4
Policyholder 11 18.6 20.8 98.1
Medical Provider 1 1.7 1.9 100.0
Total 53 89.8 100.0
Missing Data 6 10.2
Total 59 100.0
83


APPENDIX N
Frequency for Workers
Compensation History
Frequency Percent Valid Percent Cumulative Percent
No 44 74.6 74.6 74.6
Yes 15 25.4 25.4 100.0
Total 59 100.0 100.0
84


APPENDIX O
Frequency for Surveillance
Frequency Percent Valid Percent Cumulative Percent
No 26 44.1 44.1 44.1
Yes 33 55.9 55.9 100.0
Total 59 100.0 100.0
85


APPENDIX P
Frequency for Claimants Representation
Frequency Percent Valid Percent Cumulative Percent
Pro Se 6 10.2 10.9 10.9
Public Defender 1 1.7 1.8 12.7
Private Attorney 19 32.2 34.5 47.3
No Prosecution 29 49.2 49.2 100.00
Total 55 93.2 100.0
Missing Data 4 6.8
Total 59 100.0
86


APPENDIX Q
Frequency for Status of Claimants Attorney
Frequency Percent Valid Percent Cumulative Percent
AV (Very High Rating) 3 5.1 5.5 5.5
BV (High Rating) 5 8.5 9.1 14.5
Pro Se Claimant 6 10.2 10.9 25.5
Unable to Determine-No Martindale Hubbell Rating 12 20.3 21.8 47.3
No Prosecution 29 49.2 52.7 100.0
Total 55 93.2 100.0
Missing Data 4 6.8
Total 59 100.0
87


APPENDIX R
Frequency for Charges/Allegations
Frequency Percent Valid Percent Cumulative Percent
Theft 4 6.8 6.8 6.8
False Statement 7 11.9 11.9 18.6
Conspiracy 5 8.5 8.5 27.1
Forgery 3 5.1 5.1 32.2
Theft & False Statement 31 52.5 52.5 84.7
Theft, False Statement & Forgery 3 5.1 5.1 89.8
Theft, False Statement & Other 4 6.8 6.8 96.6
Forgery & Other 2 3.4 3.4 100.0
Total 59 100.0 100.0
88


APPENDIX S
Frequency for Trial
Frequency Percent Valid Percent Cumulative Percent
No 24 40.7 40.7 40.7
Yes 3 5.1 5.1 45.8
Trial Pending 3 5.1 5.1 94.9
No Prosecution 29 49.2 49.2 100.0
Total 59 100.0 100.0
89


APPENDIX T
Frequency for Plea
Frequency Percent Valid Percent Cumulative Percent
Not Guilty 3 5.1 5.3 5.3
Guilty 22 37.3 38.6 43.9
No Plea 32 54.2 56.1 100.0
Total 57 96.6 100.0
Missing Data 2 3.4
Total 59 100.0
90


APPENDIX U
Frequency for Sentence
Frequency Percent Valid Percent Cumulative Percent
Restitution 3 5.1 5.1 5.1
Restitution and Probation 4 6.8 6.8 11.9
Community Service and Restitution 1 1.7 1.7 13.6
Community Service and Probation 2 3.4 3.4 16.9
Community Service, Restitution and Probation 15 25.4 25.4 42.4
Jail, Community Service and Restitution 1 1.7 1.7 44.1
Dept, of Corrections, Parole, Probation and Restitution 1 1.7 1.7 45.8
Trial Pending 3 5.1 5.1 94.9
No Prosecution 29 49.2 49.2 100.0
Total 59 100.0 100.0
91


APPENDIX V
Frequency for Restitution
Frequency Percent Valid Percent Cumulative Percent
1,000-10,000 14 23.7 56.0 56.0
10,000+ 11 18.6 44.0 100.0
Total 25 42.4 100.0
No Prosecution 32 54.2
No Restitution Ordered 2 3.4
Total 34 57.6
Total 59 100.0
92


Full Text

PAGE 1

\ A SOCIOLOGICAL EXPLORATION OF WORKERS' COiviPENSATION FRAUD AND THE ROLE OF THE THIRb PARTIES by Lucinda Beatrice Garcia B.A., University of Colorado, Boulder A thesis submitted to the University of Colorado at Denver in partial fulfillment of the requirements for the degree of Master of Arts Sociology 2004

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This thesis for the Master of Arts degree by Lucinda Beatrice Garcia has been approved by .tJRiCllafd Anderson

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Garcia, Lucinda Beatrice (M.A. Sociology) A Sociological Exploration of Workers' Compensation Fraud and the Role of the Third Parties Thesis directed by Assistant Professor Virginia Fink ABSTRACT This is a mixed methods research study testing Donald Black's theory of the third party by analyzing data that I systematically collected from Pinnacol Assurance fraud files and in-depth interviews. Phase one of this study encompassed the review and analysis of fifty-nine State of Colorado Workers' Compensation fraud cases for the time period of 2000-2001. Phase two, consisted of conducting in-depth face-to face interviews with attorneys and investigators, who are familiar with the Colorado Workers' Compensation system. The theory of the third party seeks to understand when and how individuals intervene in the conflict of others. I specifically studied the roles of the advisers (attorneys) based on the nature and degree oftheir intervention within the Workers' Compensation fraud prosecution process. My analysis also included focusing on similarities and differences amongst the claimants accused of Workers' Compensation fraud based on gender, age, racial/ethnic entity, prior history of fraud, and occupation. This abstract accurately represents the content of the candidate's thesis. I recommend its publication. Virginia Fink lV

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ACKNOWLEDGEMENT I would like to express my gratitude to Dr. Virginia Fink for her guidance, supervision, patience, and mentorship throughout the evolution of my thesis. Working under her supervision was a confidence-building experience. I would like to thank Dr. Candan Duran Aydintug and Dr. Richard Anderson, my committee members, for their time, effort, and constructive feedback on my work. I also wish to thank the Pinnacol Assurance Special Investigations Unit and Legal Department, especially Mr. Walter Kirkwood and Ms. Kathy Stumm, for providing me the data that made this research possible, and for their continuous support. Lastly, and most importantly, my family deserves credit. The support and guidance I receive from them helps me chose the best path to take when the road leads in many different directions. Thank you.

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CONTENTS TABLES ................................................................................. ix CHAPTER 1. INTRODUCTION ................................................................. .1 2. THEORETICAL PERSPECTIVE ............................................... .3 3. LITERATURE REVIEW ......................................................... 6 4. AIM OF THE STUDY/HYPOTHESIS ........................................ 13 5. METHODS ........................................................................ 14 Data ................................................................................. 15 Phase One ........................................................................... 17 Operationalization of Variables ................................................. 18 Phase Two .......................................................................... 28 Models .............................................................................. 31 6. RESULTS .......................................................................... 33 Frequency Distribution and Statistics of Central Tendency ................................................... 28 Cross-tabulations .................................................................. 39 Interviews ........................................................................... 4 3 Gender artd Age ................................................................ 43 Race ............................................................................. 44 vi

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Weekly Wage and Occupation ............................................. .45 Workers' Compensation History And Surveillance .............................................................. 47 Claimant's Legal Representation .......................................... .48 Attorney Status ................................................................ 49 Trial/Plea ....................................................................... 51 Sentence and Amount of Restitution Ordered ........................................................... 52 7. DISCUSSION ..................................................................... 53 8. LIMITATIONS/SUGGESTIONS FOR FURTHER RESEARCH ......... 59 APPENDIX A. History of Workers' Compensation in Colorado and History ofPinnacol Assurance ...................................... 62 B. Pinnacol Assurance's Fraud Prosecution Process ..................... 64 C. Data Consent Form ........................................................ 66 D. Subject Consent Form .................................................... 67 E. Data Collection Index ..................................................... 68 F. Attorney Interview Guideline ............................................ 69 G. Investigator Interview Guideline ....................................... 71 H. Data Coding Scheme ...................................................... 74 I. Frequency for Gender ...................................................... 79 J. Frequency for Age ......................................................... 80 Vll

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K. Frequency for Race ....................................................... 81 L. Frequency for Weekly Wage ............................................. 82 M. Frequency for Occupation ............................................... 83 N. Frequency for Workers' Compensation History ...................... 84 0. Frequency for Surveillance .............................................. 85 P. Frequency for Claimant's Representation .............................. 86 Q. Frequency for Status of Claimant's Attomey ......................... 87 R. Frequency for Charges/Allegations ..................................... 88 S. Frequency for Trial ........................................................ 89 T. Frequency for Plea ......................................................... 90 U. Frequency for Sentence ................................................... 91 V. Frequency for Restitution ................................................ 92 REFERENCES ........................................................................ 93 viii

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TABLES Table 6.2.1 Claimant's Legal Representation and Sentence Cross-tabulation ............................................................ 39 6.2.2 Chi-Square Test for Claimant's Legal Representation and Sentence, N=23 ............................................... .40 6.2.3 Claimant's Legal Representation and Amount of Ordered Restitution Cross-tabulation ................................ .41 6.2.4 Chi-Square Test for Claimant's Legal Representation and Amount of Ordered Restitution, N=22 .................... .42 ix

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CHAPTER 1 INTRODUCTION Prior to the establishment of workers' compensation law in Colorado, very little recourse existed for injured workers. Injured workers had the ability to sue their employer, but it was costly for both parties involved. Thus, as mechanization in factories and mines brought an increase in work-related injuries during the Industrial Revolution, the move towards workers' compensation became top priority. In Colorado, Governor George Carlson led the fight to enact legislation. On August 1, 1915, the Colorado Workmen's Compensation Act became law (Path to the Summit, Peak Performance for Colorado Videocassette, 2002). This Act, instituted complex laws and provisions designed to provide compensation for individuals who incur workplace injuries. The current workers' compensation system provides a no fault method of compensating injured workers for medical expenses and wage losses due to on-the-job injuries. The social scope of this issue is important since, according to the United States Department of Labor, Bureau of Statistics and Labor; Injuries, Illnesses, and Fatalities Program, a total of5.7 million injuries and illnesses were reported in private industry workplaces during 2000, and 5.2 million were reported in 2001 (U.S. Department of Labor Web Site, 2004). In addition, a total of 5,920 fatal work injuries occurred in 2000, and in 2001, 5,915 fatal work injuries occurred, excluding the 2,886 1

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work-related fatalities that resulted from the September 11 terrorist attacks (U.S. Department of Labor Web Site, 2004). While the vast majority of workers' compensation claims are truthful, it has been estimated that billions of dollars of false claims are submitted each year to insurers from employees, employers, health care providers, attorneys and others. As research points out, these false and exaggerated claims have made workers' compensation fraud one ofthe fastest growing segments of insurance fraud. In tum, "workers' compensation fraud is estimated to be the second largest white-collar crime in the nation, second only to income tax evasion (Hardin, 2004:4)." In the State of Colorado, fraud is estimated to cost the workers' compensation system, billions of dollars annually. Employers, employees, insurance carriers and Colorado consumers pay the cost of fraud in 1) lost jobs and profit, 2) lower wages and benefits, and 3) higher costs for services and premiums. Very little research has been conducted in the workers' compensation fraud area, and the little research that is out there fails to focus on the State of Colorado. In tum, there is a demand for research exploring the workers' compensation fraud prosecution system, specifically the roles of judges, attorneys, and investigators involved; as well as identifying demographic similarities of individuals accused of and/or prosecuted for workers' compensation fraud. 2

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CHAPTER2 THEORETICAL PERSPECTIVE The purpose of this study is to specifically test Donald Black's theory of law, specifically his theory of the behavior oflaw and the third party. According to Black (1998) conflict occurs whenever individuals incite or express a grievance. It occurs whenever an individual participates in behavior that someone has defined as deviant or whenever an individual subjects another individual to social control. Black (1998) indicates that social control occurs throughout the universe, wherever individuals interact. Social control can occurs unilaterally (by one party against another), bilaterally (between two parties), and trilaterally (by a third party). Black (1998) suggests that the possibility of a settlement agent intervening in conflict varies with the degree of relational distance between the parties in conflict. Central to Black's theory of social control, is the argument that the social structure of a case predicts how a case will be handled. In turn, this case structure includes the social characteristics of all the parties involved, such as the principals (the alleged wrongdoer), supporters (lawyers), and third parties (such as the judge or jury) (Black, 1998). Thus, Black (1998) suggests that the social stature of a case depends on whether an attorney has been hired, by an alleged wrongdoer, to provide legal representation. According to Black (1998), the mere social status of an attorney enhances the stature of a typical criminal wrongdoer, and in turn, provides the alleged 3

