Surveillance footage leads to charges against Madera woman for workers’ compensation fraud
News: 2021 Press Release
FRESNO, Calif. — Veronica Catalina Cortes-Ambrosio, 53, of Madera, was charged on two felony counts of insurance fraud after allegedly lying about physical limitations from an injury at work in an attempt to receive undeserved workers’ compensation benefits.
An investigation by the Department of Insurance revealed on May 6, 2017, Cortes-Ambrosio was working for a farm labor company when she was struck with a gardening tool by a co-worker resulting in injuries to her right shoulder, neck, and back. She was evaluated and received initial treatment for the alleged injuries, but the workers’ compensation claim she filed was denied.
Cortes-Ambrosio continued to seek medical care and obtained legal counsel to pursue the claim. She claimed to experience severe and nearly constant pain related to the injury and was unable to perform everyday activities such as sitting, standing, walking, reaching, and lifting. Cortes-Ambrosio’s employer offered her modified duties due to her stated limitations, but she refused and did not return to work.
Video surveillance was obtained of Cortes-Ambrosio during the time she claimed physical limitations due to the injury. The video showed her cleaning in and around her home, doing yardwork, ascending and descending stairs, reaching overhead, and lifting – all tasks she claimed she could not perform and prevented her from returning to work.
Cortes-Ambrosio’s fraudulent claims of ongoing pain and an inability to perform basic work functions, led to her employer’s insurance company paying approximately $48,140 in unnecessary medical, investigative, and legal costs.
Cortes-Ambrosio is scheduled to be arraigned on May 26, 2021. This case is being prosecuted by the Fresno County District Attorney’s Office.
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Led by Insurance Commissioner Ricardo Lara, the California Department of Insurance is the consumer protection agency for the nation's largest insurance marketplace and safeguards all of the state’s consumers by fairly regulating the insurance industry. Under the Commissioner’s direction, the Department uses its authority to protect Californians from insurance rates that are excessive, inadequate, or unfairly discriminatory, oversee insurer solvency to pay claims, set standards for agents and broker licensing, perform market conduct reviews of insurance companies, resolve consumer complaints, and investigate and prosecute insurance fraud. Consumers are urged to call 1-800-927-4357 with any questions or contact us at www.insurance.ca.gov via webform or online chat. Non-media inquiries should be directed to the Consumer Hotline at 800-927-4357. Teletypewriter (TTY), please dial 800-482-4833.