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 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.
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.
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.
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.
Fraud Chronicles 