PAGE 12

wrongdoer with less severe treatment and a less severe sentence. Furthermore, Black (1998) suggests that wrongdoers, who represent themselves in criminal proceedings (pro se ), are more likely to plead guilty and, based on social characteristics, are less likely to receive a reduced sentence. Thus, according to Black, "attorneys reduce the severity of courts toward defendants (Black, 1998:69)." Black's (1998) theory of the third party seeks to understand when and how individuals intervene in the conflict of others. This theory embraces virtually all individuals or groups who intervene in any way in an on-going conflict, including those who are overtly an unabashedly partisan from the outset, such as lawyers. The theory categorizes third parties into two dimensions based on the nature and degree of their intervention. These two dimensions are classified between support and settlement roles. In addition, Donald Black's (1998) theory ofthe third party identifies a total of twelve roles, which include five support roles (informer, adviser, advocate, ally, and surrogate), as well as five settlement roles (friendly peacemaker, mediator, arbitrator, judge, and repressive peacemaker). Informers, such as investigators, are among the various supporters of individuals in conflict. A matter of fact, informers assist others by providing information, but do not actually partake in resolving the conflict itself. Informers are, "professionals, who, for a price, invest considerable resources in discovering and reporting what a client wants to know (Black, 1998)." Workers' compensation fraud investigators perform this role by investigating potential fraudulent activity, and 4

PAGE 13

reporting evidence and information to the State of Colorado's Attorney General's Office for prosecution. (See Appendix B, Pinnacol Assurance's Fraud Prosecution Process). Additionally, advocates, such as attorneys, are another supporter of individuals in conflict. Advocates publicly assert the cause of the people they support. They are directly involved in the conflict management between parties, and occasionally risk their personal reputations to benefit the principals they support. Within the settlement roles, Black (1998) indicates that judges address the matter separating the adversaries, make a settlement decision, and if necessary, enforce the decision. Historically, in the criminal prosecution process attorneys are usually seen as advocates, but in the case of workers' compensation fraud the roles are not as clear due to a variety of reasons. 5

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CHAPTER3 LITERATURE REVIEW White-Collar Crime In the world of criminal justice research, there has been relatively little attention paid to white-collar crime. The number of research studies on white-collar crime pales in comparison with the many studies on the commission and control of violent crimes and property crimes. The term "white-collar crime" was coined in 1939 during a speech given by Edwin Sutherland to the American Sociological Society. In this speech, Sutherland defined the term, white-collar crime as, "crime committed by a person of respectability and high social status in the course of his occupation (White Collar Crime FYI Web Site, 2004). Within this area of white-collar crime, Sutherland became interested in examining how upper class, white-collar offenders, were being processed within the judicial system. In the scope of his research, Sutherland noted that these criminal offenders were not being processed by criminal courts. Rather, these upper class, white-collar offenses, were being processed as civil violations, and being handled as administrative law and processed through administrative agencies. Sutherland's research brought attention to corporate deviance and upper-world 6

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criminality, because these offenders were not being considered criminals nor were they included in studies and theories of criminal behavior (Reid, 1997). Sutherland's definition, limiting white-collar crimes to occupational crimes of the upper class, created great debate. However, sociologists and criminologists have expanded Sutherland's definition of white-collar crime. For example, Reiss and Biderrnan define white-collar crime as violations of law that include the use of a violator's power, influence, or trust for the purpose of illegal gain (Reid, 1997). Edelhertz defines white-collar crime, as an illegal act committed by nonphysical means and by concealment or guilt to obtain money or property (Reid, 1997). Although there has been some debate as to what qualifies as a white-collar crime, the term today generally encompasses a variety of nonviolent crimes usually committed in commercial situations for financial gain (Legal Information Institute Web Site, 2004). White-collar crime is construed to involve deception of a victim and generally occurs where an individual's job, power, or personal influence provide the access and opportunity to abuse lawful procedures for unlawful gain. Categorization of White-Collar Crimes Many criminal acts may be classified as white-collar crimes. Some of these acts are committed primarily by individuals acting alone, through the participation of more than one person, or by corporations. These acts include, but are not limited to, 7

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various types of fraud, such as embezzlement, bribery, insider fraud, government fraud, counterfeiting, etc. The scope of this study focuses on one type ofwhite-collar crime, insurance fraud, specifically workers' compensation insurance fraud. Insurance fraud consists of false claims made to an insurance company, so that individuals can collect benefits or additional benefits. (The definition of workers' compensation, workers' compensation fraud, and the various types of workers' compensation fraud are described later in this chapter.) White Collar Crime Resolutions Unlike violent crimes, white collar crimes, do not necessarily cause injury to identifiable persons. Instead, white-collar crime causes loss to society. For example, violent crime has an immediate and observable impact on its victim, which raises the ire of the public. In contrast, white-collar crime frequently goes undetected and is more difficult to investigate. However, white-collar crimes can create the greater havoc. The victim of an assault will recover, however, the impact of a fraud can last a lifetime. White-collar crime is rarely prosecuted; when prosecuted and if a conviction is obtained, penalties tend to be extremely light (Friedrichs, 2001). The penalties for white-collar offenses include fines, home detention, community confinement, costs of prosecution, forfeitures, restitution, supervised release, and imprisonment. However, 8

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sanctions can be lessened if the defendant takes responsibility for the crime and enters a guilty plea. Workers' Compensation Background Workers' compensation is an insurance, paid for by employers/insurance policyholders, that provides financial benefits and medical care to employees who become injured or ill as a result of their work. Most states, including Colorado, require 100 percent payment of medical expenses for employees injured on the job, as well as providing disability benefits, and up to two-thirds of wage loss benefits while the employee is unable to work. Workers' Compensation Fraud As defined by the Texas Workers' Compensation Commission, workers' compensation fraud occurs, "when a person knowingly or intentionally conceals, misrepresents, and makes a false statement to deny or obtain workers' compensation benefits (Texas Workers' Compensation Commission Web Site, 2004)." In the United States, dramatic increases in workers' compensation premiums, throughout the late 1980s and early 1990s, are believed to have been fueled by fraudulent workers who were abusing the workers' compensation system. During this time period, the American Insurance Association (AlA) estimated fraud losses at about $3 billion per year, the National Insurance Crime Bureau doubled the AlA's estimate to $6 billion, 9

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and one insurance company president put the cost of workers' compensation fraud at $30 billion a year (Labor Research Association Web Site, 2004). These large amounts sparked the need for legislative and state reform. Since that time, it is estimated that more than half of the states have passed legislation on workers' compensation fraud, and/or currently have active workers' compensation insurance fraud units. It is important to note that, workers' compensation fraud currently has multiple forms and is practiced by a variety of fraudulent individuals. Employer fraud is committed by an employer/insurance policyholder who misrepresents dynamics used to determine their workers' compensation premium, such as understating employee payroll or misclassifying their business type. In addition, this type of fraud can also be perpetrated by policyholders (employers) who discourage and/or prevent their injured employees from submitting and pursuing workers' compensation claims. Health care provider fraud occurs when providers inflate their bills for services, bill for treatment or services ofnonwork-related injuries, and prescribe or refer treatment unrelated to the injury. Finally, claimant fraud occurs when an employee falsely claims (lies) about a work-related injury or exaggerates the extent of an injury to intentionally collect workers' compensation benefits. These employees are often receiving disability benefits while working a second job or performing activities beyond what their claim allows. 10

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Workers' Compensation Research Agencies Specific institutions, such as the Workers' Compensation Research Institute (WCRI) and National Counsel on Compensation Insurance (NCCI) conduct research specifically designed to study trends in the workers' compensation market with regards to legislation, policy rates, and gains and losses. The Workers' Compensation Research Institute (WCRI) is an "independent, not-for-profit research organization providing high-quality, objective information about public policy issues involving workers' compensation systems (Workers' Compensation Research Institute Web Site, 2004)." Founded in late 1983, WCRI was organized to conduct studies and obtain data involving workers' compensation systems. The Workers' Compensation Research Institute's services consist of studying individual state systems, studying legislative changes, and presenting workers' compensation findings to legislators, companies, etc. After much research into WCRI studies, I was unable to locate any information related to workers' compensation fraud. In addition, the National Counsel on Compensation Insurance (NCCI), "operates as a not-for-profit rating, statistical and data management services organization (National Counsel on Compensation Insurance Web Site, 2004)." Founded in 1919, NCCI was established as a systematic mechanism designed to create a more uniform approach to workers' compensation. Thus, NCCI's products and assistance are designed to aid insurers, legislators, and other stakeholders in making decisions regarding the economic functioning of the workers' compensation 11

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system. Pinnacol Assurance utilizes NCCI as a central organization in determining insurance costs, and evaluating trends that could possibly affect the State of Colorado's workers' compensation market. 12

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CHAPTER4 AIM OF THE STUDY !HYPOTHESIS The purpose of this research project is to sociologically explore the dynamics of workers' compensation fraud by exploring the roles various third parties play in the fraud prosecution process. One thing is obvious, however, that the availability of workers' compensation fraud literature depicts an area that has not been widely or thoroughly researched. The questions I address are these: Based on demographic characteristics, what types of individuals are more prone to commit or be accused of workers' compensation fraud? How does the workers' compensation legal and investigative community defme a high status attorney? Does the claimant's legal representation play a role in the workers' compensation fraud prosecution process and overall sentence? If the claimant is represented, does the status of their attorney play a role in the final outcome? In tum, I hypothesize that if a claimant is represented by an attorney, in workers' compensation legal proceedings, the claimant will receive a lesser sentence than if they were to represent themselves and remain pro se. 13

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CHAPTERS METHODS Although many researchers have advocated the use of a single methodology, I chose to use mixed methods research to conduct this study. Mixed methods research consists of collecting and analyzing both quantitative and qualitative data in a single study or multiple studies (Creswell, 2003). The crucial aspect in justifying mixed methods research is that both single methodology approaches, qualitative and quantitative, have strengths and weaknesses. However, combining the two methods produces improved instrumentation for data collection and sharpens the researcher's understanding of fmdings (Creswell, 2003). Recently the mixed methods approach has found application in various social and behavioral science disciplines. As Creswell (2003) indicates, in conducting mixed methods research, different types of mixed methods research designs can be employed. All these designs incorporate features such as implementation, priority given to quantitative and qualitative data collection, and the integration of both types of data. My mixed method analysis was conducted, in two phases, using a sequential explanatory design. By using this strategy, "greater priority is given to the quantitative data, and the two methods are integrated during the interpretation phase of the study (Creswell, 2003:215)." In this study, phase one consists of a quantitative 14

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analysis of workers' compensation fraud data followed by phase two, a qualitative segment, utilizing in-depth participant interviews to assist in explaining and interpreting my quantitative findings. Data In phase one of this study, I obtained my sample from Pinnacol Assurance 2000 and 2001 workers' compensation fraud files. This sample consisted of fifty-nine Pinnacol Assurance claimants who were accused of or committed workers' compensation fraud during this time period. In turn, this sample includes cases that were either prosecuted or declined prosecution by the State of Colorado Attorney General's Office, cases that were never referred to the Attorney General's Office by Pinnacol Assurance, cases that are pending trial and cases that are still under investigation or have charges pending. A major strength of using this desired sample is that I collected the data myself. To date, there is no known data set on this topic, so this allowed me to personally collect the data relevant to this particular study, and not rely on a secondary data set. Phase two of this study, consisted of conducting in-depth, open-ended interviews of workers' compensation attorneys and investigators. The purpose of these interviews was to allow the participants to depict their experiences and insights into the workers' compensation arena and fraud prosecution process. Therefore, a major strength of conducting these interviews in an open-ended format is that it 15

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allows the participants the ability to guide the conversation with their experiences and thereby become active contributors to the research process; it also allowed for the incorporation of some of their suggestions and feedback on the topic. I began the data gathering process for this study during the summer 2002 semester and I continued through spring 2004 semester. My initial process consisted ofthoroughly reviewing the State of Colorado's workers' compensation history, laws and procedures, as well as searching for any literature or materials related to my topic. In turn, I obtained approval for this study and interview guidelines from the University of Colorado at Denver, Human Subjects Committee, and obtained authority from the Special Investigative Unit Manager for Pinnacol Assurance to review and access these fifty-nine files (See Appendix C: Data Consent Form). The Special Investigative Unit Manager was aware of the realm of this study and what the data would be used for. Even though these data are not easily accessed, this information is public record and can be accessed by following the proper legal procedure of requesting public citizen information at the criminal division of the clerk's office at the respected county/district court where the case was prosecuted. Prior to conducting this study, ethical considerations were taken into account. It is important to note, that due to the nature of this study, specific situations may arise that could pose potential risks to the claimants. The claimants, in phase one of my study, could experience psychological repercussions, such as potential stigmatization if they ever obtained access to my Master's thesis or subsequent 16

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publications. It is highly unlikely, but the claimant may notice that my data consist of workers' compensation fraud prosecutions and declined prosecutions during the time period in which they were accused. In turn, this may subject them to feel socially stigmatized by thinking that others will be able to identify them. However, no potential legal risks could pose a threat to the participants in either phase of this study. In phase one of this study, under the term of double jeopardy, the claimants, in my data set, cannot be tried twice for the same offense (prohibited by the 5th Amendment of the U.S. Constitution). In phase two ofthis study, participant interviews could not subject the participants to any form of legal repercussions, because the attorneys will merely be giving their legal opinions and experiences, and the investigators will also be giving their investigative opinions and expenences. Phase One In phase one of this study, I did not conduct interviews on the claimants, but did obtain all necessary information from the Pinnacol Assurance 2000 and 2001 fraud files. These fraud files contained information about each participant, such as age, gender, and race, as well as information about their employer (policyholder), a copy of the investigation report and court/legal documents, subject's DMV record, and any information relevant to the particular case. A coding scheme was developed for part one of the study. This coding scheme gave each fraud file (claimant) an identification number. In addition, I developed a data collection index which contains 17

