Workman’s Comp

[Marshal Mo Hare, SASS #45984]

I was reminded today of two cases that my late wife related. She was a Physical Therapist. There were two workmen’s comp cases that she got on the same day. The idea is to evaluate the claimant’s injury for the insurance company.

 

#1 This fellow had a disabling back injury. She did all the required tests and when finished escorted the patient to the desk for checkout. The patient’s wife and son were waiting for him. He picked up his son and tossed him to the ceiling and caught said son with no apparent pain. Of course, this went into her report.

 

#2 The Ins Co definitely screwed up. They were supposed to only send the claimant’s medical history. The file included a private detective’s report of observing the claimant sneaking out his back door and going to various convenience stores to buy scratch tickets.

[LawMan Mark, SASS #57095L]

A construction worker for US/TVA filed a claim alleging a back injury while working at Yellow Creek NP.  Six weeks later, an investigator produced video of him water skiing a couple of days after the claim.  He was terminated, and all claims denied, including doctor's bills.  

[Subdeacon Joe]

Re back pain.  I can carry groceries, change a tire, vacuum, etc.  But if I'm in the kitchen I can stand and peel two potatoes and chop an onion and then have to lean on the counter or sit down to keep doing more.   It's not always clear cut.  

[Marshal Mo Hare, SASS #45984]

17 minutes ago, Subdeacon Joe said:

Re back pain.  I can carry groceries, change a tire, vacuum, etc.  But if I'm in the kitchen I can stand and peel two potatoes and chop an onion and then have to lean on the counter or sit down to keep doing more.   It's not always clear cut.  

I understand. I can do five or ten minutes before needing to sit.  When I’m baking something, I must plan the breaks, can’t overlap bake and prep.

[Muleshoe Bill SASS #67022]

There always cheats to everything: income taxes, spouses, school, insurance, preachers,politicians.  To cherry pick a few "cases" and thereby attempt to  impugn  workman's compensation cases as generally fraudulent is disingenuous.  To be fair on your part, tell us how many work-comp cases your wife evaluated that were legit, or a ratio of good to bad cases.

 

In my work (many years ago but still valid) there were fraud cases and ones that would break your heart.  Worst injury on the job - a letter carrier loading his mail (in Houston) properly following all safety rules, was injured when a driver ran into him and back of his vehicle. He lost both legs, had brain damage from hitting the road surface after the other car tried to back up.  The Carrier died about a year later from complications.  Fraud case - Latter Carrier claimed back injury - the Postal Inspectors videoed him changing battery out on his truck, and rotating tires. Removed and charged with theft.  From my experience - valid to fraud ration 9 - 1. 

[Cypress Sun]

During my 40++ years in the construction (electrician) industry, I've seen plenty of people file both real and fraudulent Workmans Comp Claims. I've seen real injuries questioned so much by claims investigators that the person injured was treated like a liar and a thief. Their claims were eventually approved but it took a while for the "compensation" part to be awarded. For people who don't know, many construction workers live paycheck to paycheck. Any disruption of pay results in bad things happening...like getting behind on mortgages, car payments, credit card defaults, etc.

 

That said, I've also seen plenty of fraud. One guy sticks in my memory, name was Jim. Jim was actually a pretty good electrician, but he had a drug problem. Jim would change jobs about every 3 months. At every job, Jim would work for a week or two and then, with no witnesses, he would always "injure" his back or something else so that he would get an RX for pain killers. Don't know what ever became of Jim. It's too bad, I liked Jim and he did good work...when he wasn't "injured".

 

I've had various Workmans Comp claims over the years. It wasn't hard for them to verify that the injuries were real or not. Blood, stitches and burns and bandages aren't easy to fake.

[The Shoer 27979]

5 hours ago, Subdeacon Joe said:

Re back pain.  I can carry groceries, change a tire, vacuum, etc.  But if I'm in the kitchen I can stand and peel two potatoes and chop an onion and then have to lean on the counter or sit down to keep doing more.   It's not always clear cut.  

That's about all I am good for too

 

I filled a claim couple months before I retired. I was driving truck for about 5 years before I retired, a couple months before that I got rear ended by another semi truck. My boss made me go to DR and he also said they would have workers comp paperwork started before I got back to the yard

[Red Gauntlet , SASS 60619]

In 44 years of trial practice, doing a lot of personal injury defense, I had only one case where I was actually able to prove fraud with respect to the claimed injuries. The claimant was so obviously phony that we had her testify to some specific things she could not do, and then eventually got video of her doing those things with great vigor.

 

Most surveillance explored in suspicious cases never panned out to the point where it was useful.

 

My own assessment down the years was that exaggeration of injuries was common enough, actual faked injuries far less so and hard to prove anyway.