One of our adjusters received a claim from a part-time hospital respiratory therapist of injuries to the shoulders from lifting patients. The claimant was paid lost wages for two years.
The PQME gave the claimant a 10-pound lifting limit. In his deposition, the claimant testified that he could not, and had not, lifted more than 5 pounds. He could not lift a bag of dog food or landscaping material. If he needed it, he had to get someone to go shopping with him.
The adjuster had the claimant surveilled, finding the claimant to be more active than he claimed.
Surveillance showed the claimant doing errands, including lifting large bags of peat moss, hoisting them into his lifted truck. While shopping, he was overheard telling the clerk that he purchased shoes the same color as his ambulance.
The treating doctor and the PQME both saw the video, and both changed their medical opinions, finding that he was not truthful about his disability. The PQME raised the 10-pound limit to 50 pounds.
The claim is on hold, as the Los Angeles County District Attorney filed two felony counts of insurance fraud and perjury.