Volume 6, Issue 3

(323) 275-2100 | Busted@dmaclaims.com | www.dmainvest.com

BUSTED: Victories for Truth, Justice, and Lower Insurance Premiums
The Case of the Telltale Cement

By a DMA Investigator

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 it was 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.

Finally we got some film - walking to school and picking up a child and walking home. Nothing to write home about, but at least the subject had made it into the viewfinder. The next day we again got non-conclusive film of the subject. He did not look or act injured - but then again he was not doing anything that would demonstrate his claimed disabilities to be false. But a good investigator gets a feeling when something is about to happen and makes the most of that.

As the second day of surveillance was winding down, our subject opened his garage door. There in the late afternoon sun was what caused our investigator's nose to twitch - bags of cement stacked high, construction equipment, and chain-link fencing. Something indeed was about to happen. The minute the garage door was closed and our subject had gone inside, the investigator was on the phone to the examiner to get an extra day. No way he was going to come this far and quit before the finish line.

The extra day was granted on the phone and the investigator was in place before the sun came up. That was smart as our subject started early and demonstrated his credentials as an experienced construction worker, not to mention his physical capability. A chain link fence and retaining wall were on the agenda, and what followed was 4 hours of film of the subject digging, using a pickaxe, picking up and carrying heavy bags of cement, using a wheelbarrow, and the crowning glory - using a jackhammer in positions and for a duration that would have hospitalized a lesser man.

Needless to say, the examiner was ecstatic. Her sense that something was not right was now documented in Technicolor. It did not take long for our subject to reach the "worst of times" - payments ended and the distinct possibility of a heart-to-heart conversation with law enforcement in the near future.

WORKERS' COMP NEWS
Postmarks Lead to Fraud Charges Against Ex-New York Man

By Claims Journal

Insurance fraud investigators in New York say a Florida postmark tipped them off that a supposedly injured man who had collected $39,000 in workers' comp benefits over 20 years was actually living and working in Florida as a mechanic.

State police arrested Kenneth R. Bullock, 52, of St. Regis Falls earlier this week. Investigators say numerous work activity reports Bullock mailed to the New York State Insurance Fund bearing Florida postmarks first aroused suspicion that resulted in an investigation by the Insurance Department's Frauds Bureau, the Insurance Fund and state police.

Read the full article here

SOURCE: 2010 Claims Journal

THE LEGAL ARENA

Contractor guilty of workers' comp fraud

By www.ocregister.com

SANTA ANA - A roofing contractor has been convicted of failing to provide workers' compensation insurance for an employee who injured himself in a fall from a roof.

Michael Amzie Hollings, 41, of Murrieta, pleaded guilty to 16 felony counts related to perjury, filing false documents, and making false statements, and is expected to be sentenced to three years in state prison at his sentencing June 25, Orange County prosecutors said.

Read the full article at here

SOURCE: 2010 www.ocregister.com

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