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Colorado AG Announces Guilty Pleas from Couple in Elaborate Work Comp Fraud Scheme

December 4, 2011 - WorkCompWire

DENVER — Colorado Attorney General John Suthers announced today that his office has secured guilty pleas from two Aurora residents who stole $120,000 worth of workers’ compensation funds from Pinnacol Assurance.

Martin Lobatos pleaded guilty to theft, a class-three felony, and making a false statement on a worker’s comp claim, a class-five felony. He could face up to a $750,000 fine and up to 12 years in prison on the theft count. Lobatos wife, Belen Luna Lobatos (DOB: 12/6/1973), pleaded guilty to theft, a class-four felony, and making a false statement on a worker’s comp claim, a class-five felony. She could face up to a $500,000 fine and up to six years in prison on the theft count.

As part of the plea agreement, the Lobatos have agreed to pay Pinnacol Assurance $160,000 in restitution.

According to the 18-count indictment, which the Office of the Attorney General obtained in June, Martin Lobatos first collected workers compensation following a September 29, 2008 fall off a ladder while working as a roofer. Lobatos returned to work in October 2008 but still complained of dizziness and vertigo. Lobatos’ doctors said he fully recovered from these symptoms in April 2009; however, following his termination from his job in April and subsequent to him declining to accept a $20,000 settlement from Pinnacol Assurance in September 2009, Lobatos started to complain of new symptoms, including dizziness, memory loss, difficulty recognizing his own children and other physical problems.

According to the indictment, Lobatos informed physicians over the following months of his deteriorating physical condition until around March 2010 when he reportedly became fully catatonic. Throughout the process, Lobatos’ wife accompanied him to medical appointments and assisted him during these trips and his hospital stays.

According to the indictment, Martin Lobatos was observed driving and shopping after acting during medical exams as though he were fully catatonic. He passed drivers tests with an above-average score one week after he appeared to be unable to normally function. Belen Luna Lobatos assisted her husband in defrauding Pinnacol Assurance. She also fraudulently claimed $4,000 a month from Pinnacol Assurance to care for her husband between April 2010 and May 2011.

The Lobatos are scheduled to be sentenced at 8:30 a.m. on February 2, 2012 in Denver District Court.

Source: CO Attorney General

Filed Under: Claims, Legal, & Compliance News, Top Stories, Workers' Compensation

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