| Appearances can be deceiving. Some older
| |
| | "During the course of taking statements,
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| lady might remind you of your
| |
| | it became quite clear to me that there
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| grandmother, until she starts filing
| |
| | was something wrong with the employee's
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| fraudulent insurance claims. At that
| |
| | allegations. She had been a 'problem'
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| point, the proper action is not to throw
| |
| | employee, with pending discipline, and
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| water on her but to document the fraud
| |
| | there was no report or evidence of a work
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| and turn it over to the authorities.
| |
| | related injury. Since the AOE/COE
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| DMA Claims Services ( investigates,
| |
| | investigation indicated there was
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| conducts surveillance, and if an
| |
| | something funny about her allegations, we
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| insurance claim is found to be
| |
| | suggested surveillance be conducted, and
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| fraudulent, turns the information over to
| |
| | this was authorized. We set up
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| the insurance company and the proper
| |
| | surveillance at the claimant's residence.
|
| authorities. And when that happens, the
| |
| | "The holiday season was just beginning as
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| wicked witch isn't going to melt, just
| |
| | we undertook the assignment. And our
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| end up doing some time in a small room.
| |
| | little old lady was fully into the
|
| This is a case from the DMA
| |
| | grandmother role. She drove her vehicle,
|
| Investigations archives, Part 3 of the
| |
| | shopped, carried packages, presents and
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| Fraud Chronicles.
| |
| | groceries. She picked up and carried
|
| Kindly Old Lady… or The Wicked Witch of
| |
| | small grandkids. We got film of her
|
| Insurance Fraud?
| |
| | unscrewing the kid-proof baby bottle tops
|
| By Jim Smith,
| |
| | that are so challenging for most adults.
|
| Deputy Director, DMA Investigations
| |
| | "Only one problem with this heart-warming
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| "Ladies of a certain age come in all
| |
| | scene - she was using her right arm and
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| varieties, as do 20-somethings and
| |
| | hand fully and without any limitation,
|
| 30-somethings. The baby boom generation
| |
| | contrary to the assertions on her claim
|
| of ladies, like all generations of women
| |
| | forms and to her doctor.
|
| and men alike, includes the good, the bad
| |
| | "To underscore the 'knowing' element of
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| and the ethically challenged.
| |
| | fraud (as opposed to accidentally making
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| "My inclination is to give little old
| |
| | a misstatement), our subject had two
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| ladies the benefit of the doubt, having
| |
| | medical appointments during this period.
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| had a very kindly grandmother who was
| |
| | She was driven to these medical
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| good for cookies, cake and the occasional
| |
| | appointments by another female, and
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| dollar bill slipped into my pocket when
| |
| | arrived with her arm in a sling. At each
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| Mom wasn't looking. However, if
| |
| | appointment she maintained her original
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| "grandmother" is the cover and
| |
| | assertion that she was unable to use her
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| distraction used to get away with a
| |
| | right extremity, and had to keep it in a
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| fraudulent claim that comes my way, my
| |
| | sling. Within 5 minutes of each medical
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| fondness for my grandma isn't going to
| |
| | appointment, film was obtained of our
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| help you. If your claim is bogus, I will
| |
| | subject taking off the sling and taking
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| bust you.
| |
| | over as the driver of the vehicle.
|
| "The claimant in this case was a little
| |
| | "I don't like fraud or the people who
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| old lady, who said she had gotten injured
| |
| | commit it. It's why I am good at my job.
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| on the job, and had lost ALL use of her
| |
| | Grandmother or gangster, executive or
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| right arm. She couldn't use her hand or
| |
| | laborer - if you lie about injuries in
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| fingers, and couldn't even drive.
| |
| | order to collect insurance payments and I
|
| "It began as a normal AOE/COE
| |
| | get the case, you will be busted. We may
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| investigation. This 'sweet little old
| |
| | not always have enough for prosecution,
|
| lady' could not stick with the disguise.
| |
| | but in this case we did. This file and
|
| On first contact, she became quite nasty
| |
| | evidence were forwarded to the DA and the
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| (without provocation), refused to meet
| |
| | preliminary hearing has been completed.
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| with me and immediately obtained the
| |
| | The judge has determined that the case
|
| services of an attorney. Of course this
| |
| | should go forward to a jury trial, which
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| was immediately reported to the insurance
| |
| | will commence shortly."
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| company examiner.
| |
| | Another victory for truth, justice, and
|
| "Not a cookies-and-milk type apparently.
| |
| | lower insurance premiums.
|
