Your Child and Autism

The Fraud Chronicles Part 1: Dancing on Disability

Insurance fraud is an exploding problem in America. Most consumers don't realize that 25 percent of their insurance premiums are used to pay fraudulent claims.

But some are fighting back. Some investigations companies like DMA Investigations (http://www.dmaclaims.com/investigations.shtml) are working hard to uncover insurance fraud and bust the perpetrators. In many cases, this involves someone who has filed a claim for partial or total disability. We then conduct surveillance on that person to see if they really are disabled, and often we film them in the act of doing something that a totally disabled person definitely could not do. When that happens, that claim goes away and oftentimes that person will be prosecuted for fraud.

When we bust a fraud perpetrator, that helps everyone, because it helps to bring insurance premiums down. This is a case from the DMA Investigations archives, Part 1 of the Fraud Chronicles.

Dance with Me to the Hospital Darling By Jim Smith, Deputy Director, DMA Investigations

"Through years of investigations, I have often found it to be true that a fraudulent claim is a solution to a problem, and if you find out what the problem is that the person is having, you have the solution to your fraudulent claim.

"Something didn't seem right. A nurse had claimed a significant knee injury. She returned to work, then had to take off again, then back to work, then off again.

"Your trusty investigator was called in to do some surveillance and try to find out what this woman was doing while off work on a Workers Comp claim, with her significant knee injury.

"We observed and filmed her doing a wide range of normal activities, such as shopping, driving, and taking her kids to school.

"The fact that the subject showed no signs of bodily distress - the knee was not wrapped, no cane or crutches, plus the fact that she was conducting normal activities with no apparent difficulties - was the red flag that justified more surveillance.

"Shortly thereafter we filmed the subject being transported by ambulance to the hospital Emergency Room, screaming and hollering and making a fuss. In the ER, she claimed she had slipped in the shower, and demanded a specific heavy pain medication, which she was given.

"Within a week, we got film of the subject out bowling with hubby and friends for two hours, again with no apparent difficulties. Hmm.

"Within seven days of bowling, Mrs. Free and Easy turned into Mrs. Drama Queen again, with another ambulance transport to the hospital, once again screaming and hollering. Once again in the ER she said she injured herself, again by herself with no witnesses, and once again demanded her specific heavy pain medication. Doctors noticed that the type of medication demanded seemed inconsistent with the degree and type of injury.

"More surveillance was indicated. A week after the high drama ride to the ER, we got an anonymous tip that the subject had a wedding anniversary coming up, and had a big shindig scheduled at a rented hall. We suspected she might have been bragging about her time off on the company dime, and that angered one of her friends enough to tip us off. Anyway, our intrepid investigator managed to get an invitation to the party!

"So we attended the party, and surprise, surprise. We found, and filmed, our subject dancing the night away for two hours. No screaming, no hollering, no ambulances. Party Queen instead of Drama Queen.

"Shortly thereafter, the subject was interviewed by her employer, and confronted with the film we had taken, and the fact that she appeared completely normal with no knee difficulties (while out on a Workers Comp claim), other than during her hysterical trips to the hospital. Someone who is so injured they can't work, is not usually found bowling and dancing for hours at a time.

"She finally confessed to the fact that she was addicted to painkillers. She had a prescription for these, but when the prescription would run out she would fake another injury or relapse, along with a highly dramatic trip to the ER, so she could get another fix.

"So the problem (addiction to painkillers) caused her to fake a claim. Our film of inconsistent behavior broke the case and elicited the confession. We heard she was in rehab shortly thereafter."

Another victory for truth, justice, and lower insurance premiums.

Tom Reitze is President of DMA Claims Services (http://www.dmaclaims.com), an independent claims adjusting and investigations company with 42 offices in 16 states.

MORE ARTICLES:

Leave Benefits and Protections of the Short-Term Disability Program
Employees who need brief, temporary break due to certain medical conditions are entitled to short-term disability benefits. In most cases, a worker who is suffering from a serious illness and needs treatment but does not need to go on permanent disability may avail of this benefit.

National Conference on Autism to be Held in Southwest Florida
A conference on autism, "The Road to Best Practice in Autism," will be presented for physicians, parents and educators on Saturday, April 19, 2008, 8 a.m. to 4 p.m., in the Student Union Ballroom at Florida Gulf Coast University, Fort Myers, Fla. National experts in the research and study of autism and autism spectrum disorders will address a variety of topics such as the causes of autism, evaluation and treatment, early identification and intervention, treatments for symptoms associated with autism, arrangement of long-term finance for persons with disabilities, sexuality, and more.

Autism, Learning Disabilities and ADHD Experts Convene at the Help Group Summit
Two-day seminar for professionals and parents to present cutting edge information in research and best practices.

Disability Income Insurance - Protection In Troubling Times
Nobody likes to think about being disabled. Unfortunately when accidents strike they will quickly change your financial outlook. What disability income insurance options do you have if you find yourself disabled, temporarily or otherwise? In other words do you have a plan of action if you don't have, or plan to take, disability income insurance?

Obtaining Disability Benefits: An Epic Battle Unfolding
"Remember the landmark battle between David and Goliath. Statistically, David clearly had no chance of winning. It is indeed fortunate that his heart and soul did not know that and with determination, persistence and divine intervention he prevailed. Do you ever wonder what might have happened if he was aware of what he was up to? Would he have fought with the same determination or would he have run the other way?

Autism Software Available to US Schools through MAXIMUS-AutismPro Partnership
AutismPro developer Virtual Expert Clinics and MAXIMUS, leading US government service provider, announced a partnership to deliver autism software solution to the US education market.

Understanding The Differences Between Aspergers and Autism
Autistic Disorder or Autism is a developmental disability that has a crucial impact on the normal development of the brain. It affects the cognitive portions that are significant for social integration and everyday living skills. People who suffer with Autism have deficits in the areas of social interactions and communication skills.

Social Security Disability Can Be Key to Financial Future
Allsup explains financial implications of SSDI benefits, online financial planning calculators available to people with disabilities.

Cambridge Who’s Who Recognizes Maria Calcagni for Efforts to Raise Autism Awareness
Autism Speaks volunteer leader works to resolve issues.

13-Year Old Wrestling Talk Show Expert Breaking Down Barriers for Autism
13-year old wrestling expert, host of Al's Wrestling Talk making a difference for kids with autism. He was diagnosed with Asperger Syndrome, a high functioning form of autism when he was six. Alex wants the public to know that early diagnosis and intervention is crucial Alex wants people to know all kids are individuals with unique gifts and talents that need to be discovered. Big Al was selected to be spokesperson of Wrestling Autism, a fundraising event for National Autism Association and shares information about autism on the radio show.