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Investigators working for the bad guys

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Old 10-26-2009, 01:59 AM   #1
thursday
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Default Investigators working for the bad guys

I spoke with a Private Investigator that does AOE/COE assessment interviews as well as surveillance on claimants looking for fraud and it was really interesting.
Some words of advice I would pass along when talking with anyone on the WC side:
If someone that presents themselves as working for the "insurance" company to ask you questions, have them clarify what insurance company it is- if not asked the may not correct you when you assume its you medical provider, Disability etc..
If you are on meds & loopy, make sure to tell this person that you are. This could alter the accountability of the conversation. In fact, it is probably a good idea to make note in a journal of any time you are in enough pain to take heavier meds.

Ultimately, it is not the investigators' jobs to "think" for the WC insurance companies they are testing a theory of fraud presented by them.
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Old 10-26-2009, 10:41 AM   #2
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I was in a car accident and the other side's private investigator follows me everywhere. (I expect him to die of boredom any minute.) It's amazing how these scum balls are allowed to flush our civil liberties down the toilet.

Anyway, there are a couple of things I'd like to add to the excellent advice above. Firstly, with long distance cameras, they can watch you without you knowing. Assume that you're always being watched.

Secondly, be careful of claiming that you can never or never do something. For example, I'm not supposed to lift my daughter. If she fell out of the car, would I reach out and grab her? Of course I would. And that's what the camera would get: me catching my daughter - not the days of suffering that action would cost me. So a better answer is "I might be able to do it in an emergency, but it would aggravate my condition for days." Make it clear that the camera is not telling the whole story. The way photographs can be manipulated today, I'm not sure what story they're telling anyway.

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Old 10-26-2009, 01:39 PM   #3
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Really good additions to the advice!! (I'm sorry you're being so hotly pursued Hockey Why not approach the scum and tell him politely that he's been "made"? hehe )

a couple of more things:
The more your case is worth, the higher the case you will be surveilled- it determines the sort of funds that are at stake to follow a claimant and what length the will go to to capture evidence.
Here in California they are not allowed to climb a tree to gain access to a view of you in your home. They can however ask your neighbor, if for a sum of money, they can hang out on their balcony in a cardboard box (if they wished) to get their shot. Also they cannot plant a bug in your house to listen in on you- if you rent though they could gain permission to do so through your landlord (again with $$) investigators can also point a large super amplified microphone at your window from a distance to eavesdrop. Also here in California the defense (the WC insurance) has to share everything they are going to present in court to our attorneys and it is up to us and our attorneys to go through that evidence with a fine tooth comb to make sure all of it was found within the law and that their were no extreme circumstances like Hockey mentioned in the previous post. It would be better to explain yourself to your atty than to a judge for the first time.
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Old 10-26-2009, 03:22 PM   #4
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here's some tips the other side gets- might be handy to know -
http://blog.reduceyourworkerscomp.com/?p=30


Here's an Oregon website with tips for the injured -
http://www.injuredworker.org/advice.htm
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Old 10-26-2009, 10:45 PM   #5
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Jo*Mar . . . I used to hire investigators. Sometimes an employer (of an injured worker) would "order" three days of surveillance. I almost always recommended against any surveillance until some background checks were done. Amazing how much more I could get with three days if I asked for licensing, real estate, and court checks . . . things like ski boats and race cars are hard to find in three days unless you have a clue leading you there, and then you can be more specific in your investigation. And you might not know that there was a messy divorce necessitating new child care issues for someone reluctant to return to work.

I used to abhor it when a client ordered surveillance. It often carried a dislike of the particular employee built into it. And believe it or not the opposite occurred too . . . employers who would not authorize surveillance on the deemed "good employee" that I had mounting evidence was less hurt than they were playing. It is an grossly overused tool in most cases. Just like the "Independent Medical Evaluation."

As much as I detested using surveillance, in my career I got film of claimants doing what they claimed was impossible:
  • I had one man on film looking over his left shoulder driving an old tractor that lacked power steering, something that should have been impossible for man who could not "turn his head or look up or down" or push or pull anything over 5#s.
  • I had another man on film working under the hood of his car after going to the bar, the bowling alley, and for a ride on his friend's motorcycle . . . and he said he couldn't walk or stand for more than a minute or two.
  • I got film of another claimant on a 24ft extension ladder who claimed he couldn't do sedentary desk work which the client offered him.
  • I obtained film of a claimant preparing for his next boxing match. Blew his claim for pain and suffering on a phony slip and fall claim to pieces.
  • Didn't even need film after the PI found out a slip and fall claimant had been charged with raping a woman in the back seat of her compact car just days after his "debilitating fall on melted snow on the floor" of a fast food chain location we insured.