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a record of the participant's name, their identification number, their race/ethnicity, their employer's name, their attorney's name, the judge who presided over their case, their charges and their convictions (See Appendix E: Data Collection Index). The data collection indexes are kept in a private file. The duration of the fraud file review ranged from twenty minutes to four hours per case. These time variances were a result of disorganized fraud files, multiple fraud files, and/or the need for investigator assistance and clarification. I reviewed between eight to ten cases per month, but if the claim was still under investigation or if the claimant had charges or a trial pending, I was required to go back and review these cases for updated information. Operationalization of Variables I determined the gender of the claimants based on the Department of Motor Vehicle (DMV) records provided in the fraud files. In a couple instances, a DMV record failed to be located in the file, so I directly asked the investigator assigned to the case the gender of the claimant. For purposes of data analysis, I coded # 1for male and #2for female, and #9-for missing data. The age of the claimants' accused of workers' compensation fraud is an important variable in my research. The claimants' age is substantial in determining a median age of individuals submitting workers' compensation claims, and more importantly, a median age of individuals being prosecuted for workers' compensation fraud. I obtained the claimants' date ofbirths from the investigator reports located in 18

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the fraud files. In only a few instances did the files lack these birth dates. Furthermore, I calculated the age of the claimant when they submitted the workers' compensation claim, by subtracting that date from the claimants' birth date. In addition, I calculated the age of the claimant when the claim was referred to the Office of the Attorney General for potential prosecution, by subtracting that date from the claimants' date of birth. I entered these variables as numerical values for the purpose of data analysis and coded #77-for missing data/policyholder, #88-for cases never filed with the Attorney General, and #99for missing data. The race of the claimant is substantial in all studies related to criminal research. I determined the race of the claimants based on their racial identification on their DMV records. Once again, I ran across the problem ofDMV records lacking from the fraud file, so I was required to seek assistance from the investigator who conducted the investigation. With regards to my coding scheme, I selected racial categories based on the United States census categorical coding for 2000. I selected #1-for White, #2-for Black or African America, #3-for Hispanic or Latino, #4-for American Indian or Alaska Native, #5-for Asian, #6-for Hawaiian or Pacific Islander, #7for other, and #9 for missing data. The occupation of the claimant is a significant aspect in my research, because it allows me to analyze if individual's employed in a specific occupational category are more likely to be accused of or prosecuted for workers' compensation fraud. In turn, I was able to locate each claimant's occupation on his or her first report of 19

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InJury. The claimant's first report of injury, is a worksheet filed within 48 hours of a work-related injury, and lists the occupation of the claimant at the time of injury, the date and extent of their injury, as well as the claimant's average weekly wage. In my initial analysis, I broke down the claimant's occupation into 3 main categories, based on whether they were employed in a white-collar occupation, a blue-collar occupation, or if they were a policyholder/employer. I differentiated between blue and white-collar positions based on whether the claimant's occupation required the use of If a claimant's profession necessitated manual labor their occupation was considered blue-collar. If the claimant was employed in a professional, managerial, or administrative position their occupation was deemed white collar. In turn, it is important to note that policyholders do fall into the white collar occupation schema, because as employers they do hold supervisory/managerial positions. However, I thought it was important to distinguish policyholders in order to determine to what extent policyholder fraud is committed. In a later analysis, I did integrate policyholders (employers) into the white-collar occupational category. I coded #1 for white collar, #2 for blue collar, #3 for policyholder, #8 for not applicable, and #9 for missing data. The average weekly wage of the claimant proved to be an important aspect of my research. I was interested in examining the amount of money each claimant makes in a 40-hour workweek to see if low wage earnings served as an impetus for claimants to defraud the workers' compensation system. I obtained the average 20

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weekly wage for claimants from their first report of injury. The way in which the average weekly wage was reported differed from case to case. On the first report of injury worksheet, the average weekly wage was either accounted for based on a 40hour workweek or was reported hourly._ In the instance that it was reported hourly, I calculated the dollar amount to operationalize for a 40-hour workweek. However, in many ofthe policyholder fraud claims, the policyholder was accused of or prosecuted for violating provisions of their workers' compensation policy, and not for submitting a falsified injury claim. In these instances, a first report of injury was never completed and thus, the policyholder's average weekly wage was unavailable. I entered these variables as numerical values and coded #77-for not applicable/policyholder, #88-case never filed with the Attorney General, and #99for missing data. I originally set out to establish whether each claimant had a history of submitting workers' compensation claims in the State of Colorado and throughout the United States. I thought this information was important for my study, because a continuous submission of workers' compensation claims could be a direct linkage to the mastery of defrauding the workers' compensation system. While some of the investigation reports did indicate whether each claimant had previous workers' compensation claims with other insurance carriers, many reports failed to display this information. Thus, I searched the Pinnacol Assurance database, by the claimant's social security number or first and last name, to determine whether each claimant had 21

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ever submitted or had pending workers' compensation claims in which Pinnacol Assurance was the insurer carrier. Thus, I used only this data for analysis and coded #1for no previous workers' compensation history, #2-for previous workers' compensation history, #3-for not applicable, #8 for unable to determine, and #9 for missing data. I thought it was important to determine what percentage of claimants' accused of or prosecuted for workers' compensation fraud have unknowingly been under surveillance by workers' compensation investigators. The investigator's report, in each fraud file, listed the date/s and result/s of each surveillance. With regards to the coding scheme, I coded #1-for no surveillance conducted, #2-for surveillance was conducted, #8-for not applicable, and #9-for missing data. Within the workers' compensation arena, attorneys play a significant role in the litigation process. In this research, I thought it was extremely important to differentiate between the various types of legal representation that exist within the prosecution process. To account for the types of claimant representation, I developed three,specific categories: #1-for prose (meaning that the claimant does not have defense representation and has chosen to defend themselves); #2for public defender (a lawyer who works for the state representing claimants accused of a crime who cannot afford to pay); #3-for private attorney (an attorney hired by the claimant to represent them in legal proceedings). In addition, I coded for #4-for unable to determine/case still under investigation, #5-for no attorney/file closed prior to 22

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Attorney General referral, #6-for not applicable/prosecution declined by the Attorney General, #7-for no attorney/charges pending and #9-for missing data. With regards to the respondent's representation, I coded for the same three categories as I did for claimant's representation, with one additional category. This extra category includes, #4-for assistant Attorney General (attorney at the State level representing the insurance carriers and the State of Colorado). Moreover, I coded for #5-for unable to determine/case still under investigation, #6-for no attorney/file closed prior to Attorney General referral, #7-for not applicable/prosecution declined by Attorney General, #8-for no attorney/charges pending and, #9-for missing data. In instances where claimant's hired private counsel (attorneys) for legal representation, I determined the status of both the claimant's and respondent's attorneys by obtaining each attorney's rating through the Martindale Hubbell website. Martindale Hubbell has provided the legal community with a broad array of attorney information for 130 years. An integral part of Martindale-Hubbell's service to the legal community is the Lawyer Rating system. The Lawyer Rating system evaluates lawyers and law firms, in the United States and Canada, based upon peer review. These ratings indicate a lawyer's professional ethics and legal ability, and reflect the confidential opinions of members of the Bar and Judiciary. Overall, the Martindale Hubbell Ratings are composed of two entities: the legal ability ratings and the general ethnical standards rating. The legal ability ratings are based on the lawyer's professional ability, expertise, and other professional qualifications. The legal ability 23

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rating categories are C-Good; B-High; AVery High. The general ethical standards rating is VVery High. When both categories of Ratings are confirmed, a lawyer receives a CV, BV or AV rating (Martindale Hubbell Web Site, 2003). For the purpose of my coding scheme, I operationalized the status of claimant's and respondent's attorneys by coding #1for AV (Very High Rating), #2-for BV (High Rating), #3for CV (Good Rating), #4-for prose claimant, #5-for unable to determine/no Martindale Hubbell rating, #6-for no attorney/file closed prior to Attorney General referral, #7-for no attorney/charges pending, #8-for not applicable/prosecution declined by Attorney General, #9-for case still under investigation and #99-for missing data. The name of the judge and the status of the judge were important variables in the onset of my research. However, as I started the data collection process, I realized that the fraud files lacked the judges' names, which ultimately prevented me from operationalizing for their status. I also realized that in order to obtain this information I must request public citizen information at the criminal division of the clerk's office at the respected county/district court where the case was prosecuted. Moreover, to go through this date request process is beyond the scope of this thesis. The allegation/s and charge/s each claimant was accused of and/or charged for is substantial to my study on workers' compensation fraud. This information is important in examining what types of fraudulent activities are more frequently committed. As a result, I operationalized this variable by combining allegations and 24

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charges into one category. I noticed while obtaining the data that if an individual was prosecuted, the allegations and charges brought against them coincided. Thus, the allegations and charges were the same. For the purpose of this study, I did not to go into complete detail and distinguish whether these allegations/charges consisted of a misdemeanor "(offenses lower than felonies and generally those punishable by fine or imprisonment otherwise than in a penitentiary) (Black's Law Dictionary, 1979:901)" or felony "(a crime of a graver or more serious nature than those designated as misdemeanors (Black's Law Dictionary, 1979:555)." I merely noted the allegations and the actual charges the claimant was prosecuted for, if prosecuted. In turn, I coded for the following allegations/charges: #1-theft, #2-false statement, #3-mail fraud, #4conspiracy, #5-false claim, #6-forgery, #7-theft & false statement, #8-theft, false statement & forgery, #9-theft, false statement & other, #10-forgery & other, #11charges never filed with the Attorney General, #12-other, #99-missing data. The percentage of claimants prosecuted and not prosecuted for workers' compensation fraud is an important aspect of my research. In this section of my data analysis I accounted for claimants that were prosecuted for workers' compensation fraud and went to trial, those that were prosecuted and never went to trial and finally those that were declined prosecution, had charges or a trial pending, or were still under investigation. I obtained this information from the Pinnacol Assurance workers' compensation case status reports for the years of2000, 2001,2002, and 2002. These reports are updated on a monthly basis by the Special Investigative Unit 25

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and illustrate the status of the case, indicate if charges have been filed, and whether a trial was or is being held on the claim. In turn, I coded #1-no, #2-yes, #3-no trial/prosecution declined by the Office of the Attorney General, #4-charges pending, #5-trial pending, #6-charges never filed/file closed prior to Attorney General referral, #7-case still under investigation, #8-not applicable, and #9-missing data. Within a criminal case, a plea is the defendant's statement pleading "guilty" or "not guilty" in answer to the charges (Lectric Law Library Web Site, 2003). This statement is made in open court. I obtained the plea information from either the investigator's notes or the restitution order located in the fraud file. The restitution order summarizes the case including the county in which the trial was held, the plea, the verdict, and the sentence. In this section of my data analysis, I also accounted for claimants that were not prosecuted for workers' compensation fraud by the Office of the Attorney General. I coded #1-not guilty plea, #2-guilty plea, #3-no plea/prosecution declined by the Office of the Attorney General, #4-charges pending, #5-trial pending, #6-charges never filed/file closed prior to Attorney General referral, #7 -case still under investigation, #8-case settled, #9-not applicable and #99-missing data. In criminal proceedings, the sentence is the judgment formally proclaimed by the court or judge after a conviction, imposing the punishment to be imposed (Black's Law Dictionary, 1979:1222). I obtained the sentence information from the restitution orders located in the fraud file. After analyzing the similarities and differences of 26

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each claimant's sentence, I developed my coding scheme to account for the reoccurring trends of punishment I was noticing. Then, I grouped two or three forms of punishment into single categories. For the purpose of data analysis, I coded #1for restitution, #2-for probation, #3-for restitution and probation, #4-for jail, #5-for jail and restitution, #6-for jail and probation, #7-for community service, #8-for community service and restitution, #9-for community service and probation, #10-for community service, restitution and probation, #11-for jail, community service, and restitution, # 12for deferred sentence, # 13for Department of Corrections, parole, probation, and restitution, #14-for no sentence/prosecution declined by Attorney General, #15-for charges pending, #16-for trial pending, #17-for charges never filed/file closed prior to Attorney General referral, #18-for case still under investigation, #19-for other, 20#-for not applicable and #99-for missing data. Restitution is the amount of money a criminal offender is required to repay as a condition oftheir sentence (Black's Law Dictionary, 1979:1180). In this study, restitution amounts are only applicable for claimants that have been prosecuted and sentenced. I obtained the restitution amounts from the restitution orders located in the fraud files. For the purpose of data analysis, I entered these variables as numerical values and coded #1-for trial pending, #-2 for charges pending, #3-for charges never filed/file closed prior to Attorney General referral, #4-for case still under investigator, #5-for no restitution/prosecution declined by Attorney General, #6-for no restitution ordered, #8-for not applicable, and #9-for missing data. 27

