Aroostook County Man Guilty of Workers’ Comp Fraud
An Aroostook County trial jury today convicted an individual of theft of more than $10,000 in workers’ compensation benefits. The individual received over $45,000 in benefits from the Maine Employers Mutual Insurance Company (MEMIC) from July 2009 through February 2012 by claiming that he could not work due to an injury to his hand sustained in 2006 while working at Brewer’s Service Station in Mars Hill.
Capital Investigating saved over $400,000 dollars in medical claims over disability for company!
Saving our clients time and money.
The claimant has been ordered to perform two hundred hours of community services and the client will received $2,279.40 in restitution and an apology letter from the defendant. Your cooperation and assistance in this matter is greatly appreciated.
Saving a Buck!
“I got a call today from the Attorney regarding the claimant. He was extremely satisfied with our hard work and dedication to this file. Total savings to client $90,000!”
I wanted to reach out and recognize the work your investigator has done on this assignment. It has been a top-notch investigation from inception until today. This is how investigations should be conducted.
State of Maine vs ___________ , Sr
2/29/12 | Grand Jury Charges:
__________ , Sr. did commit theft pursuant to one scheme or course of conduct by obtaining or exercising control over the property of XXXX, such property consisting of money with an aggregate value in excess of $10,000. As a result of deception, in the course of collecting WC benefits, the Defendant did intentionally create or reinforce the impressions (1) that he was not working or performing any services for pay or (2) that hand pain prevented him from working, which impressions were false and which Defendant did not believe to be true, all in violation.
From the Sr. Adjuster: The work Capital did was great. The DVD and still photos are so clear......perfect!! What are the chances we could get an injured worker on camera hanging his own business sign on a Sunday afternoon!!
Insurance Company became suspicious of the claim and hired Capital Investigating, a private investigation company, to periodically watch the claimant. In July of 2008, investigators observed the claimant filling an oil tanker for XXX Oil and proceeding to several homes where he was seen dragging the tanker’s hose to make the deliveries. In April of 2009, The Workers’ Compensation Fraud Bureau opened an investigation into the claim. He was arrested on Dec. 7
The Chief State’s Attorney’s Office
I forgot to let you know, the claimant turned himself into the NYS Insurance Fraud Bureau on December 9, 2010. He has been charged with the following felonies: 1st degree perjury, 3rd degree Insurance Fraud, Falsifying Business Records 1st degree, Fraudulent Practices (Workers Compensation Law NYS 114-1)
So you are aware, I had a great conversation with the client in the CT office this morning. She indicated that the claimant 1 and claimant 2 cases have been sent to the States Attorney’s Office to pursue fraud. Specifically, the client stated the investigator’s report and video were the sole reason for both cases have been successful.
They continuously demonstrate excellent knowledge, service, pricing and results. They have excellent investigators who know how to utilize all of the resources available to them to make sure that they maximize their efforts, opportunities and most importantly their results for their clients…. in my 16 years in the industry.
I thought I would let you know that in this case the surveillance played a major role in helping us resolve this claim for a number we could live with. It knocked at least $200,000 off their demand.
Risk Management WC Coordinator for large Self Insured box store
I just wanted to tell you that you did a great job w/ this file. The videotape clearly shows him physically active w/ no apparent low back injury. At his doctor appointment yesterday he was determined to be at MMI continuing w/ medication only and his permanent restrictions were reviewed w/ physician per the FCE (2-3 hours per day sitting/standing/walking). Contacting employer today to see if these restrictions can be accommodated and we will either get him back to work modified duty or terminate his benefits if the employer can accommodate and he refuses to return to work.
I wanted to pass along my thanks for a job well done on this.
Needless to say, the silence on the other end of the phone was priceless when I informed the attorney this morning that his “debilitated client” managed to get to Honduras for a scuba diving trip. Photos and all!
During surveillance, The Investigator noticed that the claimant was selling lawnmowers at his residence. The claimant advertised that he fixed and sold the mowers. The Investigator had his lawnmower fixed. When he picked up the mower, he secured the money exchange on camera.
The client advised that he settled the claimant’s claims for $33,000… significant savings due to the video!!!
Your work has really paid off and this one for us!!! This was the guy with the 60% SLU of his arm that was working, and you were able to get some good video of him really using that arm and not quite as disabled as his MD thought. (Even our IME MD said he had a 47.5% impairment.
We went to hearing this morning and he was awarded a 15% SLU. That amounts to a reduction of approx $83,000 on this
“Capital still remains our number one choice for surveillance.”
TPA Claims Adjuster
SmartStart investigations… I do believe this is a great product on it’s own as well as a worthwhile product before assigning the more costly traditional surveillance… I will be focusing on goals and program cost saving measures and I have some specific ideas on how to possibly incorporate this product into our usage and standards as they pertain to SIU.
Workers Compensation Supervisor at Self Insured
I just read two of your Smart Start reports and wanted to let you know how impressed I am in the quantity and quality of information they contain.
The litigation Manager promoted the product with our entire staff via email today. I think it is a great product and very fairly priced. Great value for the money.
Thanks for your continued good work.
Disability Claims VP
Capital Investigating has been a valuable partner to us for over 5 years, handling surveillance needs throughout the Northeast. Their work product has been critical in securing information for several claims involving fraud prosecutions as well as obtaining mitigating information for hearings, mediations and litigation. Their long term record of providing investigations with a solid return on investment keeps this partnership strong. In my many years in the industry I have seen many companies come and go with inferior products; therefore, I feel confident saying that Capital is here to stay because of their superior product, communication and team of investigators.
National SIU Manager
This addendum noted the surveillance DVD’s were “quite impressive in demonstrating no concern by the patient for the position or function of the left upper extremity" … he recommended that the claimant be released to full duty work responsibilities and said he found the claimant “an unreliable subjective and objective patient.
Doctor for a WC Hearing
I just wanted to reach out and let you know what superior customer service Brian Caldwell has extended on a very challenging case (Jeffrey Xxxxx). He reached out to me on several different occasions to provide updates on activity that had occurred and to clarify what I was looking for. It is not often that this happens and in such a difficult case, the extra effort Brian put forth was greatly appreciated. He is just such a pleasure to deal with.
This is the first time in the 15 years I have been doing claims that this much effort has been put in by a surveillance vendor. I truly appreciate your efforts.
Senior WC Adjuster
I have never seen a more comprehensive report in my entire career than the background and social media reports that your company does. It provides amazing information that helps very much in my day to day. I gotta say I'm super impressed with that!
Senior WC Adjuster
below… Thanks for all your help with this claim.”
“I just wanted to drop you a quick note to say that I am very pleased with the results, the report and the reasonable service invoice. I realize that I called on a “last minute” request; however that is the way that the claim developed. I’m glad that someone was able to get on this so soon. While we’re not the biggest carrier/client that you do business with, I appreciate your excellent service. Thanks again and please pass on my kudos to your investigator.”