Human Resources News & Insights

Say cheese! Workers’ comp cheat caught faking on camera

An employee on workers’ comp said his duties were limited because of a back injury. However, a video showed otherwise.

What happened:

While lifting boxes at work, a man suffered a back injury which required surgery. During his recovery, he was unable to work and received workers’ comp benefits.

The employee said that pain in his leg, which was a result of the back injury, forced him to walk with a limp and limited his activities. He claimed he could only “lift a little.”

But he was caught on tape picking up and swinging his grandchildren.

In addition, when the insurance carrier’s doctor saw him, he walked with a severe limp. But when the doctor watched him walk out to the parking lot, the limp had noticeably improved.

Benefits cut off — permanently

The Workers’ Compensation Board in New York State ruled to cut off his benefits. It also ruled to disqualify him from receiving any workers’ comp in the future.

The worker appealed the decision in a state court, but the decision was upheld.

Did the worker get what he deserved, or was the court’s ruling too harsh?

Cite: Church v. Arrow Electric (PDF)

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  • Roofis Leaking

    I have had oveer 12 major surgeries, 4 of which were serious back surgeries. I am on several narcotic pain medications and several other medications to control pain, body functions and new non narcotic medications that work differently in the brain to treat neuroaupathy pain that keep me ending the pain permanetly.
    One minute I can lift my grandchild and in another minute I have to lay down. Now what does that make me? Hey, maybe some big deal CEO will hire me to be his driver and take life as it comes at him or her?

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  • http://www.workelationships.wordpress.com Joni E. Johnston, Psy.D.

    While I think most worker’s comp claims are sincere, I once evaluated a man who claimed he was physically disabled yet was literally break dancing in my waiting room before the evaluation.

  • Dave

    Just like FMLA, the game players come out by the droves. It makes it hard on the honest ones. I have video of one individual who was collecting workers comp from us and working a second job, another who took his leg cast off as soon as he got to his car, then went to his house and started to barbeque, another back injury who had to use a walker was scuba diving……I am certainly skeptical of all of them until I feel comfortable they are legit. The sad part is, I think most of game players get away with it, costing business big money.

  • Flee

    Any time you have a plan where someone feels they can get something for nothing, there is the opportunity for abuse. WC serves a useful purpose, but, there will continue to be problems when ee’s don’t have to pay for the privilege. I think ERs have to be exceptionally diligent with the claims.

  • Sue

    I can certainly relate to this article and to Dave’s experiences. I once had an employee who was collecting workers comp and when medical tests could not determine why his knee was so severely bruised and swollen and unable to heal, video showed that he was severely beating the inside of his knee with his fist (other weapons suspected as well). Another who was putting a chemical in his eye to keep it infected and when the specialist suspected foul activity, decided to sew his eye closed, the employee’s eye magically healed. In my 40+ years experience, I have also found that often times, we must watch the “good guys” who in an effort to “prove” the validity of their “injury”, will continue to work another 4 or 5 shifts following their reported injury before they actually start missing work. Many times these are very likely to malinger and/or be involved in previously planned or scheduled acitivties. I learned this valuable lesson when video showed that he boated tp an island; loaded and unloaded a tent, camping supplies to last a month including a chainsaw and the park records verified that he had reserved the spot a year in advance. Woe was I when I reviewed records and learned he had done this in 2 previous years!

  • Cindy

    While I agree most claims are ligitimate, I come across cases like this on a regular basis. A game player and typically, we have more than one day of surveillance to protest us from claimants that say one day they are fine and the next day they can hardly walk. A pattern of being able to perform the essential functions of the job is difficult to prove, but when you do, it is exciting to finally close the claim down as fraud. Most people are honest and hard working and if injured, they simply want to return to work. I had one case where a man had worked at a company for 22 years. He had a back injury and returned to work. 2 months later, he suddenly is disabled due to his back injury. We performed a surveillance and caught him working at his landscaping company while he claimed total disability. At the hearing he was asked what he was able to do while he was off of work and he said he could not move off the couch. When we showed the video, suddenly he said he had a good day and he did not get paid for cutting other people’s grass. We showed the next days video at another address and finally he was caught. All of this over $900 of comp? And of course he was terminated after working for the employer for 22 years. Make sure you have more than one day of video!

  • Julia

    I am also very much against employees who lie and cheat to receive worker’s comp. It’s completely unfair to those employees who have legitimate claims. But, what boggles my mind are the lengths in which some employers will go to prove an employee a liar. Who is following these employees around, taking these videos, etc.? And, where do they find the time. Unless employers are hiring private detectives to catch these frauds, it is my opinion that the company is wasting a lot of time and money just to be able to say, “gotcha!”

  • Cindy

    A reputable employer or TPA would only use a licensed private detective firm. I have never heard of anyone using just a guy off the street. Saying gotcha is not the point. The point is making sure employers are only paying for ligitimate injuries.

