Through years of investigations, I have often found it to be true that “A claim is a solution to a problem, so what is the problem?” In other words, if you find out what the problem is that the person is having, you have the solution to your fraudulent claim.
Something didn’t seem right. A nurse had claimed a significant knee injury. She returned to work, then had to take off again, then back to work, then off again.
There was a male claimant who worked in the audio/visual department of a large teaching hospital. For a year this man kept a secret diary of any and all negative comments made by his coworkers regarding the audio/visual equipment used at the hospital.
After a year of keeping his secret diary of these negative comments, the man filed a “stress” claim due to the nature of the comments made by his co-workers. He claimed that these negative comments had caused irreparable harm to his psyche, and that as a result he had suffered an inability to work or function in any workplace or common social situation.
Normally investigations don’t involve an excess of adrenaline in the blood system. Or if they do, one has messed up big time. But every now and then, the only way to get a produce requires that an investigator walk where angels fear to tread, which in turn can cause an elevated heart rate.
A recent file of mine is an example of the above.
Stress claims are not the claimant/PI Attorney bonanza they were once upon a time, but they have not disappeared altogether.
This claim was based on workplace trauma and incident alleged to be so severe that our traumatized claimant could not work and filed for financial relief courtesy of the Worker’s Compensation carrier. According to her claim she could not leave her house or speak to anyone outside her immediate family.
She began treating with a psychiatrist as well. As the weeks rolled by, she showed no improvement.The examiner on the claim was among the people she could not speak to, and the claimant’s mother had to act as her representative.
Ladies of a certain age come in all varieties, as do 20-somethings and 30 somethings. The baby boom generation of ladies, like all generations of women and men alike, includes the good, the bad and the ethically challenged.
My inclination is to give little old ladies the benefit of the doubt, having had a very kindly grandmother who was good for cookies, cake and the occasional dollar bill slipped into my pocket when Mom wasn’t looking. However, if “grandmother” is the cover and distraction used to get away with a fraudulent claim that comes my way, my fondness for my grandma isn’t going to help you. If your claim is bogus, I will bust you.