In this position, I receive so many press releases that it’s difficult to keep up and some sit in my email inbox unread because they don’t relate to this industry in the slightest way. However, I recently received one press release that not only caught my attention, it amazed me and inspired me to write this post about it.
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It tells of a man named Paul Colbert, who is the president and CEO of Meridian Investigative Group, a workers comp investigation company. With more than a decade of experience, Paul has seen some of the worst workers comp fraud cases in history. Below are a few of the more severe ones he shared in the email (names have been changed):
- Kristy G: She alleged that her right foot was so injured that she couldn’t walk for for extended periods of time or be a productive member at her place of employment. Video caught her walking into the doctor’s office with her crutches and ambulatory aid for her ankle. Later, she was videotaped walking around without the crutches and holding her boot in her hand, trying to hit someone with it and then walking off quickly without any aid or signs of disability.
- Kathy V: Her alleged injury was to her neck and shoulders, and in her claim, she indicated that she gets regular injections in her arm for pain. Her pain was so severe, that she could not work. Video caught her riding in a rodeo competition on two different occasions, after her date of injury.
- Eddie R: His alleged injury was to his back, left ankle and heel. Again, his injuries were to such a degree that he could not work anymore. Video captured Eddie handily pushing his pickup truck after it stalled.
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- Burt F: Burt filed a claim indicating the he was allegedly legally blind due to his workplace injury, but apparently not blind enough to prevent him from working as a maintenance man at an apartment complex. He was captured on video driving a golf cart and performing maintenance duties.
Do you know of any extreme workers comp fraud cases?
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We had a guy who was going to go perm total for problems with his wrists. We caught him on surveillance teaching his kid how to use nunchucks!
Claimant had a back injury. His job involved lifting items up to 50lbs. He had low back surgery with extensive recovery time. During that recovery time he was video recorded participating in numerous Civil War re-enactments including the unloading and carrying of numerous miniature cannons weighing 120lbs. each. When the evidence was presented for a fraud charge at the state WC level, the judge told the parties to go out into the hall and work out a nuisance value settlement because he didn’t wanted to tie up his schedule with a fraud case. Not only did the guy not face criminal charges, he walked away with cash in his pocket. These are the major problems with fraud 1) Validly injured workers deciding to “milk it” 2) State systems going out of the way to make it difficult for carrier’s to pursue charges.
Often, most of the business becomes a victim of one or other type of internal frauds or scams because they ignore the necessity of putting a proper fraud deterrent and fraud prevention system in their business or organization thus they become the victim of the fraud done by one of their employees or any outsider. And it is where the role of a fraud and risk consultant starts.
While there may be workers that fake workman comp claims most of the workman’s comp fraud is committed by companies against injured workers. Since the worker was forced to provide a Workers comp report three weeks ago, the have been harassed by supervisors at Kelly Services and American Eagle Outfitters. One day they went so far as to have three large men come out and tell the person that she had been reported dead in her car and they should get rid of the carnage. It was a very uncomfortable situation. Where they forced the reporting a day after the OT stopped their ongoing attempts to get out of needed therapy to repair the repetitive motion injury is a huge fraud. They harm the employee by fraudulently having them report a real injury they have no intention of treating and they continually attempt to get out of paying for proper care to heal an arm that was injured. From reading this website, the person has decided not to return to work where they would video her working despite the pain and insist that this represents fraud. The deep tissue repetitive motion injury is a very serious type of injury that if not provided appropriate care and therapy could result in permanent damage to someone’s arm that uses her right arm to make a living, play piano, and a variety of other daily care/activities that strains the arm.
The corporate fraud that has come to the surface in this case has initiated a full investigation of the pay checks she has received where before her arm started hurting she was concerned that they were not paying her the OT time and one-half and double time they promised. A financially challenge worker does not have a company like Esis to protect their rights, but uses their attorneys and position to FRAUDULENTLY tyrannize venerable employees. Companies may lose a few dollars due to Workers Comp Fraud, but that amount does not come close to the amount lost collectively by venerable consumers in America and around the world. There are sensors that can detect deep tissue pain, today and thus the company’s invasion of privacy is perverse and totally unnecessary to verify if the injury truly exists. Yes, some people break the law on purpose, but most of the time the law is broken by monopolies and corporations that have no entity large enough to regulate them.
I tend to think there is way more fraud in the Workers Comp AGENCY than any the clients bring to the table. Client fraud cases seem to be few and far between. However the AGENCY fraud continues on a daily basis, their methods are despicable, they do deliberately rob injured workers of their legal rights and the bottom line with the AGENCY seems to be money that insurance companies give to people like Greg Abbott who in turn provide concessions and benefits to insurance companies as a thank you. Those concessions and benefits simply mean “chase the clients away”. In Texas, it isn’t just WC. The corruption now reaches all the way to and into the State of Texas Supreme Court.