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David Morse & Associates Fraud Chronicles 5: Fraud Busting at 12,000 Feet
Workers Comp costs are a true crisis for businesses around the US today. Many states have had to pass major reforms to try to ease the burden on business. One of the reason Workers Comp costs are so high is because of fraud. People will claim that they are completely disabled, and collect monthly disability checks, when in fact they are completely able to work or do other physical activity.
Investigative firms like David Morse & Associates (http://www.davidmorse.com) provide surveillance on suspicious Workers Comp claims. And if the person is found not to be disabled and it can be proven, usually by filming the person engaging in physically demanding activities, then their claim is disallowed and often the person will be prosecuted. After all, insurance fraud is against the law, and it hurts everyone by raising insurance premiums.
Over the years, DM&A investigators have been led on many unusual excursions by subjects in the course of their personal activities, unaware that they had investigative company. But the case described below exceeds all others in both altitude and difficulty.
You Can't Get Film Unless You Go Where They Go
Andy Schwarz, Investigations Manager Los Angeles
"Our subject had been collecting benefits for some time based on his assertion of total disability. I started in Denver at the subject's address. Turned out his wife was there, but the male individual we got on film was not the subject. Too bad we weren't doing divorce work - I could have closed the file.
"A canvass of the neighborhood turned up the fact that the subject was living in the mountains five hours west of Denver. I arrived late that afternoon and immediately obtained film of the subject working under an old car, crouching, crawling, bending and lifting objects of varying weight and size. Our subject was looking pretty spry.
"I quit at dusk and return the next morning. Our subject and friends departed in a jeep and headed out of town. And then uphill, a very steep hill on a very old and tattered dirt road. Fortunately the subject and myself were not the only ones putting our vehicles through their paces on this mountain trail, and I could follow without appearing out of place.
"I had rented a jeep for this assignment and I was thinking that was a particularly brilliant move on my part. I found out later that standard issue jeeps and other 4 wheel drive models are not recommended for this trail, only vehicles fitted with special protective plates underneath and special low gearing in order to ease wear and tear on the brakes coming down. But as we started up I was oblivious to my under-equipped condition.
"As we proceeded the road was getting worse but I was getting great film of the subject's vehicle performing superbly in difficult conditions and rattling its contents (including the subject) severely. I got film of stops at lookouts and our subject's confident maneuvers on foot over, around and on large rocks.
"The road was now a mule trail with a sheer drop off on one side, cliffs on the other. It was getting very cold and I was having trouble with the thin air. Turning the wheel felt like hauling a hundred-pound sack from side to side.
"Just when I thought conditions could not get worse, they did. We started down hill. It turns out that going up was a walk in the park compared to going down. And this is why they provide extra low gearing on the vehicles recommended for this road. Thank goodness I had all the film I needed, because it was now necessary, actually vital, that I concentrated on bringing my rental vehicle back instead of leaving it several thousand feet down the vertical cliff on the right.
"After a few miles, I was thinking that I was getting the hang of this and would live until tomorrow. Then, while negotiating a small stream that crossed the mule trail and dropped off the edge into oblivion, I got a flat tire. As I got out of the vehicle and stepped into 6 inches of freezing cold water, I realized that I was still suffering from oxygen deprivation, quickly found a place to sit down as far from the edge as possible and put my head between my knees.
"For those of you who have not experienced the attempt to breathe at 12,000 feet above sea level, let me give you a brief description. The body feels very heavy, there are pains everywhere, particularly the head and heart, and one wonders how a function like breathing that one took for granted suddenly became an Olympic competition.
"After some minutes of sitting there it came to me that I had to change this tire. But I was too exhausted to even look for the jack, let alone get it out of the car. Slowly it dawned on me that I was in trouble and toward the end of afternoon it was going to get really, really cold. Just then another off road vehicle came down the hill and stopped. The driver and passengers offered to help which I thankfully accepted. They changed my tire and cheerfully sent me on my way down in front of them.
"It seemed like the worst must be over. But then I hit the switchbacks, hairpin turns in the road as it snakes down a place where no road should ever go. I made the first, but on the second I went into it just a hair too fast and the back end of the jeep got loose, finding gravel over near the edge. The hair on my arms was standing straight up as I planned a leap from the jeep - and then it stopped. Even after catching my breath, no easy task at this altitude, I could not bring myself to start back down.
"My benefactors from the tire changing in the stream showed up moments later. From the position of the jeep and my very pale complexion, they know exactly what happened. An older gentleman from the party took control, offered to drive me down the hill, and I was saved. It was during this part of the trip that I learned we had just crossed Black Bear Pass, one of the more difficult off-road adventures available in the United States, and one which kills four or five people every year. I learned about the modifications made to vehicles to be used in such adventures. And of course I learned a lot about my benefactors, a family that makes the trek twice a year and has been doing so for 15 or 20 years.
"Someone put the oxygen back into the air and I found my disposition remarkably improved. I was alive and without broken bones, and the pains in the head and muscles were distant memories. The car rental company did not notice the permanent indentations my fingers left in the steering wheel. Life is good. Best of all, I had film and the subject was well and truly busted."
Another victory for truth, justice and lower insurance premiums.
About the Author: Tom Reitze is President of David Morse & Associates (http://www.davidmorse.com) , an independent investigations and claims adjusting company with 41 offices in 15 states.
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