| The whole point of Workers Compensation | | | | our subject. This was not a restaurant that a |
| insurance is to pay benefits to people who have | | | | normally cautious, health-conscious person such as |
| been injured on the job, and cannot work. But | | | | myself would frequent, since it was neither clean |
| what if someone is not really injured, and actually | | | | nor did it inspire confidence with regard to the |
| can still work? If they claim they are unable to | | | | protein sources for the main dishes. |
| work and collect benefits, but ARE able to work, | | | | We also had to rig up our body camera to |
| that is known as insurance fraud and it is a crime. | | | | operate out of a shirt pocket. The surveillance |
| Some people even take it a step further, by filing | | | | was going to be sufficiently complicated that I |
| a claim of total disability and collecting benefits, | | | | decided to go myself (at this point I had not seen |
| while at the same time going out and getting | | | | the restaurant or I might have thought better of |
| another job. | | | | it). I invited several others from the office to |
| When a case has indicators of possible fraud, an | | | | come since a group would provide better cover. |
| investigator is often brought in to find out the | | | | We all took off to meet our investigator in the |
| true facts. DMA Claims Services ( investigates | | | | parking lot. There we made last minute |
| suspicious cases, conducts surveillance, and if an | | | | adjustments to the camera and got a good |
| insurance claim is found to be fraudulent, turns the | | | | description of the subject. |
| information over to the insurance company. | | | | We went into the restaurant and sure enough, |
| This is a case from the DMA Claims Services | | | | there was the subject waiting on tables, cleaning, |
| Investigations archives, Part 8 of the Fraud | | | | and stocking food on the buffet. We had no |
| Chronicles, where the investigators had to endure | | | | choice but to eat, since we were on the verge of |
| hazard to their stomach linings for the sake of | | | | getting great film on the subject. We chose the |
| the bust. | | | | most innocent looking stuff we could find on the |
| Greasy Spoon Film Busts Fraudster | | | | buffet, with each of us pretty much converted to |
| By John Crittenden, Investigations Supervisor, | | | | a vegetarian state of mind. |
| DMA Claims Services San Bernardino | | | | Twisting and turning, getting up to find some |
| Our subject in this investigation claimed that his | | | | additional napkins, etc., I was able to follow our |
| injured condition caused him to be unable to sit or | | | | subject with my shirt pocket camera as he |
| stand for more than 10 minutes at a time, due to | | | | performed his duties. And then fortune smiled on |
| his restricted range of motion. | | | | us - our subject came to our table to fill our ice |
| My chief investigator had seen him leave his | | | | teas and promote future meals at the |
| apartment and tailed him to a rather seedy | | | | establishment. The closeups would be wonderful. |
| looking restaurant, where he disappeared inside. It | | | | Naturally we encouraged the idea of large parties |
| was morning and the restaurant was closed, | | | | of business people showing up and engaged him in |
| leading to a pretty good bet that our subject was | | | | several minutes of animated conversation. |
| working there, probably off the books. Our | | | | I admit we failed to clean our plates as we made |
| investigator was too conspicuous to hang out in | | | | a beeline for the office (but I dont think we |
| this neighborhood, and had already gotten a | | | | missed much in terms of desert). While we |
| thorough look-over by a car full of unknowns. He | | | | spooled the tape and waited to see if everything |
| called in and got out of there. | | | | had worked, intestinal rumblings and protests |
| We decided that we would not take a chance on | | | | afflicted each of us. Soon all discomfort was |
| our investigator having been made (i.e., spotted as | | | | forgotten - the video was perfect and our |
| an investigator by the subject) but we were not | | | | investigator gave us the final confirmation that we |
| about to pass up this potential bust. Unfortunately | | | | had the right guy. |
| the only way to see what was happening with | | | | The examiner and defense attorney loved the |
| our subject inside was to have lunch at this | | | | tape and turned the subject in for fraud after |
| greasy spoon. | | | | getting the claim thrown out. |
| I would never have been in this restaurant in the | | | | Another victory for truth, justice and lower |
| first place, if it had not been the only way to bust | | | | insurance premiums. |