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| Volume 4, Issue 17 |
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| BUSTED:
Victories for Truth, Justice, and Lower Insurance Premiums |
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| Weathering
Unfavorable Weather Conditions |
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San Bernardino County is diverse in terms of geography and includes mountains over 10,000 feet, some of the hottest deserts in the country, forests, lakes and everything in between. Many of its residents are scattered in lightly populated communities, a greater challenge to the investigator than any of the geographic features. Both aspects of America's largest county came into play in this investigation.
The subject had been collecting worker's compensation benefits for several years. His claim included the assertion of injuries from head to toe with specific restrictions for lifting, bending, stooping, range of motion and standing for long periods of time.
Our subject lived in a mountain community near a golf course, so I had to make myself almost invisible to prevent aroused suspicion. There were a few days at first where I was doubtful if this individual would ever emerge from his residence during the relatively short time periods I could position myself nearby (the cloak of invisibility has a finite duration).
After a few weeks without success, a holiday weekend was upon us. Holidays are wonderful times to find the falsely incapacitated bounding like lambs on spring days. There is something irresistible to the fraudster about a 3-day weekend that combines with a conclusion that one and all, investigators included, are on vacation.
My hopes were high as I got up early to get to our subject's residence. My hopes began to fall as I drove up the mountain. First I ran into fog. Then snowflakes began to fall and swirl. As the altitude increased, light snow grew increasingly heavy. In this weather, he'd have to be into cross-country skiing to leave the warmth of the house. And even if I did find him active, there would be no way to get film on which the subject could be ID'd. But at least I did not have to worry about being spotted.
Providence often smiles on the intrepid investigator who does not turn around and drive down the mountain the snowflakes start, the investigator who sits on a location while freezing various parts of his anatomy off. Such was the case this day.
The subject appeared in the vicinity of his driveway and started loading something into the truck, no telling what. But at least he was moving. He then got into the truck and drove away. A hint of the high hopes from earlier in the day returned - perhaps he would drive to a place where the snow was lighter and unload whatever he had loaded and I would be able to get film.
You can imagine the thrill when I tailed him onto the highway going down the mountain, out of the snow, out of inves
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the fog. Sure enough he drove all the way down to 65-degree temperatures in bright sun. But the best was yet to come. His final destination revealed what he had loaded in the truck - golf clubs.
Golf should probably receive an award from the American Society of Surveillance Investigators for the strength of its attraction to the fraudulently inclined. I have had more busts on golf courses than in any other recreational field of play.
Our subject demonstrated in clear sharp detail his ability to climb in and out of truck beds, to bend and twist, to swing a golf club and to walk for close 5 hours playing a full round (no cart for our subject). Much of this dexterity was memorialized on film, which of course made its way to our client with priority.
Knowing the "good day" defense well, our client authorized additional surveillance and was rewarded with a substantial amount of film of the subject washing his full sized truck. And on another day, excellent footage of our subject expertly docking and unloading a boat at a marina.
Our subject's repeat performances of physical activity in direct contradiction to his claim along with the complete absence of any evidence of pain or discomfort brought an end to his ill-gotten gains. If I don't miss my guess, the case will referred for prosecution.
Faint heart neither wins fair lady nor turns a day of foggy snow into a golf documentary starring our "disabled" subject.
Investigator
San Bernardino Office
DMA Claims Services
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WORKERS' COMP NEWS |
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| New
State Report Cards Released by Work Loss Data Institute |
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| By Work Loss Data Institute |
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Encinitas,
CA - Work Loss Data Institute (WLDI) announces the release of the
much-anticipated 2009 State Report Cards for Workers' Comp, using
the most current data available at this time. The report cards help
employers, insurers, TPA's, state governments and consultants answer
the questions, "Who is doing well and why?"
WLDI's State Report Cards are
based on data from OSHA Form 300's and 200's, which cover all OSHA
recordable injuries and illnesses and provide the basis for rating
state-by-state workers' compensation performance. The 2009 release
adds four more years worth of data (2003-2006) to the rankings,
which makes for a total of seven years of data since it includes
statistics collected in the last publication, which was released
in 2004.
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US Map
by Most Recent Grades US
Tier Rankings by State SOURCE:
2009 Work
Loss Data Institute |
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FRAUD
CHRONICLES Tales from the Front Lines
Insurance
fraud is a significant factor in insurance costs. Estimates of
insurance premium devoted to paying fraudulent claims range from
5% to 30% and any of these percentages translate into billions
of dollars lost.
The front
line in the fight against many types of insurance fraud is the
field investigator, armed with digital camcorder and telescopic
lens. Here is where the truth as to physical condition and claimed
disability can be found.
To obtain
a copy of Fraud Chronicles: Tales from the Front Lines, please
go to the following URL: http://www.dmainvest.com/fraudchronicles
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| THE
LEGAL ARENA |
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| AOE/COE
Investigations - Getting the Most for Your Money |
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Read the full article here |
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19
OFFICES IN CALIFORNIA, 45 OFFICES IN 16 STATES
(800)
649-7602 |
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