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Stories

Injured ambulance worker NOT injured

May 9, 2023

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… Read More

Categories: work comp fraud Tags: workers' compensation fraud

Major bodily injury claimed when car was going less than 2 mph?

April 12, 2023

Two years ago, an adjuster was assigned an auto injury claim involving one of our insured’s ambulances. Nothing like large commercial policy limits to whet an attorney’s appetite. Our driver admitted fault, actually offering to pay for the damage himself. It seems our ambulance caused a little damage – $530 worth –  to the Prius…. Read More

Categories: auto insurance fraud Tags: auto fraud

Fraudulent durable medical equipment helped us break up a work comp ring

March 8, 2023

When Investigation Solutions started 13 years ago, we opened an investigation into Prime Orthopedics, noting what seemed to be unreasonably high charges for durable medical equipment (DME), billed on California workers’ compensation claims. DME must be prescribed by the attending physician. The actual equipment must be certified, and it must be billed with the appropriate… Read More

Categories: work comp fraud Tags: workers' compensation fraud

Here’s what happens when an “off-the-books” employee is injured

February 15, 2023

An Arrowhead General Insurance Agency premium auditor was working on a workers’ compensation policy audit for a construction company. The employer reported having only one employee. Their policy application showed a denial of the use of subcontractors. However, the premium auditor identified two claims filed during the policy year. The employer explained that they had… Read More

Categories: work comp fraud Tags: workers' compensation fraud

Worker claims injury after he quit

January 24, 2023

ACM’s claims examiner was assigned a two-month late report: a post-termination work injury claim. The attorney reported that the claimant fell from scaffolding, two stories off the ground, suffering major injuries. The insured said the claimant did not work on the claimed date of loss, nor did any of their staff, as they are closed… Read More

Categories: work comp fraud Tags: workers' compensation fraud

Surveillance prevents an auto theft claim

October 27, 2022

A senior investigator was doing what he enjoys – personally conducting surveillance on a workers’ compensation claim in Anaheim, California. Always aware of his surroundings, the investigator saw a car stop in the middle of the street. The passenger got out, and it was clear he was particularly interested in the truck behind the investigator…. Read More

Categories: auto insurance fraud Tags: auto fraud
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Recent Stories

Injured ambulance worker NOT injured

Major bodily injury claimed when car was going less than 2 mph?

Fraudulent durable medical equipment helped us break up a work comp ring

Here’s what happens when an “off-the-books” employee is injured

Worker claims injury after he quit

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