  • Another Sue

    Having a roommate with a back injury, I feel compelled to comment. I hope the vidoe surveilance went beyond the single-mentioned occurrence, as I have witnessed the fact that medications can affect what an injured person might be capable of, as does the amount of time lapsed between dosages. 30 minutes after taking pain meds, a person can be capable of doing things they might not be able to do when it is time for another dose. As with a normal (un-injured) person, good days and bad days can play a factor. We all can wake up feeling pains & stiffness depending on any given day. An injured person cannot assure that their nerves are flared up 24 hours a day. They are not the ones in control. The way they slept (if any) the previous night can affect their basic capabilities the following day. Just because my roommate occasionally has numbness and trips/falls does not mean he trips/falls every time he attempts to walk.

  • Julia

    Dear Cindy:

    No one mentioned using anyone “off the street.” I’m just very curious why an employer would spend so much time and money investigating a suspected employee of fraud. Supposedly, they’re concerned about the cost to the company. I’m sorry, but I feel that there are more honest people in the workplace than not. And, to support what Sue says, I am an employee with a chronic illness which requires me to be on pain medication 24/7. My condition is also listed under the ADA. Few days are better than others. The way I work and act depends on what kind of day I’m having and how well my medications are working that particular day. I’ve had employees on worker’s comp. who look completely normal one day and the next they’re in hospital. I also happen to be the head of the HR Department where I work. If I was suspicious of every employee taking FLMA, STD/LTD, Worker’s Comp, etc., then that’s all I’d be spending my time on. I feel very sorry for the employees who work for an employer who is so suspicious of its workers. I’m also very glad I don’t work for one.

  • Cindy

    Dear Julia – An employer decides to utilize professional surveillance because they suspect the disability may not be appropriate. It could be for several reasons. I have never had anyone ask for surveillance “just because”. Most workers’ compensation claims are ligitimate. Very few are fraud. But some people begin their disability with a ligitimate injury, and decide not to come back to work. They do everything they can to continue the disability. I do not disagree with most of what you write, however, I take exception to your remarks about an employer who decides to perform surveillance is not what would be considered a good company. When you are receiving workers’ compensation, and you are still employed by the company, it is their right to check on your disability whether it be by a second opinion evaluation or a surveillance. Possibly your employer did check on you – how would you know for sure? By performing a surveillance, it is not a personal attack, just someone checking to make sure the disability is appropriate. You should not be so defensive about this type of activity with the position you hold. Sometimes it is an appropriate tool to utilize. Keep in mind the compensation payments do not grow on trees, employers are paying this from their bottom line. They have a right to make sure it is appropriate just as you had the right to request the compensation.

  • Dave

    Cindy,
    Please! Just because you have legitimate chronic illnesses doesn’t change the fact that OFTEN, people are trying to scam the system. Wake up. If your employer isn’t suspicious and checking up on these claims, they are probably throwing thousands of dollars out the window. There might be more honest ones than not, but there are plenty of dishonest ones – I’ve seen them, and so have most in the HR profession that deal with it.

  • Dave

    whoops – my last remarks are for Julia…sorry Cindy.

  • R. B.

    I’ve had a case very similar to the one above, though he didn’t have surgery as the pain was subjective in nature. We lost in WC Court in spite of the fact we had video of the employee doing all kinds of things he supposedly couldn’t do. The video spanned many days, many events and several weeks during which the employee claimed he couldn’t even lift his arms to shoulder height and couldn’t walk without a cane. In a couple of the videos, he was lifting yard art that weighted over 100 lbs., without assistance, into the back of his pickup truck (he made these in his at-home business, which was flourishing while he was off work). He used the cane (he needed to walk), as he reached over the back of the truck, to poke the tarp down securely that he had thrown over the top of the items. In spite of such hard evidence, he was awarded a large settlement. Shortly thereafter, we had a rash of such claims, which tends to happen when one person gets away with it and brags. Go figure…

  • sickofscams

    This is the same situation we see now with autism. Autism is real. It’s serious, but because of the fraud that has infiltrated the definition of autism politics, there is some serious problems as shown on the YOU TUBE video: “autism spectrum seems out of control” and “autism epidemic out of control”

    This tells us something about human behavior. Whenever there is something good or legit, there will always be people who abuse the situation to benefit themselves so it’s really up to all of us to keep each other checked…if you see someone faking autism or faking disablity then expose them like we all should this is just wrong when people do this

  • Carol

    I have a pinched nerve (possibly herniated disc – know next week) in my neck causing numbness and severe pain from shoulder to hand. Not a WC claim. I have good and bad hours where pain in almost non-existent. My doctor has told me not to lift anything from my right arm and not to use my hand until the feeling comes back. What I don’t understand from these people is just because you have a good day – you know it won’t last and why force more down time? I’m sure with legit claims the doctors have told them things to avoid doing. I have good moments, but I’m not going to jeopardize the healing process to wash the dishes or hold my grandchild. She can sit in my lap. I want to be well, not disabled.

