OC SOCIAL SERVICES AGENCY EMPLOYEE SENTENCED FOR COMMITTING OVER $30,000 INSURANCE FRAUD BY FALSIFYING CLAIMS ABOUT WORK-RELA

Case # 15CF2317

Date: May 13, 2016

OC SOCIAL SERVICES AGENCY EMPLOYEE SENTENCED FOR COMMITTING OVER $30,000 INSURANCE FRAUD BY FALSIFYING CLAIMS ABOUT WORK-RELATED INJURY

SANTA ANA, Calif. – An Orange County Social Services Agency (SSA) group counselor sentenced today for defrauding over $30,000 from the County of Orange by making fraudulent statements relating to his workers’ compensation claim. Maluelue Tafua, 41, Orange, pleaded guilty to a court offer today, May 13, 2016, of two misdemeanor counts of insurance fraud and two misdemeanor counts of making fraudulent statements. The defendant paid over $30,000 in restitution today and was sentenced to three years informal probation, ordered to complete 100 hours of community service, and pay $100 to the Worker’s Compensation Fraud Assessment Fund as well as statutory fees.

At the time of the crime, Tafua worked as a group counselor for SSA.

On Jan. 8, 2014, Tafua claimed that he injured his right shoulder and elbow restraining someone while working at Orangewood Children’s Home. SSA attempted to accommodate his injury by assigning him to modified duties within the work restrictions prescribed by the treating physician. Tafua subsequently went to his doctor and claimed to be unable to use his right arm. SSA could not accommodate that restriction and placed Tafua on temporary total disability.

On June 3, 2014, Tafua bench pressed 315 pounds in a gym. During a medical appointment with his doctor the following day, Tafua claimed that his pain had not improved and that he had been complying with his treatment. The defendant failed to report that he exercised using weights at the gym.

On July 14, 2014, the County began investigating this case after observing inconsistencies in the defendant’s statements, what was observed at the gym, and what activities he told the doctor he was capable of performing.

“Workers’ compensation insurance fraud is not a victimless crime,” said California Department of Insurance Commissioner Dave Jones. “We all pay for fraud when insurers pass the cost of their losses onto business through higher rates, and ultimately consumers pay through higher costs for goods and services.”

Deputy District Attorney Pam Leitao of the Insurance Fraud Unit prosecuted this case.