The Alleged Claim of Fraud

On June 28th, Edward faxes 23-documents including a cover letter to attorney Davis. The cover letter stated, in two relevant parts:

  1. “Do I need to forward these to anyone…or do you handle all this?” and,
  2. Ed stated he has been working as a contractor for Andy one day a week earning $10.00 per hour since February and he may be able to increase it to two days a week”.

The attorney placed all documents and cover letter into the WCB case files on July 2nd.

Note: Ed’s unsure who’s to forward the documents to Sentry. Therefore, based on the question raised by Sentry, Ed asks the question who is responsible to send these to the carrier.  Further, Ed was informing his attorney what he was working since their initial conversation. The original single-project turned out to be ongoing each week. Andy was now considering Ed for part-time status as was defined by attorney Davis.

After receiving the documents regarding their question raised, in August Sentry again raises an argument to fraud, citing §114-a (1). The allegation raised was, Ed knowingly made a false statement and misrepresented a material fact, by failing to notifying Sentry of his “return to work”, 6-months prior in February. The WCB holds a hearing and orders depositions of Ed’s doctors and all moving papers fully briefed by October and orders in record “Closed”.

Three months later, Sentry submits its Memorandum and includes false and misleading documents fabricated through their attorney’s, Stewart, Baker & Myers, LLP and lead attorney, Susan Andres. This Memo authored by Attorney Andres stated Edward has been working since his injury and never reported any single invoice for any work. She stated he had two very active web-sites, attended social functions, was on the radio, gave a talked to the Rotary Club and attended a black tie event with Hollywood celebrities for Breast Cancer. She claims, he was paid for all these activities and never reported it. However, attorney Andres never provided any proof he worked, let alone, was paid.

The QUESTIONS for conversation thus far

Q:  Did Edward knowingly make any false or misleading statements?

Q:  Were attorney Andres actions, false and misleading?

Q:  Based on the law and the material evidence of record, was “…a false statement or representation as to a material fact” made with or without knowledge by the injured worker for “the purpose of influencing any determination regarding any such payment”?

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