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Phase Two Prior to conducting phase two of this study, the participants interviewed gave their approval to partake in this study by signing the required consent forms. This form illustrated the intent and expectations of the study, and provided the name and telephone number of the chair of thesis research in case of questions or concerns (See Appendix D: Subject Consent Form). By giving each participant a number to serve as an identification code, the participant's information was recorded IIi such a manner that no individual attorney or investigator could be identifiable. I have kept a record of the participant's name, their identification number, their phone number, their address, the date of the interview, and the duration of the interview in a private file. In addition, the interview notes only contain identification numbers. As my secondary method of data collection, I used a convenience sampling technique in order to obtain participants. I acquired the names of key informants best suited to participate in this study, from Pinnacol Assurance legal and investigation department employees. The fmal sample consisted of four workers' compensation attorneys, two male and two female, and four workers' compensation investigators, two male and two female, who were are all knowledgeable with the State of Colorado workers' compensation laws and procedures. I purposely selected participants (attorneys) who are licensed to practice law in the State of Colorado, have knowledge and experience with workers' compensation laws and procedures, and fit one the 28

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employment criterion of being previously employed as an Administrative Law Judge, District Attorney, or private counsel. In addition, my criterion for selecting subjects (investigators) is that they must currently be employed within the workers' compensation investigation arena and they must have experience investigating workers' compensation fraud cases. Furthermore, I interviewed the participants using a guide consisting of mostly open-ended interview questions (See Appendixes F & G: Interview Guidelines). I chose to use open-ended questions in order to encourage free and open responses from interview participants. My goal was to capture the participants' experiences and insights within the workers' compensation fraud arena. In addition, the interview guidelines aided me in pacing the interviews, and by making them more systematic and comprehensive. The interviews were conducted in English and all sessions were audio taped, with the consent of the participant. This allowed me to give my full and undivided attention to the participants during the interview. The audiotape was also turned off during the interview if the participants got uncomfortable at any time. All of the interviews were conducted at Pinnacol Assurance, because of my accessibility to confidential conference rooms. The first part of the interview consisted of a series of demographic questions focusing on the participant's educational background, as well as their years of experience as an attorney/investigator within the workers' compensation area. The second part of the interview consisted of general content questions. In this part of the interview, I asked 29

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the participants to describe the role of attorneys, investigators, and judges within the workers' compensation area, and specifically asked them whether they believe the status of these individuals has an affect on the overall verdict in a case. Moreover, I specifically asked the subjects to indicate how they would define the status of an attorney. I asked this question in order to examine if participants definition of status is based on the demographic and social characteristics of attorneys. In addition, I asked the subjects to describe whether they believe specific types of individuals, based on gender, race, age, and income are more prone to commit or be accused of workers' compensation fraud. I observed all ofthe participant's facial expressions, body posture, affects, visual emotions during the interview and I entered these in my field notes. After the completion of the interviews, I transcribed the tapes as soon as possible, verbatim, and typed up all field notes. The length of the interviews varied from seventeen to forty minutes, and no follow up interviews were conducted. Based on the participants' work and personal schedules, it took approximately three months to complete the interview process. I began the data analysis process by reviewing the data I collected from the fraud files, interview transcripts and field notes. After reviewing the fraud data, I consulted with the investigator who performed the investigation for clarification on any questions that arose. In addition, I noted similarities and differences in participant interview responses to establish new categories in the coding scheme. Next, I began 30

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coding data from the fraud files based on the 18 variables established in Appendix C. (See Appendix F: Data Coding Scheme). Models For this study, first I used descriptive statistical techniques. I used a frequency distribution because it is the simplest method for organizing and describing categorical (nominal) data. Since I was working with new data, I thought it was important to utilize frequency distribution to ensure that no data entry errors existed, and to determine if there was a need to combine any of the categorical variables for further multivariate analysis. A frequency distribution was important in this study a.S a tool for identifying demographic similarities of claimants accused of and/or prosecuted for workers' compensation fraud. Along with the frequency distribution, for each variable I also reported its variability, and central tendency of continuous variables. In addition, measuring the mean, percentage, and range of some of these variables. While frequencies show the numbers of cases in each level of a categorical variable, they fail to provide information about the common distribution of two variables. I used a cross-tabulation procedure for the purpose of identifying relationships between categorical variables, and to test the significance and association of these two variables. 31

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Within the cross-tabulation procedure, I performed a measurement analysis to test the statistical significance of my data. I was interested in testing whether claimant's representation, either by private counsel or prose, played a role in the claimant's overall sentence and ammmt of ordered restitution. The chi-square test was used to assess statistical significance. Due to my small sample size, Fisher's exact test was also used to determine statistical significance. 32

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CHAPTER6 RESULTS Frequency Distribution and Statistics of Central Tendency We see from the frequency distribution for gender (see Appendix I) that there are a total of 59 cases, 58 valid and 1 missing. These results exhibit that males account for 69% of the population and females account for the remaining 31%. Thus, these results suggest that, in the time period of2000-2001, more males were accused of and/or prosecuted for workers' compensation fraud than females. In the frequency distribution for age (see Appendix J) there are at total of 59 cases, 4 7 valid and 12 missing. It is important to note, that the age range of claimants accused of and/ or prosecuted for workers' compensation fraud is 3 5, ranging from 21 to 56 years old. In addition, these frequency results exhibit that 40 and 37 year olds encompassed the highest percentages of individuals accused of and/or prosecuted for workers' compensation fraud. The data depicts that six, 40 year old claimants, accounted for 12.8% of the population and 5, 37 year old claimants, accounted for another 10.6% of the population. The mean age of claimants accused of and/or prosecuted for workers' compensation fraud is 39.3 and the median age is 39. Furthermore, for the time period of 2000-2001, these results suggest that individuals 33

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in their late 30's to mid 40's exhibited the highest percentage of those accused of and/or prosecuted for workers' compensation fraud. In the frequency distribution for race (see Appendix K) there are a total of 59 cases, 58 valid and 1 missing. These results exhibit that Whites account for 74.1% of the population, Black or African Americans for 5.2%, and Hispanics the remaining 20.7%. Thus, these results suggest that, in the time period of2000-2001, more Whites were accused of/and or prosecuted for workers' compensation fraud than any other racial/ethnic category. We see from the frequency distribution for weekly wage (see Appendix L) that there are a total of 59 cases, 51 valid and 8 missing. These results illustrate the average wage claimants, accused of and/or prosecuted for workers' compensation fraud, accrued in a week. It is important to note, that eleven of these cases were policyholder fraud cases, which ultimately lacked information about their weekly wage. In tum, the remaining weekly wage range of claimants, accused of and/or prosecuted for workers' compensation fraud, is $937.69, ranging from $120.00 per week to $1057.69 per week, and the mean weekly wage is $474.15. These results suggest that, in 2000-2001, the weekly wage claimants, accused of and/or prosecuted for workers' compensation fraud, accrued greatly varied. In the frequency distribution for occupation (see Appendix M) there are a total of 59 cases, 53 valid and 6 missing. These results exhibit that eleven claimants, 20.8%, who were accused of and/or prosecuted for worker's compensation were 34

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employed in white collar positions. In addition, thirty claimants, 56.6%, were employed in blue collar positions, eleven claimants, 20.8%, were Pinnacol Assurance policyholders, and one claimant, 1.9%, was a medical provider. Thus, these results suggest that, in the time period of2000-2001, individuals employed in or encompassing blue collar positions exhibited a higher percentage of claimants accused of and/or prosecuted for workers' compensation fraud. In the frequency distribution for workers' compensation history (see Appendix N) there are a total of 59 cases, with 59 valid. These results depict that forty-four claimants, 74.6%, did not have a workers' compensation history with Pinnacol Assurance. However, fifteen claimants, 25.4%, had previously submitted one or more workers' compensation claims with Pinnacol Assurance. Thus, these results suggest that the majority of claimants, accused of and/or prosecuted for workers' compensation fraud, did not have a workers' compensation history with Pinnacol Assurance. We see from the frequency distribution for surveillance (see Appendix 0) that there are a total of 59 cases, with 59 valid. These results depict that thirty-three claimants, 55.9%, were unknowingly under surveillance by workers' compensation investigators, and, twenty-six claimants, 44.1 %, were never monitored. These results suggest that, in the time period of 2000-2001, almost half of individuals, accused of and/or prosecuted for workers' compensation fraud, were unknowingly observed by workers' compensation investigators. 35

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In the frequency distribution for claimant's representation (see Appendix P) there are a total of 59 cases, 55 valid and 4 missing. These results depict the type of representation that claimants, who were prosecuted for workers' compensation fraud, selected to represent them in legal matters. Thus, six claimants, 10.9%, opted to remain Pro Se and represent themselves in legal matters, while one claimant, I. 7%, was represented by a public defender, and nineteen claimants, 34.5%, hired private attorneys as their means of representation. Thus, these results suggest that, in the time period of2000-2001, a majority of claimants prosecuted for workers' compensation fraud, hired private counsel to represent them in legal proceedings. In the frequency distribution for status of claimant's attorney (see Appendix Q) there are a total of 59 cases, 55 valid and 4 missing. These results depict the status of claimant's attorneys as rated on the Martindale Hubbell Website. In tum, out of the twenty claimants who opted for legal representation from a private attorney or public defender, eight of these attorneys, 14.6%, achieved a status rating of either A V or BV. In addition, twelve attorneys, 21.8%, were lacking status ratings on the Martindale Hubbell website. The results suggest that even though only eight attorneys out of the twenty contained Martindale Hubbell ratings, these attorneys still obtained high status ratings, very high to high, by their legal peers. In the frequency distribution for charges/allegations (see Appendix R) there are a total of 59 cases, with 59 valid. These results depict the charges/allegations of claimants accused of and/or prosecuted for workers' compensation fraud. Out of 59 36

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claimants, 52.5% were accused of and/or charged for theft and false statement. In addition, seven claimants, 11.9%, were accused of and/or charged for false statement, while 8.5% were accused of and/or charged for conspiracy. The remaining charges/ allegations consisted of theft, forgery, and a combination of all charges. Thus, these results suggest that a majority of individuals, in 2000-2001, were accused of and/or charged for theft and false statement infringements. In the frequency distribution for trial (see Appendix S) there are a total of 59 cases, with 59 valid. These results depict that out of the 30 claimants prosecuted for workers' compensation fraud, only 5.1% opted to have their case heard before a jury. In addition, another 5.1% are still awaiting trial. These results suggest that a majority of individuals prosecuted for workers' compensation fraud, in 2000-2001, pled guilty at the preliminary hearings or settled their case, instead of opting for a jury trial. We see from the frequency distribution for plea (see Appendix T) that there are a total of 59 cases, 57 valid and 2 missing. These results depict that out of the cases in which claimants were prosecuted for workers' compensation fraud, at least 38.6% of the time, claimants pled guilty at the preliminary hearings or plea bargained, and 5.3% pled not guilty. In addition, thirty-two claimants, 54.2%, did not enter a plea, because they were either never prosecuted, their prosecution was pending, or their case settled. In turn, these results indicate that a majority of claimants accused of and/or prosecuted for workers' compensation fraud plead guilty at preliminary hearings or plea bargained. 37

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In the frequency distribution for sentence (see Appendix U) we see that there are a total of 59 cases, with 59 valid. These results depict the legal sentences of claimants prosecuted for workers' compensation fraud. Out of thirty claimants prosecuted for fraud, only three still have not been sentenced anci are awaiting trial. In tum, out of the remaining twenty-seven claimants, 25.4% obtained a sentence consisting of community service, restitution, and probation. Another ten claimants, 17.0%, obtained a sentence consisting solely of community service, restitution or probation or a mixture of two of these sentences. The two most severe sentences consisted of one claimant, 1. 7%, receiving a sentence consisting of serving time in jail, community service, and restitution, and another claimant, 1.7%, obtaining a sentence consisting of serving time at Department of Corrections, parole, probation, and restitution. These results suggest that a majority of claimants prosecuted for workers' compensation fraud, in 2000-2001, received no incarceration time, but were required to perform community service, pay restitution, and serve probation. Finally, in the frequency distribution for restitution (see Appendix V) there are a total of 59 cases, with 59 valid. These results depict the amount of restitution, claimants sentenced for workers' compensation fraud were ordered to pay. It is important to note, that the range in the amount ordered in restitution is $83,564.00, ranging from $1,436.00 to $85,000.00. In turn, the mean amount of restitution ordered is $17,506.22, and only two claimants, 3.4%, were not ordered to pay restitution. Furthermore, for the time period of2000-2001, these results suggest that 38

