There are times when the claim reeks of fraud from the beginning. The examiner or the employer can react to red flags immediately. When this condition arises, simultaneous assignment of both AOE/COE and surveillance investigations can be an extremely effective. Chief among the many benefits of assigning an AOE/COE investigation and surveillance together is the certain knowledge of where the subject will be on the day the statement is to be taken.
While we have handled many cases in this manner, one standsout as a particularly good example. The EE was claiming almost 100% knee disability. She had her statement with our AOE/COE investigator and a doctor’s appointment scheduled for the same day, so we knew she would be active. Our investigator arrived early and was alerted to a slight movement at the door of the second story entrance to her home. Quite suddenly, the EE exited and dropped a file of papers down her steps. The investigator obtained excellent film as she moved quickly, gracefully and without apparent difficulty to retrieve the documents in several trips. Her walking and bending skills, demonstrated on steep steps, appeared completely unimpaired.
All this unexpected document retrieval made her late for her bus. She then had to bolt, while filming continued, down two flights of stairs, up the block and onto her bus. The subject’s physical conditioning, as detailed on film, was admirable. She was not even breathing deeply as she climbed the steps of the bus.
Our investigator was easily able to beat the bus to the stop closest to her doctor’s office and was able to get film of the subject slipping on the knee brace prior to her appointment.
The surveillance investigator then awaited the arrival of our subject to keep her appointment for the AOE/COE statement. Knowing the nature of the claim, it came as a small surprise to see her approach, hobbled and limping severely, requiring much time to cover a short distance.
Her assertion of nearly 100% disability due to knee injury did not stand up. In fact her assertions, when compared to film taken on the same day, undoubtedly caused her some stress as to whether she might be indicted for fraud. Thus far she has escaped that fate, perhaps some consolation for the lost disability award.
Good film is often obtained when we know where the EE will be present, such as an appointment with the AOE/COE investigator. The film before and after the meeting combined with positive, unassailable identification of the subject, has led to many successful claim resolutions.
We recommend the strategy highly when that certain scent of fraud pervades one of your files.