Commissioner Jones Announces Surrender Of Bay Area Woman For Insurance Fraud
News: 2011 Press Release
Insurance Commissioner Dave Jones announced today the surrender of Emily Kathleen Everett, aka: Emily Hegner, age 34, of Daly City, California, on the charges of making a false/misleading statement in support of a claim, perjury, grand theft, knowingly failing to disclose an event, and preparing a false writing related to a workers compensation claim. Everett surrendered herself to San Francisco County Jail on March 9, 2011.
"Workers Compensation Insurance fraud will be fully investigated by my Department," said Commissioner Dave Jones. "Those who feel that they are above the law and who commit perjury and grand theft and then file a false insurance claim will be prosecuted to the fullest extent of the law."
On or about February 27, 2008, Intercare Insurance Services forwarded this case to the California Department of Insurance, Fraud Division, for investigation. Intercare oversees workers compensation claims for the City and County of San Francisco. Intercare alleged that Everett was making material misrepresentations, specifically about her physical limitations in support of her workers compensation claim. Intercare alleged that Everett received disability benefits that she was not entitled to as part of her injury claim.
Everett claimed that on July 19, 2007, during the course of her employment with the City and County of San Francisco, was injured while performing her regular work duties as a Health Worker III for Laguna Hospital in San Francisco. Everett allegedly slipped and fell on a puddle of water, subsequently complaining of right wrist, left knee, and hip area pain and was restricted from returning to work. At this time Everett began receiving total temporary disability benefits. Everett allegedly maintained she was in constant pain as a result of her alleged injuries and she continued to receive workers' compensation benefits and medical treatment. Everett alleged severe back spasms and was utilizing a right wrist brace and walked with the use of a cane.
Subsequent investigation revealed that Everett had participated in a Muir Woods Marathon racing event on April 12, 2008. Everett participated in a 7 mile race which included 1¼ mile as part of the Dipsea trail. The course included climbing 1800 feet, climbing wooden steps, running through sand and rolling terrain for about 1½ miles, and descending downhill to the finish line for about 2½ miles.
Evidence was also obtained showing Everett her using a cane when arriving at a doctor's appointment, then following the appointment she was no longer using the cane.
On September 3, 2008, Everett was examined by an orthopedic surgeon. Everett allegedly maintained she used a cane and a right wrist splint and claimed to have pain about 85% of the time. Everett stated that she would have difficulty returning to work due to walking distances. She allegedly denied participating in any sporting events, and also stated that walking and climbing stairs is slow and difficult for her but better with the use of a cane. It is believed that Everett made material misrepresentations to support the severity and extent of her physical disability. Everett is believed to have deceived her treating physician by not reporting her true level of disability or physical activities. Everett had also requested a handicap placard from her treating physician.
Everett was wanted on a $120,000.00 bail arrest warrant that included five felony counts of Insurance Code Section 1871.4(a) 1, one count each of Penal Code Sections 550(a) 5, 550(a) 1, 550(b) 3, one count of Penal Code Section 134, and one count of Penal Code Section 487.
As a result of Everett's alleged misrepresentations she received approximately $9,529.00 in total temporary disability benefits. The total payments made on this claim were approximately $50,267.00 which included medical benefits, medications, and claim expenses.
The San Francisco County District Attorney's Office is prosecuting this case.
The California Department of Insurance, established in 1868, is the largest consumer protection agency in California, regulating the $123 billion insurance marketplace. In 2013 the California Department of Insurance received more than 170,000 calls from consumers and helped recover over $63 million in claims and premiums. Please visit the Department of Insurance web site at www.insurance.ca.gov. Non-media inquiries should be directed to the Consumer Hotline at 800.927.HELP or 213.897.8921. Telecommunications Devices for the Deaf (TDD), please dial 800.482.4833.