From the very moment you sustain an injury on the job, your interests and those of the workers compensation carrier are at complete odds with one another. You want to receive all the medical care your injury requires and receive the full amount of lost wages you’re entitled to. The workers compensation insurance company wants to pay as little as possible for your medical care and actively pursues ways to avoid paying you lost wages. This conflict of interests exists in work comp claims as well as personal injury, products liability, and any other claim involving injuries.
Contained below are descriptions of cases involving unscrupulous and disreputable conduct engaged in by workers compensation insurance carriers. Experience has taught us to anticipate such conduct from the beginning. It’s been said that experience is the best teacher, but the tuition is more expensive than anywhere else. Metaphorically, the comparison of experience to a costly institution of higher learning is true. We’re fortunate in that the expense associated with gaining such experience is behind us.
In regard to deceptive activities engaged in by insurance carriers, helping to put our clients beyond the possibility of defeat means doing the hard, tedious, and time consuming work. It means spending the time necessary to discuss each client’s case at length. Through such discussions, we make sure our clients are aware of what information insurance companies may try and use against them.
More often than not, what you may think is a harmless statement can have a major impact. It may seem paranoid to always be on guard concerning our client’s cases, but the reality is an insurance company will take any and every opportunity to deny a claim or otherwise minimize their potential exposure. We take any and every opportunity to help ensure that does not happen. A sense of satisfaction comes from knowing that our client did not fall in one of the many hidden, unknown traps used by insurance carriers. We cannot guarantee what an insurance company will do or not do. However, we can guarantee that we will do everything we can to ensure you’re in the best position possible. Consultations with our office are free: (727) 853-6275.
An attempt to try and prove you are more physically capable than you represent yourself to be is common deceptive tactic used by insurance carriers. The purpose of doing so is to try and establish that the person is misrepresenting the severity of their injuries. “Exaggerating the significance of their injuries for the purpose of obtaining worker’s compensation benefits,” is a common phrase insurance defense attorneys and adjusters use in alleging insurance fraud. A case involving the use of this deceptive tactic involved taking video of an injured worker changing his car tire. His tire went flat because the investigators hired by the insurance company to conduct surveillance slashed his tire while he was away from his vehicle attending a doctor visit. In further detail: A workers compensation insurance carrier sent out two investigators to conduct surveillance on a particular male individual. The individual was recovering from a recent surgery to his lumbar spine. While the individual was attending a follow up doctor visit, one of the two investigators approached the injured man’s vehicle and slashed one of his tires. After intentionally destroying the injured employee’s property, the investigators retreated to a place they believed would conceal their presence. Continuing under their false belief of being concealed, these investigators videotaped the man changing his tire. The video tape of the man changing his flat tire was used by the workers compensation insurance company in an attempt to fraudulently establish the injured employee’s functional capacity exceeded what he informed his authorized treating physicians. Fortunately for this injured employee, a nurse from the doctor’s office witnessed the entire event. She reported the event to his authorized treating physician. The physician reported the incident to the insurance adjuster and the firm representing the injured worker. What ultimately transpired with respect to the criminal activity engaged in by the investigators is unknown. However, speculating that the injured employee did not experience further problems in his work comp claim is likely.
Another instance of deceptive tactics used by insurance companies involved a claim in New York. The claim resulted from a work related injury to a male employee’s left knee. He’d recently undergone a surgery to his knee. The knee surgery took place approximately three weeks before the Christmas holidays. The injured employee’s plans for the holidays involved traveling a few hours to stay with family. He reported the fact that he would be traveling to visit family to the adjuster. He was not represented by any attorney with respect to his workers compensation benefit. Because he was unrepresented, he would engage in direct communication with the insurance company. When represented, communication with the insurance company goes through our office. Controlling the transfer of information between you and the insurance company is a means of helping to ensure a favorable outcome in your claim.
With knowledge of his plans to visit family, the insurance carrier placed the man under surveillance. While under surveillance, the insurance company followed the man and his family members to a particular bar with a dance floor. The insurance company also hired the most attractive female they could find to enter this particular bar and flirt with the injured employee. Her “mission,” so to speak, was to entice the injured employee out onto the dance floor where video could be taken of him dancing and otherwise engaging in activity that the insurance company could try and use against him. Unfortunately for the injured employee, he did end up on the dance floor with this female. The video that was taken was detrimental to the outcome of his case.
While far from the only other instance of deceptive insurance practices, the remaining example for the sake of this article involved a Florida case in which an employee injured her right shoulder in a work related accident. During her deposition, she testified that she did not use her right arm when driving. The insurance company conducted surveillance that involved following her while she was driving and taking video of her as she drove. Sure enough, she did not use her right arm. In order to try and prove the woman lied in her deposition, the insurance company played the video of her driving through a television facing a mirror. The reflected playback of her driving reversed the images of her activity; thereby making it appear as though she was using her right arm. The insurance company took a second video whereby they filmed the reflected playback of her driving wherein the reversal effects made it appear as though she was using her right arm. Apparently, using a tripod to stabilize the camera used to film the reversed playback did not occur to the individuals involved with this unscrupulous scheme. After a number of minutes of playback, the camera slipped and revealed the mirror for a quick moment. The attorney representing the female saw the slip and realized what he was seeing. The attempt to wrongfully deprive this woman of her entitlement to workers compensation benefits was exposed.
Please bear in mind that you can be under surveillance at any time regardless of whether your claim involves workers compensation benefits. Hiring individuals to follow you around or sit outside your house with a video camera is not particularly expensive for an insurance company. If they can obtain video they believe will result in their successful denial of the claim, the insurance company would consider the expense of surveillance to be justified. If you have any questions about any type of legal matter, contact our office to discuss it. Call the Dolman Law Group at (727) 853-6275.
Dolman Law Group
5435 Main Street
New Port Richey, FL 34652