Police investigating after man claiming workers’ comp treated day before for sports injury

Posted at 5:44 PM, Dec 04, 2013
and last updated 2013-12-05 11:24:58-05

A delivery driver who said he hopped off a truck and hurt his left calf -- later collecting thousands of dollars in benefits -- was treated in an emergency room a day earlier for a basketball injury to his left calf, according to court records obtained by NewsChannel 3.

State police insurance-fraud investigators have seized ER records detailing the ambulance trip to Sentara Princess Anne Hospital, and the treatment for the worker's ruptured Achilles tendon that he told doctors happened on a basketball court. A search-warrant affidavit identified the worker as Shaun Lopez James, of Virginia Beach. NewsChannel 3 went to his last address, a home listed under his name in court records, but he was not there. A woman who answered the door said she and her family moved in a year ago and she did not know James.

The affidavit says on April 25, 2011, James filed a workers' compensation claim, saying he was hurt while on the job at Peltz Marine Supply in Norfolk. Owner Jack Peltz told NewsChannel 3 James was out of work for several months and that put a burden on the company's small workforce.

"It's a small group and everyone has a job," Peltz said. "So we miss people when they are not here. And when a driver is gone, the other guys have to work a lot harder."

Peltz' business gathers and delivers supplies to cargo ships visiting Hampton Roads. It's a round-the-clock operation, seven days a week. Peltz said James was one of three delivery drivers.

The state-police affidavit says private insurance investigators discovered the ER visit that came a day before the claim.

The affidavit shows James was paid more $12,400 in benefits. The document also reveals that when investigators asked James about the ER visit, he denied he told the doctors he was hurt playing basketball. Then later, according to the affidavit, he denied he went to the ER. The records show police last month seized ER records in the name "Shaun L. James" for treatment on April 25, 2011.

"That's the worst possible scenario, to have someone ... take advantage of you," Peltz said. "It takes advantage of everybody in the building, all the others who work harder to do his job."

State police did not return a message seeking comment for this story. Virginia Beach police have a mug shot of James from an unrelated arrest, but declined to release it because state police officials had not returned their calls either. A state-police report shows investigators handled 144 workers' compensation fraud claims last year. That amounts to 27 percent of all injury-fraud cases, the report stated.

The court records do not indicate James has been charged in this case. Peltz said James stopped working for his company last Spring.

Peltz said he's happy that both the private insurance investigators and state police are checking on suspicious claims. Fraud, he says, can drive up his insurance rates.

"It costs money, and it costs time," he said.