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a higher percentage of restitution was ordered between the amounts of$1,000 and $10,000. Sentence Total Cross-tabulations Table 6.1.1 Claimant's Legal Representation and Sentence Cross-tabulation Claimant's Legal Representation Private ProSe Counsel Claimant Restitution, Probation Count 16 5 and Community Service % within clrep 94.1% 83.3% Dept. of Corrections, Jail, Count 1 1 Parole, Community Service, % within clrep 5.9% 16.7% and Restitution Count 17 6 % within clrep 100.0% 100.0% Total 21 91.3% 2 8.7% 23 100.0% The purpose of this cross-tabulation, table 6.1.1, was to detennine whether the type of claimant's legal representation, either the hiring of private counsel or prose, played a role in their final sentence. This cross-tabulation table focuses only on 23 out of the 59 claimants who in fact, were prosecuted for workers' compensation fraud. This analysis excludes the three claimants who are pending trial, and the four claimants, who lacked information as to how they were represented in these legal proceedings. Out of the 17 claimants who obtained private counsel as a means of representation, 16 claimants, 94.1% received a final sentence consisting of restitution, probation, or community service or a combination of two or more of these sentences. 39

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The one remaining claimant, who was represented by private counsel, obtained a sentence consisting of Department of Corrections, parole, probation, and restitution. Thus, out of the 6 claimant's.who opted to represent themselves and remain prose, 5 claimant's 83.3%, received a final sentence consisting of restitution, probation, or community service or a combination of two or more of these sentences. The remaining pro se claimant received a sentence consisting of jail time, community service, restitution, and probation. These results suggest that the level of representation for claimant's prosecuted for workers' compensation fraud, did not play a direct role in their overall sentence. Table 6.1.2 Chi-Square Test for Claimant's Legal Representation and Sentence, N=23 Value df Asymp. Sig. Exact Sig. (2-sided) (2-sided) Pearson Chi-Square .650 1 .420 Continuity Correction .000 I 1.000 Likelihood Ratio .577 1 .447 Fisher's Exact Test .462 Linear-by-Linear Association .621 I .431 N of Valid Cases 23 a. Computed only for a 2x2 table Exact Sig. (I-sided) .462 b. 2 cells (50.0%) have expected count less than 5. The minimum expected count is .52 Table 6.1.2, shows that the chi square is not significant, x2 (1, N=23) = .65, p=.42, so the two variables, claimant's representation and sentence, are independent. In addition, Fisher's exact test is also not significant, p=.462. 40

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Restitution Amount Table 6.1.3 Claimant's Legal Representation and Amount of Ordered Restitution Cross-tabulation Claimant's Legal Representation Private ProSe Counsel Claimant 1,000-10,000 Count 8 4 Total 12 % within clrep 50.0% 83.3% 54.5% 10,0001+ Count 8 2 10 % within clrep 50.0% 33.3% 45.5% Total Count 16 6 22 %within 100.0% 100.0% 100.0% stclatty The purpose of this cross-tabulation, table 6.1.3, was to determine whether the type of claimant's legal representation, either representation by private counsel or self representation (pro se ), played a role in their amount of ordered restitution. This cross-tabulation table focuses only on 22 out of the 59 claimants who in fact, were prosecuted for workers' compensation fraud. This analysis excludes the three claimants who are pending trial, the four claimants who lacked information as to how they were represented in these legal proceedings, and the one claimant in which no restitution was ordered. In tum, out of the twenty-two claimants who obtained private counsel representation, eight claimants, 50.0% were required to pay between $1,000-$10,000 in restitution. Another eight claimants, 50.0% were required to pay $10,000+ in restitution. Thus, out of the six claimant's who opted to represent themselves and remain prose, four of them, 83.3%, were required to pay between $1,000-$10,000 in 41

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restitution, and the remaining two claimants, 33.3%, were required to pay $10,000+. These results suggest that the level of representation for claimant's prosecuted for workers' compensation fraud, did not play a direct role in their overall sentence. Pearson Chi-Square Continuity Correction Likelihood Ratio Fisher's Exact Test Table 6.1.4 Chi-Square Test for Claimant's Legal Representation and Amount of Ordered Restitution, N=22 Value df Asymp. Sig. Exact Sig. (2-sided) (2-sided) .489b 1 .484 .048 1 .827 .498 1 .481 .646 Linear-byLinear Association .467 1 .495 N of Valid Cases 22 a. Computed only for a 2x2 table Exact Sig. (1-sided) .417 b. 2 cells (50.0%) have expected count less than 5. The minimum expected count is 2.73. Table 6.1.4, shows that the chi square is not significant, x2 (1, N=22) = .49, p=.48, so the two variables, claimant's representation and amount of ordered restitution, are independent. Fisher's exact test is also not significant, p=.646. Thus, these results do not support my hypothesis. These results suggest that claimant's representation by an attorney, at workers' compensation legal proceedings, does not contribute to the claimant receiving a lesser sentence. 42

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Interviews Gender and Age All interview participants indicated that males encompass the bulk of workers' compensation claim submittals, and the majority of claimants accused of and/or prosecuted for workers' compensation fraud. One attorney participant indicated that males make up at least 90% of claimants accused of and/or prosecuted for workers' compensation fraud. Furthermore, male/female gender roles were an occurring theme as to why males constituted for such a large proportion of the claim submittals, and claimants accused of and/or prosecuted for workers' compensation fraud. Five participants specifically suggested that males constitute a higher percentage of work related injuries and potential fraudulent activity, because they perform more manual labor than women. An investigator participant explained that, "the man's the provider in the family, so I think what happens is they're also the ones that are probably more exposed to higher risk positions (M2S6, 2003)." With regards to age, participants overwhelmingly indicated that middle-aged workers, submit the bulk of workers' compensation claims, and account for the largest proportion of claimants accused of and/or prosecuted for workers' compensation fraud. The participants' definition of"middle-aged" varied. Some participants indicated that they considered a middle-aged individual to be someone in their late 30s to early 40s. One investigator participant defined middle-aged as someone in their mid to late 60s. Finally, one attorney participant indicated that in all 43

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the years he/she has worked in the workers' compensation fraud area, they have never experienced a fraudulent claimant over the age of 45. In all of these participant interviews there was a definite consensus suggesting that younger individuals rarely submit workers' compensation claims, and as a result a low percentage, of young claimants, will actually be accused of and/ or prosecuted for workers' compensation fraud. One attorney participant suggested that young workers, late teens and early 20s, in general, often refrain from filing workers' compensation claims, because they lack the knowledge and sophistication to file a claim: Young workers don't know that workers' compensation Insurance exists, and if they do, they don't know what it is or what the benefits are. I feel sorry for young workers, because in many instances their employers take advantage of the situation (S5E3, 2003). With regards to the racial/ethnic identity of claimants, five interview participants implied that Hispanic individuals are the majority of claimants who submit workers compensation claims, and the bulk of claimants accused of and/or prosecuted for workers' compensation fraud. One investigator participant attributed this explanation to the large Hispanic population in the State of Colorado. Another attorney participant proposed that the large percentage of Hispanics, submitting workers' compensation claims and being accused of fraudulent activity, is a result of 44

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the influx in seasonal migrant workers. Therefore, suggesting that field work consists of extensive manual labor, resulting in a large amount of work-related mJunes. Three participants similarly suggested that every racial/ethnic group participates in workers' compensation fraudulent activity. In addition, these three participants indicated that, based on their experiences and insights, one racial/ethnic group is not more likely than another to get accused of and/or prosecuted for workers' compensation fraud. For example, I've dealt with all different types of races. I can't say from my experiences that I've seen one more prevalent than the other. I think it involves, or can involve all different races (H6M2, 2003). Weekly Wage and Occupation I had expected that the wage claimants accrued in a week would be a factor in their submittal of workers' compensation claims, and their participation in fraudulent activity. Thus, if a claimant earned a small weekly wage, they would be more likely than a higher wage earner to defraud the workers' compensation system. However, only one participant indicated that, based on their experiences, the lower wage earner is more inclined to submit workers' compensation claims and partake in fraudulent activity. As this participant stated, "there's less incentive for them to get back to work (H6M2, 2003)." In addition, the remaining participants overwhelmingly suggested that higher wage earners are less likely to submit workers' compensation 45

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claims, and/or partake in fraudulent activity. Their insights were based on the State of Colorado's Workers' Compensation Act. 'This Act provides injured workers only 2/3 of their average weekly wage, and as participants suggest, results in a larger loss of income for the higher wage earner. For example, Workers comp is capped out, so if you're making $1000 a week, your workers' comp is capped out at much less than what you're taking home (M2S6, 2003). With regards to occupation, participant interviews overwhelmingly indicated that individuals employed in blue-collar occupations, are the majority of claimants accused of and/or prosecuted for workers' compensation fraud. The majority of bluecollar workers are employed as construction workers, carpenters, and field workers. One investigator participant implied that individuals employed in white-collar occupations partake in a smaller amount of workers' compensation fraud because, similar to that of the higher wage earner, the incentive and benefits are lacking. Within the area of policyholder fraud, four participant interviews yielded information indicating that policyholder fraud greatly exists, but it's a silent crime. As one investigator participant explained, "it runs rampant; nobody wants to say anything about it. Actually what it is, nobody likes to accuse policyholders of fraud, because it's the bread and butter of the insurance industry (M2S6, 2003)." Four attorney participants specified that policyholder fraud is extremely difficult to prosecute, because currently, the State of Colorado's fraud statute lacks enforceable measures. Thus, there must be concrete evidence proving that a policyholder participated in 46

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some type of workers' compensation fraudulent activity. Surveillance, witnesses, or confessions seem to be the main forms of As one investigator participant noted, "it's difficult to obtain this evidence, especially in instances where the policyholder altered a workers' compensation certificate or provided false statements. How are you going to get this information without a confession (T1K08, 2003)?" Workers' Compensation History and Surveillance Within the participant interviews, I did not specifically ask the participants whether they believed a history of submitting workers' compensation claims was characteristic of fraudulent claimants. However, one attorney participant freely mentioned that, he/she believes that a history of submitting workers' compensation claims is definitely typical of fraudulent claimants. According to this participant, when claimants consistently submit workers' compensation claims, they tend to feel that they have acquired the experience and knowledge to defraud the workers' compensation system. Participant interviews suggested that many situations arise initiating the need to have surveillance conducted on potential fraudulent claimants. For instance, in situations where claimants are receiving disability benefits, and are required to refrain from any type of employment, specific acts may spark the need for surveillance. Claimants who consistently miss doctor's appointments or arrive at doctor's appointments wearing work clothes may indicate that the claimant is employed. If a 47

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claimant is supposed to be at home, resting f
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Attorney Status Within all participant interviews, each participant gave their definition of a high status attorney and, based on their experiences, what role the status of the claimant's attorney plays in the workers' compensation fraud prosecution process. It is important to note that responses to these questions greatly varied between the attorney and investigator participants. For example, the investigator participants all based attorney status on material aspects. Similarly, all investigator participants defined high status attorneys as those who look and play the part. These are the attorneys that drive nice cars, have exquisite offices, and in many cases, wear the nicest clothes. One investigator participant indicated that high status attorneys are the attorneys that are in the media a lot. Basically, these attorneys take the high profile cases that subject them to media attention or they have television advertisements marketing their services. Attorney participants defmed a high status attorney based on demographic characteristics, such as gender and age, as well as years of experience practicing law. With regards to gender, each attorney participant indicated that gender definitely determines status within the legal community. According to these participants, female attorneys are, and have historically been, considered less superior than male attorneys. For example, 49

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Gender assumptions are out there questioning the ability of female attorneys to thoroughly practice law. Those assumptions are generally negative, so that forces female attorneys to work harder to prove themselves (S5E3, 2003). All attorney participants stressed that the age of the attorney and years of legal experience contribute to an attorney's status. Based on participant interviews, it was indicated that, within the legal community, a bias exists against younger attorneys. As one attorney participant explained, "these younger attorneys do not have the judgment or the maturity of older, more experienced, attorneys (S5E3, 2003)." These younger attorneys seem to lack the experience, respect, and reputation that the attorney participants believe constitutes a high status attorney. One attorney participant suggested that attorneys, who possess these high status characteristics, positively affect the claimant's verdict (outcome) in workers' compensation proceedings. High status attorneys often get better results and better settlement offers from the judges. With regards to race, interestingly, all attorney participants believed that an attorney's race does not directly affect their status. One attorney participant specifically indicated: There are Anglo attorneys who are written off, because they're considered to be fools. There are Hispanic attorneys who are written off, because they're considered to be fools. There are African American attorneys who are written off, because they are considered to be fools. An attorney's race doesn't play a role, it's their excellence and tenacity (S5E2, 2003). 50

