Insurance Official Arrested

CHATSWORTH — The head of the Southern California special investigations unit for Cigna Corp.’s casualty insurance division was arrested Wednesday for allegedly falsifying statements in order to block payment on a workers’ compensation claim.

The statements were used to deny a claim filed by a female clerk who said she was injured while being sexually assaulted by her boss, according to court documents.

Thomas Michael Rutkoske, 54, head of Cigna’s Chatsworth investigations office, was charged with conspiracy and insurance fraud. If convicted, Rutkoske could be sentenced to a maximum of eight years in prison.

His bail has been set at $250,000, said Gayle Falkenthal, spokeswoman for the San Diego County district attorney’s office.

Also arrested was Cigna claims representative Lisa Michelle Canepa, 31, who worked with Rutkoske. She was also charged with fraud and conspiracy.

The case demonstrates that “fraud can go both ways” when it comes to workers’ compensation, Falkenthal said. “We’ve heard all about employees faking injuries, but this is the mirror image . . . it’s got to be chilling for the people who rely on this type of coverage.”

A Cigna spokesman declined to speak in detail about the case, but said the company is committed to fairly handling claims. “We are cooperating with the ongoing investigation,” said James Ely, spokesman for the property and casualty division.

Ely said Rutkoske has been with Cigna about 2 1/2 years, and Canepa joined the company five years ago.

According to court papers, Rutkoske and Canepa began an investigation of a claim filed last November by a clerk in a northern San Diego County convenience store, then allegedly sought to omit from the final report some of the information the investigation turned up.

The case involved a homeless woman who was working at the store in late October and who had submitted a workers’ compensation claim for treatment of a knee injury, court papers said.

Prosecutors allege Rutkoske and Canepa suspected the woman’s claim was fraudulent and hired a private investigator to interview her co-workers.

Investigator David Sossaman tracked down the victim, who was no longer working at the store, prosecutors said.

Initially, she told Sossaman she had slipped and fallen at work, but pressed further she told the investigator that her former boss had sexually assaulted her, threatening to fire her if she resisted, they allege.

She told Sossaman that during one assault she was pushed onto her knees and injured.

But when Sossaman’s boss, Larry Sutton, tried to pass the information to Rutkoske, he was told to omit it, prosecutors allege.

Later, in a phone conversation secretly taped by Sutton, Canepa told him to leave out the information, saying, “By us volunteering anything, we’re just opening ourselves for more litigation and more hassle and potentially paying a claim,” according to court documents.

Prosecutors stated the woman’s boss was fired after Canepa contacted his employer about the incident.

Prosecutors alleged Rutkoske falsified statements in order to deny compensation, and knowingly concealed information affecting a claimant’s right to payment, a violation of state insurance codes.

Cigna is an $18-billion-per-year multinational insurance company based in Philadelphia. Although workers’ compensation insurance is an important part of the company’s property and casualty division, Cigna is not regarded as one of California’s leading workers’ compensation providers, said Ira Zuckerman, vice president of Nutmeg Securities and a Cigna specialist.

Zuckerman called the arrests “an individual case, not a widespread practice.”

But Richard Stephens, spokesman for the California division of Workers’ Compensation, said that in three separate audits of Cigna’s claims administrators and third-party administrators in Chatsworth, state investigators had levied “a higher than average number of penalties,” and also found the firm owed money on claims to injured workers.

An audit in December resulted in a $26,000 penalty assessed against the company in connection with problems in claims-handling practices, he said.

Falkenthal said an attorney hired by Cigna tried unsuccessfully to persuade a judge to lower Rutkoske’s bail at a court hearing late Wednesday, saying Cigna intended to post bail for the pair.