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