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An attorney's competence, reputation, and ability to speak multiple languages were all commonalities indicated to be associated with status. In turn, only one attorney participant suggested that the educational institution where the attorney obtained their law degree contributed to status: Some law schools are harder to get into, and when an individual graduates from those institutions, it is automatically assumed that they're the best. There's a notion that they're brighter, harder workers, and more exceptional because of the school they went to (S5E3, 2003). The remaining three attorneys all indicated that the institution where the attorneys obtained their degrees, does not contribute to their status. They believed that this aspect does not play a daily role in their interactions with other attorneys, nor does it play a role in the legal proceedings they partake in. Trial/Plea All interview participants indicated that, the majority of claimants prosecuted for workers' compensation fraud, typically plead guilty at preliminary hearings or settle their case instead of opting for a jury trial. One participant, who has been employed as a workers' compensation fraud investigator for 5 years, indicated that she/he has yet to testify at trial. It was indicated that claimants tend to enter a guilty plea for fear that they will receive a stiffer penalty if found guilty at a jury trial. Within the plea-bargaining process, if a claimant plea-bargains, they are aware of the sentence they will receive prior to pleading guilty. Claimants will know in advance if 51

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their sentence consists of incarceration time, community service hours, fines, restitution, etc. If claimants fail to plead guilty and opt for a jury trial, claimants are subjected to the provisions of the law. Based on the charges, these provisions could range from the most minimum sentence to the most possible maximum sentence. Sentence and Amount of Restitution Ordered Participants indicated that claimants prosecuted for workers' compensation fraud are rarely incarcerated. Typically, claimants are required to perform community service hours, pay restitution, and serve probation. As one investigator participant stated, "workers' compensation fraud is white-collar crime. There's no blood, there's no body (TIK08, 2003)." Only one interview participant indicated that they know of one claimant that has received actual jail time. The only reason this claimant received jail time was because the claimant had prior felonies on their criminal record. With regards to race, one investigator participant indicated that, based on his/her experiences, Caucasians are typically required to pay back larger amounts of restitution. 52

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CHAPTER 7 DISCUSSION Given the importance of the demographic and social similarities of claimant's accused of and/or prosecuted for workers' compensation fraud, the frequency distributions and interview analyses suggest variations in these characteristics. Both of my results (quantitative and qualitative) shed light on many facets of the workers' compensation fraud prosecution process in the State of Colorado. The frequency distribution analyses identified the demographic and social characteristics of individuals accused of and/or prosecuted for workers' compensation fraud. As distinguished in the frequency distribution for gender (see Appendix D the data suggest that a higher percentage of males were accused of and/or prosecuted for workers' compensation fraud than females. Based on participant interviews, participants did suggest that, based on their experiences and insight, males do encompass the bulk of workers' compensation claim submittals, and the majority of claimants accused of and/or prosecuted for workers' compensation fraud. In the frequency distribution for race (see Appendix K) the results indicate that White claimants accounted for the highest percentage of individuals accused of/and or prosecuted for workers' compensation fraud. It is important to note, that the quantitative data results and the experiences and insights of interview participants differed. First of all, certain participants implied that Hispanic individuals are the 53

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majority of claimants submitting workers compensation claims, and the bulk of claimants accused of and/or prosecuted for workers' compensation fraud. Moreover, others suggest that every racial/ethnic group participates in fraudulent activities, and one racial/ethnic group is not more likely than another to get accused of and/or prosecuted for workers' compensation fraud. We see from the frequency distribution for weekly wage (see Appendix L) that the results indicate that the average wage claimants, accused of and/or prosecuted for workers' compensation fraud, accrue in a week greatly varies. In addition, participant interviews did not produce much information suggesting that a specific wage earner is more likely to be accused of and/or prosecuted for workers' compensation fraud. Thus, only one participant commented, suggesting that the lower wage earner is more inclined to partake in fraudulent acts The frequency distribution for occupation (see Appendix M) suggest that individuals employed in blue-collar positions exhibited the highest percentage of claimants accused of and/or prosecuted for workers' compensation fraud. Participant interviews do support these results, and provide additional insight as to why white collar occupations, specifically those of policyholders, are not prosecuted. We see in the frequency distribution for workers' compensation history (see Appendix N) the results suggest that the majority of claimants accused of and/or prosecuted for workers' compensation fraud did not have a previous workers' compensation history (a submittal of prior claims) with Pinnacol Assurance. Thus, a 54

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history of submitting claims, may or may not, be a direct characteristic of individuals accused of and/or prosecuted for workers' compensation fraud. This is difficult to determine because, due to the scope of this study, I was only able to obtain workers' compensation history from Pinnacol Assurance and not from other insurance companies in Colorado or throughout the Nation. However, one interview participant did indicate that, based on their experiences, he/she believes that a history of submitting claims is a characteristic of fraudulent claimants. In the frequency distribution for surveillance (see Appendix 0) the results suggest that almost half of individuals accused of and/or prosecuted for workers' compensation fraud were unknowingly observed by workers' compensation investigators. In turn, the participant interviews suggested that many situations arise initiating the need to have surveillance conducted on potential fraudulent claimants. The results of the frequency distribution for claimant's representation (see Appendix P) suggest that a majority of claimants prosecuted for workers' compensation fraud selected private attorneys to represent them in legal proceedings. The participant interviews shed light on the reasons why participants felt, based on their experiences, that it is more beneficial for claimants to hire private representation instead of remaining pro se and defending themselves in legal proceedings: In the frequency distribution for status of claimant's attorney (see Appendix Q) the results suggest that the eight attorneys containing Martindale Hubbell ratings obtained high status ratings (high to preeminent) by their legal peers. In turn, 55

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participant interviews provided information depicting how each participant personally defmes a high status attorney and, based on their experiences, what role the status of the claimant's attorney plays in the workers' compensation fraud prosecution process. Frequency distribution tables reiterated that respondents (i.e, insurance carriers and the State of Colorado), are represented in workers' compensation fraud legal proceedings by an Assistant Attorney General. While obtaining the workers' compensation fraud data, I was unable to locate the names of Assistant Attorney Generals who represented Pinnacol Assurance and the State of Colorado in all of these legal proceedings. Thus, without having their name and information, I was unable to obtain each Assistant Attorney General's Martindale Hubbell status rating. In the frequency distribution for charges/allegations (see Appendix R) the results suggest that a majority of individuals accused of and/or prosecuted for workers' compensation fraud, were accused of and/or charged for committing theft and false statement infringements. Moreover, only one interview participant commented as to why a claimant could be charged for theft and false statements. The results in frequency distributions for plea and sentence (see Appendixes S & T) indicate that a majority of individuals prosecuted for workers' compensation fraud pled guilty at preliminary hearings or settled their case instead of opting for a jury trial. In turn, participant interviews yielded supporting information suggesting that claimants charged with fraud, typically do plea at preliminary hearings instead of carrying out the process and resorting to trial. 56

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In frequency distributions for sentence and restitution (see Appendixes U & V) the results suggest that a majority of claimants prosecuted for workers' compensation fraud received no incarceration time, but were required to perform community service, pay restitution, and serve probation time. Thus, a higher percentage of restitution was ordered between the amounts of$1,000 and $10,000. The participant interviews supported these results by providing information suggesting that, based on their experiences, participants rarely knew of instances where claimants, prosecuted for workers' compensation fraud, received incarceration time. In addition, one participant indicated that based on his/her experiences, Caucasians are typically required to pay back larger amounts of restitution. In general, the literature indicates that since workers' compensation fraud is considered a white-collar crime, and if a claimant plea-bargains or gets convicted of fraud, the sentences tend to be extremely light (Friedrichs, 2001). However, My hypothesis asks whether the legal representation claimants choose to utilize in workers' compensation fraud proceedings affects their final sentence? Do claimants who are represented by attorneys in workers' compensation fraud legal proceedings, receive a much more lenient sentence than claimants who opt to remain pro se and represent themselves? Because claimant's legal representation and sentence, as well as, claimant's legal representation and amount of ordered restitution, were not significant in both cross-tabulations, I will not argue that the type of claimant's representation plays a 57

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direct role in them receiving a lesser sentence. However, participant interview analyses do suggest that attorney representation is more beneficial for claimants in workers' compensation fraud legal proceedings, due to the complexity of the law and an attorneys' ability to better assess a case. 58

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CHAPTERS LIMITATIONS/SUGGESTIONS FOR FURTHER RESEARCH The purpose of this study was to research the role of the third party within the workers' compensation fraud prosecution process, specifically the roles of attorneys and investigators. In addition, this study also explored the demographic characteristics of claimants, accused of and/or prosecuted for workers' compensation fraud. In the workers' compensation industry, measuring and distinguishing trends in the workers' compensation fraud area has yet to reach any level of precision. The numbers and data that workers' compensation intellects utilize are broadly based on the rule of reason and common sense. Since this was the frrst research project of its kind to explore the State of Colorado workers' compensation fraud prosecution process, the available literature and research focuses mainly ori the evolving definition of white-collar fraud, as well as the various types of white-collar fraud. It is important to note that the majority of the information related to insurance fraud, is specifically focuses on automobile insurance fraud and arson. In turn, it is extremely difficult to complete a study, in this field, that would be generally conclusive and above reproach. 59

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Among other limitations, the cooperation of the study population, claimants accused of and/or prosecuted for workers' compensation fraud, would be minimal and inconsistent. It would be extremely difficult to obtain a representative sample size of these fraudulent claimants who would be willing to partake in interviews or adhere to a standardized survey. Thus, in order to thoroughly complete a study, in this field, it would be necessary for the researcher to conduct research and obtain information not only from one insurance carrier, but multiple agencies. In addition, the researcher, by requesting public citizen information, should access claimant prosecution data from the criminal division of the clerk's office at the respected county/district court where the case was prosecuted. This information would yield the researcher with the names of judges that presided over the case and all necessary outcome data. Due to the time allotment of my study, I was unable to obtain a representative sample of workers' compensation attorneys and investigators to partake in interviews. In future studies, it would beneficial to obtain a larger sample of these participants, and also interview Assistant Attorney Generals, judges, and any other individuals associated with workers' compensation fraud prosecution. In future studies, the operationalization for attorney status should definitely be reevaluated. On the onset of this research, I anticipated that the Martindale Hubbell web site would provide the attorney status ratings for all practicing attorneys. However, after diving into this research study, a high proportion of attorney status ratings failed to be located in this database. If the Martindale Hubbell web site is 60

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utilized for a future study, the researcher should contact a Martindale Hubbell representative to inquire reasons as to why the attorney status ratings may be lacking in their system. Finally, evaluation research would be useful in exploring the various demeanors in which insurance carriers respond and manage potential fraudulent workers' compensation claims. This type of research would enable legislators and insurance carriers to comparatively analyze the various methods and programs other insurance carriers utilize to combat workers' compensation fraud. Thus, providing legislators and insurance carriers essential information, which would allow them to assess whether other procedures of battling workers' compensation fraud could potentially benefit their State or insurance company. 61

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APPENDIX A History of Workers' Compensation in Colorado and History of Pinnacol Assurance Founded in 1915, after the Colorado General Assembly passed the Workmen's Compensation Act, Pinnacol Assurance became the assured source of Colorado workers' compensation insurance. Originally named the State Compensation Insurance Fund, Pinnacol Assurance, was technically a State agency under the supervision of Colorado's Industrial Commission. Over the years, the State Compensation Insurance Fund experienced a series of name changes as well as institutional changes. In 1987, the State Compensation Insurance Fund changed its name to the State Compensation Insurance Authority. In addition, it became a quasipublic authority of the State of Colorado, consisting of a governor-appointed board of directors. In 1990, this quasi-public insurance company came to be known as Colorado Compensation Insurance Authority (CCIA). In 1999, CCIA became Pinnacol Assurance, by adopting a name that reflects the company's Colorado heritage and commitment to being the best and assured workers' compensation carrier. As a nonprofit insurer, Pinnacol Assurance has established itself as Colorado's largest writer of workers' compensation by having a market share of approximately 48 percent (Pinnacol Assurance Web Site 2003)." Thus, due to Pinnacol Assurance's background of more than 85 years in Colorado and 62

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their current status of being the leading provider of workers' compensation insurance in the state, I obtained, Pinnacol Assurance fraud data, as a basis of my study. 63

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APPENDIXB Pinnacol Assurance's Fraud Prosecution Process The workers' compensation fraud investigation process begins when either an outside source or an in-house referral suggests that a workers' compensation claimant, policyholder, or medical/legal provider may be partaking in fraudulent activities. Within Pinnacol Assurance, this tip or lead is assigned to a special investigator who becomes the sole party responsible for conducting investigation into the potential fraudulent acts. This investigation consists of conducting interviews with individuals who may provide information regarding the claimant's activities, such as employers, co-workers, family members, friends, and neighbors. In addition, investigators are responsible for retrieving motor vehicle records and traffic accident reports, checking for history of workers' compensation claim submittal, and if need be, assuring that surveillance is conducted by one ofPinnacol Assurance's surveillance vendors. In turn, a final investigation report is completed depicting all aspects of the investigation. In turn, if Pinnacol Assurance investigators believe there are elements of potential claimant fraud, a referral is made to the Colorado State Office of the Attorney General for prosecution. This referral contains a case packet consisting of all investigation documentation, all records, a witness list, and all evidence suggesting claimant's fraudulent activity. From this stage, the Attorney General's Office 64

