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.
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.
There are certain cases where “normal procedure” will produce no usable product while subjecting the investigator to potential difficulties. Subjects that live in very bad neighborhoods and drive as if auditioning for the demolition derby fall into this category.
This was a claim of bilateral carpal tunnel on its way to a finding of total disability. The first pass through the neighborhood in which our subject lived was not encouraging – very minimal parking in an area manned by drug dealers and their runners virtually 24 hours a day. The crack cocaine industry does not tolerate surveillance cameras or non-customers hanging around.
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.