Diagnosis: Fraud

Saturday, March 24, 2007 | 0

By Tom Reitze

This claim was based on a supposed workplace incident and trauma so severe that our traumatized claimant could not work at all, and filed for financial relief courtesy of the Worker's Compensation carrier. According to her claim the incident had caused her to not be able to leave her house or speak to anyone outside her immediate family.

She began treating with a psychiatrist as well. As the weeks rolled by, she showed no improvement. Coincidentally, the insurance examiner on the claim was among the people she could not speak to, and the claimant's mother had to act as her representative.

The psychiatrist continued to treat the claimant with no result and no idea of what might be wrong with her that might be cured. The insurance examiner on the other hand (without needing an advanced psychiatric degree) diagnosed the case perfectly. Her prescription? Put the claimant under surveillance.

The insurance examiner assigned the case to DMA Investigations. Before long, our investigator had ample videotape of this claimant, who supposedly could not leave her house or talk to anyone outside of her family, working at a hair salon on a regular basis. The video showed her laughing and chatting with customers while she did their hair. The examiner's diagnosis had been correct. A severe case of insurance fraud.

The insurance carrier decided to pursue criminal prosecution of this claimant. To get further evidence, one of our investigators showed up unannounced at the hair salon and found her there, working. He got a statement from her in which she lied repeatedly, about when she started working, her work schedule and about other activities we had filmed and documented during our investigation.

Our Special Investigations Unit packaged up the evidence and sent it to the authorities. We have recently learned that the examiner's diagnosis, combined with our investigator's effective treatment, resulted in a full cure of our "traumatized" claimant's ailment. She was arrested for insurance fraud.

Tom Reitze is the president of DMA Investigations. DMA Investigations (http://www.dmainvest.com) is an independent investigations company with 45 offices in 15 states, specializing in investigations of possible Workers Comp fraud and abuse.

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