Insurance fraud costs insurance companies and, subsequently, their customers, a huge amount of money every year. We believe that insurance companies do want to pay the legitimate claims as much as they want to ferret out the cases where claims are fraudulent. But it is often difficult to tell the difference.
Soft tissue injuries are difficult to prove or disprove. Sometimes these are part of slip and fall injury claims, sometimes the underpinning of a personal injury investigation or an auto bodily injury investigation. In this case, it was a both a workers compensation fraud investigation and a long term disability fraud investigation.
This memorable case was that of a young man who said he was hurt at work. No one witnessed the accident, but he claimed the injuries were bad enough to prevent him from working. The young man had previously been a motocross racer and he was healthy and fit before the accident. After, he hobbled into a deposition and submitted to an independent medical examination (IME). The doctor noted the patient had difficulty straightening up and his gait was not regular. He also noted that after several steps the patient asked to sit.
The patient was sent to physical therapy and his progress was slow, if any progress was made at all. After many weeks, the adjuster requested an investigator take a look at the young man’s activity for a few days.
The worker compensation fraud uncovered became a story seasoned adjusters shared for a long time with new adjusters.
The investigator videotaped an afternoon of the young man atop a race motorcycle, running laps at a local circuit. After further investigation, it was revealed that he was in training for a big pro race coming up. The investigator compiled everything into a report and presented it to the adjuster. The insurance company asked the investigator to attend the race to see if the claimant was a contestant and videotape what he found.
Well, you know what he found, don’t you? Indeed, the racer was competing. The funny part was that he did pretty well – ending up on the podium.
As is often the case here at International Investigators, we don’t know if the end result was a denied long term disability insurance claim or a trial. No matter which, we are pretty sure he didn’t feel too good ending up as the star of this video.
-T. Wilcox, CEO, International Investigators