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proceeds with the case, and determines whether the claimant will be prosecuted. If the claimant is prosecuted, the Office of the Attorney General conducts further investigation, and appoints an Assistant Attorney General to represent the State of Colorado, Pinnacol Assurance, and the employer at legal proceedings. 65

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APPENDIXC Data Consent Form I. The purpose of this study is to gain information regarding Worker's Compensation Fraud prosecutions in the State of Colorado. The main goal ofthis study is to examine the role of the third party, specifically the roles of the advisers (attorneys), investigators, and judges exclusive to each case. This study will be conducted by researching and reviewing Pinnacol Assurance fraud files of prosecuted claimants for the time period of 2000-2001. This study is expected to take about six months to complete. 2. There are many benefits that can be expected from this study. This study will provide information illustrating the impacts and the roles various parties play in the fraud prosecution process. In addition, it will provide statistical information regarding the physical and economic similarities amongst the fraudulent claimants for purposes of profiling. 3. Subject confidentiality will be protected with the utmost concern. The researcher (Lucinda Garcia) will keep all material pertaining to the study in a private locked file. Identity numbers will be assigned to each subject, so that names and all pertinent information will remain confidential. The actual fraud files will be kept at Pinnacol Assurance under management by the Special Investigative Unit. 4. The data from this study will solely be used for educational purposes, including but not limited to a Master's thesis, educational presentations, and scholarly publications. 5. The undersigned is aware that the researcher (Lucinda Garcia) is an employee ofPinnacol Assurance, and does agree to allow her access to this data even in the event of termination or resignation from Pinnacol Assurance. 6. The undersigned is encouraged to ask the researcher (Lucinda Garcia) any questions about the study. The questions will be answered as well as possible without jeopardizing the methodology of the research. 7. Questions about the study should be directed to Lucinda Garcia at (303) 440-1350. Questions or concerns about the research process should be directed to the Office of Academic Affairs, CU Denver building, Suite 700. (303) 556-2550. 8. The undersigned will be given a copy of this consent form for their records and will be given a fmal copy of the research if desired. !. ____________________________ for Pinnacol Name Title Assurance agrees to allow Ms. Garcia to review the entire 2000-2001 fraud files. I also agree by signing this to all of the terms and conditions written out above. Name (print). ____________ .Date: ______ Signature ____________ This researcher, Lucinda Garcia (303) 440-1350, agrees by signing below to the above consent form's terms and conditions. Researcher's Signature ________ __:Date: ______ 66

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APPENDIXD Subject Consent Form 1. The purpose of this study is to gain information regarding Worker's Compensation Fraud prosecutions in the State of Colorado. The main goal of this study is to examine the role of the third party, specifically the roles of the advisers (attorneys), investigators, and judges exclusive to each case. This study will be conducted by researching and reviewing Pinnacol Assurance fraud files of prosecuted claimants for the time period of 2000-2001. This study is expected to take about six months to complete. 2. Each subject is requested to take part in at least one interview. This will last for about one hour, or how ever long it takes to complete the interview. If enough information is not attained in the first interview, a second one may be requested. Interviews will be tape-recorded. If at any time the subject wants the recorder turned off, that request will be honored. 3. It is possible that some subjects may experience some discomfort while discussing their views. 4. There are many benefits that can be expected from this study. This study will provide information illustrating the impacts and the roles various parties play in the fraud prosecution process. In addition, it will provide statistical information regarding the physical and economic similarities amongst the fraudulent claimants for purposes of profiling. 5. Subject confidentiality will be protected with the utmost concern. The researcher (Lucinda Garcia) will keep all material pertaining to the study in a private locked file. Identity numbers will be assigned to each subject, so that names and all pertinent information will remain confidential. The actual fraud file will be kept at Pinnacol Assurance under management by the Special Investigative Unit. 6. The data from this study will solely be used for educational purposes, including but not limited to a Master's thesis, educational presentations, and scholarly publications. 7. Each subject's participation is completely voluntary, and the subject may leave the study at any time that they feel necessary. Withdrawing from the study will not cause any penalty. 8. The undersigned is encouraged to ask the researcher (Lucinda Garcia) any questions about the study. The questions will be answered as well as possible without jeopardizing the methodology of the research. 9. Questions about the study should be directed to Lucinda Garcia at (303) 440-1350. Questions or concerns about the research process should be directed to the Office of Academic Affairs, CU Denver building, suite 700. (303) 556-2550. 10. The undersigned will be given a copy of this consent form for their records and will be given a fmal copy of the research if desired. I agree to be a research subject of this study of Workers' Compensation fraud. I also agree by signing this to all of the terms and conditions written out above, knowing my participation is completely voluntary, and I may withdraw my services at any time with no penalty. Subject's Name (print) Date: _______ Signature _________ This researcher, Lucinda Garcia (303) 440-1350, agrees by signing below to the above consent form's terms and conditions. Researcher's Signature Date: ______ 67

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APPENDIXE Data Collection Index Identification No. Claim No.,W.C. No., Policy No. Gender Race/Ethnicity: Date of Birth: Name of Employer: Weekly Wage: Occupation: Claimant's Representation: Martindale Rating: Respondent's Representation: Martindale Rating: Previous W.C. Injuries: Date of Injury: Nature of Case: Surveillance Conducted: Date Referred to Attorney General's Office: Allegation/Charges: Plea (Guil!Y/Not Gui!!Y): Trial County/City Where Trial Held: Verdict: 68

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APPENDIXF Attorney Interview Guideline Interviewer: Interviewee: ID# Interviewee's contact number: Location of the interview: Date of the interview: Time of the start of the interview: Time of the end of the interview: PART I: Demographic questions The object of these following questions is to gain information that is both descriptive and demographic in nature of the subject and of their knowledge of Workers' Compensation law. Interviewee's age: Interviewee's race: Interviewee's gender: Number ofyears of school completed: Where did you earn your degree/degrees: Number of years experience as an attorney: Number of years experience as an attorney in the field of Workers' Compensation: PART II: Content questions (preliminary sample) Please explain the Workers' Compensation process in the State of Colorado. For example, a worker gets injured, what are the next steps? How many hours to they have to submit a claim, etc.? Has this process changed over time? (Specific laws of importance) Based on race, gender, and age, do you perceive that certain types of individuals submit more Workers' Compensation claims than others? I'm not looking for statistics; I'm just interested in your perception. Have you done much work in the area ofWorkers' Compensation fraud? If so, explain. (Have them differentiate between their work experience as a claimant's counsel, in-house counsel, prosecutor, or judge). How has this changed over time? Do you perceive that a specific type of individual is more prone to committing or being accused of Workers' Compensation fraud? Male vs. female Age Race 69

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Appendix F (Cont.) In your experience, do you believe that it is more beneficial for a claimant to hire an attorney to represent them in legal proceedings or should they remain pro se? (Have them elaborate why they believe this way) Once again, in your perspective, what role does the gender of the claimant play within Workers' Compensation legal proceedings? For example, does it play a part in determining the outcome in hearings (Hearings, Fraud Prosecution Process, etc.). Based on your beliefs and experiences, how would you define the status of an attorney? For example, how would you determine that this attorney is a good/notable attorney within the legal community? Do you perceive that race plays a role, what about sex, what about age? Does the school in which the attorney graduated contribute to this? Based on your experience, what role does the status of the claimant's attorney play within legal proceedings? Do you perceive that if a Claimant is charged with workers' compensation fraud that they will receive a much more lenient sentence if they hire a high status attorney vs. a lower status attorney? What about a high status attorney vs. prose? (Have them elaborate) What role does the gender of the attorneys involved play within Workers' Compensation legal proceedings? Do you believe gender plays a part in determining the outcome in hearings (Hearings, Fraud Prosecution Process, etc.). What role does the gender of Judge/Administrative Law Judges play within Workers' Compensation legal proceedings? Do you believe gender plays a part in determining the outcome in hearings (Hearings, Fraud Prosecution Process, etc.). On the same lines, does the race of the claimant play a role within Workers' Compensation legal proceedings? Do you believe the race of the claimant plays a part in determining the outcome in hearings (Hearings, Fraud Prosecution Process, etc.). How does the race of the attorneys play a role within Workers' Compensation legal proceedings? Do you believe the race of the attorneys plays a part in determining the outcome in hearings (Hearings, Fraud Prosecution Process, etc.). What role does social status play in the Workers' Compensation legal proceedings? Tell me, based on your knowledge, do claimants with a higher social status receive much more lenient sentences? Do you believe there are questions in this interview that I you feel I may have missed or is there any other pertinent information that you would like to contribute? 70

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APPENDIXG Investigator Interview Guideline Interviewer: Interviewee: ID# Interviewee's contact number: Location of the interview: Date of the interview: Time of the start of the interview: Time of the end of the interview: PART I: Demographic questions The object of these following questions is to gain information that is both descriptive and demographic in nature of the subject and of their knowledge of Workers' Compensation law. Interviewee's age: Interviewee's race: Interviewee's gender: Number of years of school completed: Where did you earn your degree/degrees: Number of years experience as an investigator: Number of years experience as an investigator within Workers' Compensation: PART II: Content questions (preliminary sample) Please explain the steps that lead to the investigation of a Workers' Compensation claim. (Ask if these are the same steps followed for potential fraud cases). How and by whom are investigations initiated by? What sparks these investigations? What is your role/duty in conducting these investigations? Etc. What is the Workers' Compensation fraud prosecution process in the State of Colorado. (Example: Investigator obtains a request to conduct an investigation. The investigator realizes this claim may be potentially fraudulent, what are the next steps taken?) Do you perceive that a specific type of individual is more prone to committing or being accused of Workers' Compensation fraud? Explain. Male vs. female Age Race 71

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Appendix G (Cont.) Within this same realm, do you think that individuals occupying certain types of occupations commit more or are more prone to committing or being accused of Workers' Compensation fraud? (Example: For example, do you see more policyholders committing fraud than laborers, i.e. construction workers). What role does the gender of the claimant play within the Workers' Compensation fraud prosecution process? For example, do you perceive that it plays a part in determining the overall verdict of a case? What role does the gender of the attorneys involved play within Workers' Compensation legal proceedings? Do you perceive that if the claimant's attorney is a male that the claimant will receive a more lenient sentence than if the claimant's attorney was a female. Explain. What role does the gender of Judge/ Administrative Law Judges play within the Workers' Compensation fraud prosecution process? Based on your experience and insight, if the Judge is male and the claimant's attorney is female does this play a part in the fraud prosecution process and the final verdict? What ifthe Judge is male and the claimant's attorney is male? (Give all possible scenarios) On the same lines, does the race of the claimant play a role within the Workers' Compensation fraud prosecution process? Do you believe the race of the claimant plays a part in determining the overall verdict of a case? Do individuals occupying a particular race get accused or prosecuted for Workers' Compensation fraud more often than individuals occupying other races? Based on your perception, does the race of the claimant's attorney play a role in the fraud prosecution process and the fmal verdict? Explain. Based on your have you ever noticed or had the inclination that the Judge/ Administrative Law Judge based the verdict of the case solely on race of the claimant? What about the gender of the claimant? Age? What role does social status, i.e. wealth (money) play in the Workers' Compensation fraud prosecution process? Based on your perception, do claimants with a higher social status (well-known in the community, i.e. policyholder, wealthy) receive much more lenient sentences or do you notice that charges are rarely filed on them? Based on your perception, are there status differences amongst attorneys? Explam. Do you think that certain attorneys are hired to represent claimants based on their status? (Explain my definition of status: famous, known for getting individuals charges dropped or lenient sentences, come from well-known/prestigious firms, expensive to hire, etc.). If these statuses do exist, then based on your perception, do you believe that if a claimant is represented by a high status attorney, then the claimant will receive a lenient sentence? 72

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Appendix G {Cont.) As an Investigator, have you ever felt that one of your cases was denied prosecution by the Attorney General's Office based on your race, gender, or age? As a female/male Investigator, do you feel that you are treated differently than your male/female counterparts by your immediate supervisor, by others in your department, within the Workers' Compensation Investigation sector? Do you believe there are questions in this interview that I you feel I may have missed or is there any other pertinent information that you would like to contribute? 73

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APPENDIXH Data Coding Scheme ITEM (VARIABLE NAME) CODES AND INSTRUCTIONS Identification No. (IN) 2 digit nwneric variable Gender(G) 1 digit numeric variable 1-Male 2-Female 9-Missing Data Date of Birth (DOB) 2 digit character variable ## 77-Missing Data/Policyholder 88-Case Never Filed with Attorney General 99-Missing Data Race/Ethnicity (RE) 1 digit numeric variable 1-White 2-Black or African American 3-Hispanic 4-American Indian or Alaska Native 5-Asian 6-Hawaiian or Other Pacific Islander 7-0ther 9-Missing Data Occupation (0) 1 digit numeric variable 1-White Collar 2-Blue Collar 8-Not Applicable 9-Missing Data Average Weekly Wage (AWW) 8 digit character variable ######## 77-Not Applicable/Policyholder 88-Not Applicable 99-Missing Data Previous W.C. Claim (PWCC) 1 digit numeric variable 1-No 2-Yes 3-Not Applicable 8-Unable to Determine 9-MissingData Surveillance Conducted (SC) I digit numeric variable 1-No 2-Yes 8-Not Applicable 9-MissingData 74

