December 23, 2016. Command Investigations and Frank Winston Crum Insurance announce the arrest of Santos Rios for insurance fraud.
Rios suffered an alleged work-related accident in August of 2011.
Based upon this accident, Rios made clear and definitive statements that he was unable to drive, turn his neck, or use his left arm and hand.
In 2013, Rios received a Permanent Total Disability (PTD) rating.
Due to the circumstances of the accident, the reported physical injuries and ongoing medical treatment, surveillance was assigned to ascertain the current activity level of the claimant.
Command was assigned multiple days of surveillance; wherein, clear video documentation of Rios was obtained. Video footage included the claimant driving, utilizing his left hand and left arm, and carrying various tools and cleaning items. He moved in an apparent unrestricted and fluid manner without any signs of outward physical impairment.
Rios’ treating physicians were provided the opportunity to review the surveillance footage. The doctors all provided revised medical opinions stating that Rios was exaggerating his symptoms and that his complaints were not consistent with his activities on the surveillance video.
As required under Florida Statutes 626.9891 and 440.105, Command’s SIU Department submitted a referral to the Florida Department of Financial Services (DFS), Division of Insurance Fraud (DIF) for material misrepresentation.
Rios was arrested on November 21, 2016, in Miami-Dade County. He was charged with the following:
- F.S. 440.105 (4b) – Workers’ Compensation Fraud
Rios was released on a $7,500 bond. His criminal trial is pending.
All parties are presumed innocent until proven guilty.
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