Department of Insurance investigation leads to multiple felony counts of insurance fraud and perjury
August 3, 2021 - LOS ANGELES — Frank Simplicio, 45, of Porter Ranch, was arraigned on multiple felony counts of insurance fraud and perjury. A Department of Insurance investigation revealed Simplicio 
allegedly claimed to be too injured to work in order to collect over $50,000 in disability payments from one employer’s insurance company while illegally working for other employers.
On May 2, 2017, Simplicio, while working as a greensman, filed a claim with his employer's insurance company stating cumulative trauma to his neck and back. He also claimed the job led to his diabetes, internal injuries and sleep disturbance. He reported the dates of his cumulative trauma injuries as July 19, 1996 through May 29, 2015. The claim however was filed two years after his alleged injuries.
The investigation found that Simplicio was paid Temporary Total Disability payments from February 20, 2018 through September 19, 2018, totaling $32,051. He also received Permanent Disability payments from September 20, 2018 through December 13, 2019, totaling $18,610.
In a deposition, Simplicio stated he was a landscaper, but he had not worked since the date of his injury. However, surveillance footage in October 2018 and February 2019 revealed Simplicio was actively working as a landscaper. A search warrant was later issued for Simplicio's bank account records, which found he collected checks from clients from June 2015 through December 2019, totaling over $450,000. This does not include possible income from direct deposits through his account.
When told what the investigation found, the Qualified Medical Examiner who handled Simplicio's claim stated Simplicio lied and if they had known about his abilities and concurrent employment they would have never put him on Temporary Total Disability. Simplicio's alleged actions resulted in him receiving $50,661 in undeserved disability payments. The total loss for the insurance company in this case was over $100,000, which includes unnecessary medical, investigative, and legal costs.
Simplicio self-surrendered to the Los Angeles Superior Courthouse and was arraigned on July 29, 2021. The Los Angeles County District Attorney's Office is prosecuting this case.
The California Department of Insurance, established in 1868, is the largest consumer protection agency in California. Insurers collect $340 billion in premiums annually in California. Since 2011 the California Department of Insurance received more than 1,000,000 calls from consumers and helped recover over $469 million in claims and premiums. Please visit the Department of Insurance website at www.insurance.ca.gov. Non-media inquiries should be directed to the Consumer Hotline at 800-927-4357. Teletypewriter (TTY), please dial 800-482-4833.
Source: CA. Dept. of Insurance