On the other hand, I smugly presented one client film of their employee shopping with the kids for back-to-school clothes. When they objected, believing she was violating her restrictions, I suggested that we could ask the doctor if he felt she should not take the kids out shopping because of her work injury . . . to which they were willing to let it drop.

I always advised my clients not to expect their injured employees to stop living . . . as that was not in their best interest. A few times I actually remarked that at least they (the employer) were seeing evidence that their injured employee's conditions were improving for all the medical and rehabilitation expenses they were incurring!


Actually, the most common reasons for an employer believing a claim is worthy of a couple thousand in surveillance is an injury reported in proximity to disciplinary action, lay-off notice, demotion, schedule changes which disrupt child care, and tips from fellow employees alleging either no injury or that they have heard or seen the claimant doing work while off with an injury.
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Old 10-26-2009, 11:09 PM   #6
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The advice to keep a record of everything is critical. Keep a three-ring binder or some other very organizable system, and take it to every appointment and every meeting with you. Keep pain charts (the 1-10, best to worst type), med charts, appointment calendars, and if you have home therapy or self-treatment (like walking) document it well. Ask for copies of the previous visit's chart notes at each appointment, or at the least, major progress reports . . . and read them. Have errors or omissions in the records corrected asap by your physicians. Miss no appointments unless the reason is critical and compelling, and then call to reschedule ASAP, preferably if you can in advance.

Ask questions and participate in your healing just as if it were for a personal, not work related, injury. For remember, no matter what comes of your claim, you still have to live with the body you have. Skipping any treatments or therapies because you are afraid to return to work or unhappy at work will only hurt you in the end.

And by all means, continue to live your life as close to normally as you can. If you do have an event or activity looming that you feel you can't avoid, tell your doctor or physical therapist. For example "I am planning a beach week-end. We are taking a ferry and plan to do some driving, and a lot of walking too. Are there any activities I should avoid to prevent aggravation?" And if the doctor says have fun, at least you can say he had the chance to say no dune buggies or para-sailing . . . right? You need to use your head when doing things in public that might be interpreted as violating your work restrictions. You have to put groceries in your car when you shop, but hoisting luggage might not be so wise. A walk on the flat sand of the beach is not the same as a hike over tricky tide-waters or even body surfing! And for gosh sakes, don't lie about what you did if you do have a week-end away from home. Just say you had plans and followed the recommendations of your doctor in the activity level you observed while away.
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Old 10-27-2009, 06:32 AM   #7
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"(I'm sorry you're being so hotly pursued Hockey Why not approach the scum and tell him politely that he's been "made"? hehe )"
Hi Thursday,

The scum bag makes sure I see him. The insurance company has seen my medical records: they know I'm profoundly and permanently disabled. They also know the drunk driver they insured is 100% responsible for my injuries. The watching really isn't about trying to spot fraud - it's a form of harassment designed to make me drop my suit. Insurance adjusters are one step above child molesters - maybe.

Speaking of child molesters, I called the cops on the PI while he was snapping pictures of me and my young daughter. They gave him what for. You can't take photos of a minor without parental consent. Seriously, she was in her little swimsuit. How could I be sure this morally bankrupt scumball wouldn't keep copies to post on some pervert site?

Ambulance chasing lawyers, shady PIs, crooked adjusters, doctors for hire... there has got to be a more rational way to sort out claims. I find this side of the accident more difficult than rehab. I really don't need the stress. I wish I lived in a province with public auto insurance.

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Old 10-27-2009, 01:59 PM   #8
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Quote:
Originally Posted by Hockey View Post
"(I'm sorry you're being so hotly pursued Hockey Why not approach the scum and tell him politely that he's been "made"? hehe )"
Hi Thursday,

The scum bag makes sure I see him. The insurance company has seen my medical records: they know I'm profoundly and permanently disabled. They also know the drunk driver they insured is 100% responsible for my injuries. The watching really isn't about trying to spot fraud - it's a form of harassment designed to make me drop my suit. Insurance adjusters are one step above child molesters - maybe.

Speaking of child molesters, I called the cops on the PI while he was snapping pictures of me and my young daughter. They gave him what for. You can't take photos of a minor without parental consent. Seriously, she was in her little swimsuit. How could I be sure this morally bankrupt scumball wouldn't keep copies to post on some pervert site?

Ambulance chasing lawyers, shady PIs, crooked adjusters, doctors for hire... there has got to be a more rational way to sort out claims. I find this side of the accident more difficult than rehab. I really don't need the stress. I wish I lived in a province with public auto insurance.

Cheers

I am sorry you have to deal with this. I would have quit my job immediately if I had found I was working for a company that subscribed to these kinds of practices. Some companies would rather spend a thousand dollars to save a buck, and I used to find that kind of thinking insane, especially in comp cases, where the money should be spent to get the person well. It's like being a celebrity and struggling with the intrusive paparazzi . . . only you aren't and shouldn't have to.
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