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Appendix H (Cont.) Claimant's Representation (CR) 1 digit numeric variable 1-Pro Se 2-Public Defender 3-Private Attorney 4-Unal:ile to Determine/Case Still Under Investigation 5-No Attorney/File Closed Prior to Attorney General Referral 6-Not Applicable/Prosecution Declined by Attorney General 7-No Attorney/Charges Pending 9-Missing Data Status of Claimant's Attorney (SCA) 1 digit numeric variable 1-A V (Very High Rating) 2-BV (High Rating) 3-CV (Good Rating) 4-Pro Se Claimant 5-Unab1e to Determine/No Martindale Hubbell Rating 6-No Attorney/File Closed Prior to Attorney General Referral 7-No Attorney/Charges Pending 8-Not Applicable/Prosecution Declined by Attorney General 9-Case Still Under Investigation 99-Missing Data Respondent's Representation (RR) 1 digit numeric variable 1-Pro Se 2-Public Defender 3-Private Attorney 4-Assistant Attorney General 5-Unable to Determine/Case Still Under Investigation 6-No Attorney File Closed Prior to Attorney General Referral 7 -Not Applicable/Prosecution Declined by Attorney General 8-No Attorney/Charges Pending 9-Missing Data 75

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Appendix H (Cont.) Status of Respondent's Attorney (SRA) I digit numeric variable 1-A V (Very High Rating) 2-BV (High Rating) 3-CV (Good Rating) 4-Pro Se Claimant 5-Unable to Determine/No Martindale Hubbell Rating 6-No Attorney/File Closed Prior to Attorney General Referral 7-No Attorney/Charges Pending 8-Not Applicable/Prosecution Declined by Attorney General 9-Case Still Under Investigation 99-Missing Data Allegation/Charges (AG) I digit numeric variable !-Theft 2-False Statement 3-Mail Fraud 4-Conspiracy 5-False Claim 6-Forgery 7Theft & False Statement 8Theft, False Statement & Forgery 9Theft, False Statement & Other 10-Forgery & Other It-Charges Never Filed with Attorney General 12Other 99-Missing Data Trial (T) I digit numeric variable 1-No 2-Yes 3-No Trial/Prosecution Declined by A.G. 4-Charges Pending 5Trial Pending 6-Charges Never Filed/File Closed Prior to Attorney General Referral 7-Case Still Under Investigation 8-Not Applicable 9-Missing Data 76

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Appendix H (Cont.) Plea (P) 1 digit numeric variable 1-Not Guilty 2-Guilty 3-No Plea/Prosecution Declined by A.G. 4-Charges Pending 5Trial Pending 6-Charges Never Filed/File Closed Prior to Attorney General Referral 7-Case Still Under Investigation 8-Case Settled 9-Not Applicable 99-Missing Data Sentence (S) 1 digit numeric variable !-Restitution 2-Probation 3-Restitution and Probation 4-Jail 5-Jail and Restitution 6-Jail and Probation ?-Community Service 8-Community Service and Restitution 9-Community Service and Probation 1 0-Community Service, Restitution and Probation 11-Jail, Community Service, and Restitution 12-Deferred Sentence 13-Dept. of Corrections, Parole, Probation, and Restitution 14-No Sentence/Prosecution Declined by Attorney General 15-Charges Pending 16Trial Pending 17-Charges Never Filed/File Closed Prior to Attorney General Referral 18-Case Still Under Investigation 19-0ther 20-Not Applicable 99-Missing Data 77

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Amount of Restitution (AR) Appendix H (Cont.) 1 digit numeric variable 1-Trial Pending 2-Charges Pending 3-Charges Never Filed/File Closed Prior to Attorney General Referral 4-Case Still Under Investigation 5-No Restitution/Prosecution Declined by Attorney General 6-No Restitution Ordered 8-Not Applicable 9-MissiJ!g Data 78

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APPENDIX I Frequency for Gender Frequency Percent Valid Percent Cumulative Percent Male 40 67.8 69.0 .0 Female 18 30.5 31.0 100.0 Total 58 98.3 100.0 Missing 1 1.7 Data 59 100.0 Total 79

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APPENDIXJ Frequency for Age Frequency Percent Valid Cumulative Percent Percent 21 1 1.7 1.7 2.1 26 2 3.4 3.4 6.4 29 1 1.7 1.7 8.5 31 3 5.1 5.1 14.9 32 2 3.4 3.4 19.1 33 1 1.7 1.7 21.3 34 3 5.1 5.1 27.7 35 3 5.1 5.1 34.0 36 2 3.4 3.4 38.3 37 5 8.5 8.5 48.9 39 2 3.4 3.4 53.2 40 6 10.2 10.2 66.0 41 1 1.7 1.7 68.1 43 1 1.7 1.7 70.2 44 3 5.1 5.1 76.6 46 1 1.7 1.7 78.7 47 3 5.1 5.1 85.1 49 1 1.7 1.7 87.2 50 3 5.1 5.1 93.6 51 1 1.7 1.7 95.7 56 2 3.4 3.4 100.00 Total 47 79.7 79.7 Missing 12 20.3 20.3 Total 59 100.0 100.0 80

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APPENDIXK Frequency for Race Frequency Percent Valid Cumulative Percent Percent White 43 72.9 74.1 74.1 Black or African American 3 5.1 5.2 79.3 Hispanic 12 20.3 20.7 100.0 Total 58 98.3 100.0 Missing Data 1 1.7 Total 59 100.0 81

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APPENDIXL Frequency for Weekly Wage Frequency Percent Valid Percent Cumulative Percent 11 18.6 18.6 21.6 Policyholder 1 1.7 1.7 23.5 120.00 2 3.4 3.4 27.5 150 00 1 1.7 1.7 29.4 200 00 1 1.7 1.7 31.4 208.40 1 1.7 1.7 33.3 256.62 1 1.7 1.7 35.3 260.00 1 1.7 1.7 37.3 281.20 1 1.7 1.7 39.2 283.20 2 3.4 3.4 43.1 300.00 1 1.7 1.7 45.1 312.00 3 5.2 5 2 51.0 320 00 1 1.7 1.7 52.9 340.00 1 1.7 1.7 54 9 353.57 1 1.7 1.7 56.9 400.00 1 1.7 1.7 58.8 420 00 1 1.7 1.7 60.8 424 80 2 3.4 3 4 64.7 440.00 1 1.7 1.7 66.7 491.46 1 1.7 1.7 68.6 496 80 1 1.7 1.7 78.6 500.00 2 3.4 3.4 70.6 520.00 1 1.7 1.7 74.5 538.00 1 1.7 1.7 76.5 580.00 1 1.7 1.7 78.4 590.00 1 1.7 1.7 80.4 640 00 1 1.7 1.7 82.4 653.12 1 1.7 1.7 84.3 660.00 1 1.7 1.7 86.3 800.00 1 1.7 1.7 88.2 840 00 1 1.7 1.7 90.2 841.20 1 1.7 1.7 92.2 852 .53 1 1.7 1.7 94.1 889.41 1 1.7 1.7 96.1 896.00 1 1.7 1.7 98.0 1057.69 51 86.4 86.4 100.0 Total 8 23.6 23.6 Missing 59 100.0 100 0 82

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APPENDIXM Frequency for Occupation Frequency Percent Valid Cumulative Percent Percent White Collar 11 18.6 20.8 20.8 Blue Collar 30 50.8 56.6 77.4 Policyholder 11 18.6 20.8 98.1 Medical Provider 1 1.7 1.9 100.0 Total 53 89.8 100.0 Missing Data 6 10.2 Total 59 100.0 83

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Frequency No Yes Total APPENDIXN Frequency for Workers' Compensation History Percent Valid Percent 44 74.6 74.6 15 25.4 25.4 59 100.0 100.0 84 Cumulative Percent 74.6 100.0

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APPENDIXO Frequency for Surveillance Frequency Percent Valid Cumulative Percent Percent No 26 44.1 44.1 44.1 Yes 33 55.9 55.9 100.0 Total 59 100.0 100.0 85

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APPENDIXP Frequency for Claimant's Representation Frequency Percent Valid Cumulative Percent Percent ProSe 6 10.2 10.9 10.9 Public Defender 1 1.7 1.8 12.7 Private Attorney 19 32.2 34.5 47.3 No Prosecution 29 49.2 49.2 100.00 Total 55 93.2 100.0 Missing Data 4 6.8 Total 59 100.0 86

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APPENDIXQ Frequency for Status of Claimant's Attorney Frequency Percent Valid Cumulative Percent Percent A V (Very High Rating) 3 5.1 5.5 5.5 BV (High Rating) 5 8.5 9.1 14.5 Pro Se Claimant 6 10.2 10.9 25.5 Unable to Determine-No 12 20.3 21.8 47.3 Martindale Hubbell Rating No Prosecution 29 49.2 52.7 100.0 Total 55 93.2 100.0 Missing Data 4 6.8 Total 59 100.0 87

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APPENDIXR Frequency for Charges/ Allegations Frequency Percent Valid Cumulative Percent Percent Theft 4 6.8 6.8 6.8 False Statement 7 11.9 11.9 18.6 Conspiracy 5 8.5 8.5 27.1 Forgery 3 5.1 5.1 32.2 Theft & False Statement 31 52.5 52.5 84.7 Theft, False Statement & 3 5.1 5.1 89.8 Forgery Theft, False Statement & 4 6.8 6.8 96.6 Other Forgery & Other 2 3.4 3.4 100.0 Total 59 100.0 100.0 88

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APPENDIX S Frequency for Trial Frequency Percent Valid Cumulative Percent Percent No 24 40.7 40.7 40.7 Yes 3 5.1 5.1 45.8 Trial Pending 3 5.1 5.1 94.9 No Prosecution 29 49.2 49.2 100.0 Total 59 100.0 100.0 89

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APPENDIXT Frequency for Plea Frequency Percent Valid Cumulative Percent Percent Not Guilty 3 5.1 5.3 5.3 Guilty 22 37.3 38.6 43.9 No Plea 32 54.2 56.1 100.0 Total 57 96.6 100.0 Missing Data 2 3.4 Total 59 100.0 90

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APPENDIXU Frequency for Sentence Frequency Percent Valid Cumulative Percent Percent Restitution 3 5.1 5.1 5.1 Restitution and Probation 4 6.8 6.8 11.9 Community Service and 1 1.7 1.7 13.6 Restitution Community Service and 2 3.4 3.4 16.9 Probation Community Service, 15 25.4 25.4 42.4 Restitution and Probation Jail, Community Service and 1 1.7 1.7 44.1 Restitution Dept. of Corrections, Parole, 1 1.7 1.7 45.8 Probation and Restitution Trial Pending 3 5.1 5.1 94.9 No Prosecution 29 49.2 49.2 100.0 Total 59 100.0 100.0 91

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APPENDIXV Frequency for Restitution Frequency Percent Valid Cumulative Percent Percent 1,000-10,000 14 23.7 56.0 56.0 10,000+ 11 18.6 44.0 100.0 Total 25 42.4 100.0 No Prosecution 32 54.2 No Restitution Ordered 2 3.4 Total 34 57.6 Total 59 100.0 92

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REFERENCES Beirne, Piers and James Messerschmidt. 1999. Criminology: 3'd Edition. Boulder, CO: Westview Press. Bequai, August. 1987. White-Collar Crime. A 20th-Century Crisis. Lexingotn, Mass: D.C. Heath. Black, Donald. 1976. The Behavior of Law. New York: Academic Press, Inc. Black, Donald. 1979. "Common Sense in the Sociology of Law." American Sociological Review, Vol. 44, Issue 1 (Feb. 1979):18-27. Black, Donald. 1984. Toward a General Theory of Social Control. New York: Academic Press, Inc. Black, Donald. 1989. Sociological Justice. New York: Oxford University Press. Black, Donald. 1998. The Social Structure of Right and Wrong. San Diego, CA: Academic Press Limited. Black, Henry Campbell. 1979. Black's Law Dictionary; Special Deluxe Fifth Edition. St. Paul, :MN: Publishing Company. California State University Web Site. 2004. "ASA Style Guide." February 5, 2005. (http://www.calstatela.edu/library/bi/rsalina/asa.styleguide.html). Colorado Department of Labor and Employment Web Site. 2003. "Workers' Compensation Fraud." March 14,2003. (http://www.coworkforce.com/ ICE/wc.asp ). Colorado Division of Workers' Compensation Web Site. 2003. "Colorado Division of Workers' Compensation Employers Guide." June 10,2003. (http://www. coworkforce.com/DWC/PUBS/employers _guid %202002 _web_ version. pdf). Creswell, John W. 2003. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches (2nd ed). Thousand Oaks, CA: Sage Publications. 93

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