You Can't Get Film Unless You Go Where They Go

Saturday, June 17, 2006 | 0

Fraud is an ever present factor throughout the world of insurance. Workers' Compensation may have the strongest attraction to those inclined to cheat the system due to the legal mandate requiring universal coverage. Whatever the reason, there is plenty of fraud in "them thar Workers' Comp hills" and someone has to track down the perpetrators, prove the fraud and bring them to justice. That's our job and our passion. Below we bring you the story of a successful investigation and we hope you find it of interest.

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.

"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 turns up the fact the subject was living in the mountains five hours west of Denver. We arrive late that afternoon and immediately obtain film of the subject working under an old car, crouching, crawling, bending and lifting objects of varying weight and size. Our subject is looking pretty spry.

We quit at dusk and return the next morning. Our subject and friends depart in a jeep and head out of town. And then uphill, a very steep hill, on a very old and tattered dirt road. Fortunately the subject and myself are not the only ones putting our vehicles through their paces on this mountain trail, and I can follow without appearing out of place.

I had rented a jeep for this assignment and I am thinking that was a particularly brilliant move on my part. I find 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 start up I am oblivious to my under-equipped condition.

As we proceed the road is getting worse but I am getting great film of the subject's vehicle performing superbly in difficult conditions and rattling its contents (including the subject) severely. I get film of stops at look-outs and our subject's confident maneuvers on foot over, around and on large rocks.

The road is now a mule trail with a sheer drop off on one side, cliffs on the other. It is getting very cold and I am having trouble with the thin air. Turning the wheel feels like hauling a hundred-pound sack from side to side.

Just when I think conditions cannot get worse, they do. We start down hill. It turns out that going up is 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 have all the film I need, because its now necessary, actually vital, that I concentrate 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 am thinking that I am getting the hang of this and will live until tomorrow. Then, while negotiating a small stream that crosses the mule trail and drops off the edge into oblivion, I get a flat tire. As I get out of the vehicle and step into 6 inches of freezing cold water, I realize that I am still suffering from oxygen deprivation, quickly find 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 comes to me that I have to change this tire. But I am too exhausted to even look for the jack, let alone get it out of the car. Slowly it dawns on me that I am in trouble and toward the end of afternoon it is going to get really, really cold. Just then another off road vehicle comes down the hill and stops. The driver and passengers offer to help which I thankfully accept. They change my tire and cheerfully send me on my way down in front of them.

It seems 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 make the first, but on the second I go into it just a hair too fast and the back end of the jeep gets loose, finding gravel over near the edge. The hair on my arms is standing straight up as I plan a leap from the jeep - and then it stops. Even after catching my breath, no easy task at this altitude, I cannot bring myself to start back down.

My benefactors from the tire changing in the stream show 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 takes control, offers to drive me down the hill, and I am saved. It is during this part of the trip that I learn we have 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 learn about the modifications made to vehicles to be used in such adventures. And of course I learn 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 has put the oxygen back into the air and I find my disposition remarkably improved. I am alive and without broken bones, and the pains in the head and muscles are distant memories. The car rental company does not notice the permanent indentations my fingers have left in the steering wheel. Life is good. Best of all, I have film and the subject is well and truly busted."

Andy Schwarz
Investigations Manager Los Angeles

David Morse & Associates (www.davidmorse.com) is an independent investigative firm with 36 offices in 14 states.

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