Truck Adjusting in Southern CA
I am an after-hours truck adjuster for David Morse & Associates (DMA). A successful truck adjuster makes life easier for the examiner and company assigning – and that means making settlement possible at the earliest possible juncture. If he or she can do that, there will be plenty of work assigned.
This is the story of a routine assignment that came in very early on a Tuesday morning – nothing spectacular, but a demonstration of effective adjusting that supports rapid file closure. We got to the scene (not always easy in Southern California on a weekday morning). Our driver and his damaged rig were on the shoulder, having rear-ended another big rig when traffic stopped suddenly. We waited for a wrecker to arrive and tow the equipment away. I then gave the driver a ride to his company’s yard.
A female employee went out on a Workers Comp claim due to the repetitive motion injury “carpal tunnel syndrome” in both wrists. She and her doctor indicated that she had a fairly severe case of carpal tunnel and could not use either arm or wrist for lifting, twisting or typing.
Surveillance was approved, and initially we did not see any evidence contrary to the claimant’s allegations. But rumors persisted in the workplace that the claimant was not as injured as she claimed.
Since the holiday season was approaching, I suggested that we conduct surveillance near Christmas, thinking we might find the claimant involved in typical holiday activities inconsistent with her claimed injuries.
In handling Disability investigations it pays to have a working knowledge of the game of golf. It is remarkable how often one ends up near and some-times on a golf course in pursuit of documentation in the matter of questionable claims.
Sometimes one can prepare and sometimes not. In the case at hand two of us had flown into the subject’s city on short notice.We had picked up the subject exiting his garage and followed, arriving shortly thereafter at an upscale public golf course. Time to think fast.
Sometimes the claimants with bogus injuries are so incautious that one could suspect they desire enough restraint (provided by others) in order to straighten themselves out.
Our claimant worked for a roofing company and went out on temporary disability alleging a back injury. Had he stayed at home, watching daytime TV, his income stream would have been secure.
Our subject had been at odds with her employer, and subsequently she went out on a job-related stress disability claim. Later investigation of the cash register and inventory sheets revealed a suspicious development: the company had come up short for several items of merchandise during the employee’s tenure.
DMA Investigations was called upon to locate the employee and conduct surveillance to find out what she was up to while out on her stress claim. The employer told us they suspected she might be trying to start up a cleaning service business.
Our subject was out on a total disability claim, from a back injury. That disability claim was paying our subject enough money to maintain a rather nice lifestyle, which included a late-model luxury car, country club membership, and a gated house in the hills. There was only one problem with this happy scenario – our subject was a fraud, lying through his teeth.
His golf swing was not going to give Tiger Woods a scare at Augusta anytime soon. But it was a beautiful morning on his country club course and you could see our subject was having a very good time. No pain, no hesitation, no problems swinging or picking up the ball.
It was the best of times (getting paid without having to work), then it was the worst of times (getting busted). Not an uncommon trajectory for those inclined to fraud, whose daily activities we are asked to monitor and document. But getting this file from “best” to “worst” was no walk in the park and required a highly developed sense of smell as it applies to false claims.
Our subject was a “disabled” construction worker (back, shoulders, wrists). Our first surveillance produced no film of the subject, although we saw plenty of other people in and around his address. A reopen of the investigation several months later looked like itwas going the same route. The investigator canvassed the area and determined our subject had moved and found the new address only a few blocks away.
It is a general belief that in a contest involving force vectors, big will overwhelm small and emerge victorious. And while this is often true, one should not bet the rent money on that outcome.
Our subject for this surveillance was big. Not fat. Big…as in big and strong. Perhaps this was the red flag raised when the subject went out on disability due to knee, shoulder, neck and extremities injuries preventing him from working.
Normally car maintenance is an activity that is good for morale and poses no threat to the individual providing care for his or her equipment. But a person claiming disability and attempting to collect Workers Comp benefits ought to know better than to clean a car, increase tire pressure,open and close garages and perform similar tasks. The potential of a large “gift” from Workers’ Compensation would incline the truly devious person to require such tasks to be performed by a spouse, a “significant other” or a hired hand.
Our subject claimed left arm, left leg and back injuries and was collecting benefits. She was reportedly using a cane. The assignment was for two days of surveillance.
A good investigator in this day and age develops internet search and background investigation skills. The more information you have before you hit the street, the better your chances of documenting the truths that some claimants would prefer to keep hidden.
In this instance, “the street” would not come into play. Our assignment was internet background and social media investigation. Our subject was represented, the accident was low impact and a policy limits demand was coming.