  • ZS

    If it is proven that the employee is cheating the system, I think it is absolutely fair for them to lose their benefits and future benefits. And, if you think about it – if he was just having a “good day”, as some people have suggested, and hurt himself further by his actions, should he be allowed to receive the full amount of benefits or extra benefits since he was responsible for delaying the healing process? They have to be held personally accountable for their decisions whether cheating or just irreponsible.

  • Shrmlady

    Julia, so what’s your point? We should let these dishonest people get away with it! In my opinion, there are a few programs and acts I’d get rid of like for example – FMLA. Which is highly abused as well.

  • Janet Brown

    I had an employee immediately after claiming he just hurt is back to a fellow employee start jumping up and down laughing and singing I just hurt my back over and over again saying he gets workers comp. I find if I follow workers comp rules and what the doctors say are the restrictions an employee who wants to cheat the system with mess it up themselves. However, if I felt the employee was being dishonest and they were following the rules I might or might not hire a detective. I don’t think there are any employers who automatically hire dectives everytime someone makes a claim. But when you have claims the more you have the higher your rates go. Which makes you have to sell your product at hire rates. So in the end we all pay. People have to stop being dishonest. You can’t get something for nothing.

  • Dave

    I once got an honest answer from a dishonest person. I asked “Why do you cheat the system?” The answer I got was “Because I can.”

  • Julia

    I wasn’t going to comment on the responses concerning my opinions. However, I find it absolutely astounding the total lack of respect my comments garnered by some of the people above.

    I have never, nor will I ever, condone any employee trying to cheat the company. I have zero tolerance for cheaters and the employees know that I will enforce all procedures and policies set forth by the company with no exceptions. However, I don’t treat my fellow co-workers with suspicion. I do not have the mind-set of “punish all for the actions of a few.” Acting on proven suspicions is what HR is supposed to do. Unfortunately, most of what I’ve read here treats all employees with suspicion. It’s an unhealthy way to run an HR department. It also speaks volumes about the morale of your companies.

    This forum is a waste of time. Some of my comments were either innocently misconstrued or deliberately twisted by others trying to get their point across. I thought this was a site that encouraged discussion and other points of view. Instead, I find it’s a site where others feel they have the right to try and beat others down.

    I have no interest in this type of forum.

  • Another Sue

    Julia,
    Don’t let a few negative minded comments direct you or your feelings. This is obviously a heated subject that accompanies much controversy. I have the misfortune of seeing it from both sides and I agree with you. I believe most people that have suffered unfortunate work injuries are only concerned with getting the injury fixed (if possible) and getting back to work. It is apparent that the individuals that have taken advantage of our system are making it bad for the rest. It is truly unfortunate that employers do often assume the employee is trying to take advantage, instead of focusing on making things right and doing right by their injured employee. I am sorry this has turned into such a negative experience for you as this should not have been the outcome.

  • Dave

    Why would you assume that those who aggressively try to catch the cheaters aren’t even more aggressive at taking care of the legitimate cases? A good HR department does both, equally as well as the other.

  • cissy

    Question:
    Have an employee who has a past WC case from another company. WC paid about $15,000.00 to close the case. Employee has spent that money (within months) and now is complaining about illnesses, needs this, needs that or cannot work. Comes in then goes home ill. After over one year of incidents getting closer and closer together, employee sent home until Doctor clears. Off employee went to clinic, got off work note and is now threating legal action if not back on schedule. What to do? I feel company is being set up for a new claim.

  • Debi

    I don’t think it’s the employer who videos the injured worker – it’s typically the insurance company. However, the insurance company won’t randomly use surveillance; only when the employer suspects foul play.

  • Ryan

    I am being accused of workers comp fraud. I resent it because I was truly hurt. I also was only on comp for 3 weeks. I had absolutely no weight restrictions and they said they have me taking a toolbox that weighs 3.5 lbs from my house to my garage. FRAUD, I am on video taking my groceries out of my car, no weight restrictions, FRAUD. I was seen leaving my house to go to therapy and a followup doctors visit. I pushed my screen door open to get out of my house and into my car. FRAUD. WHY? because I pushed the screen door open to go to the doctors and had a restriction of no pushing or pulling. How am I supposed to leave my house to go to therapy and the doctors. I bent over to tie my shoe FRAUD. Restriction no bending or kneeling. So I tied my shoe big deal FRAUD. No prolonged sitting it took me 45 minutes to drive to the doctors office to receive my therapy. FRAUD See I was sitting in my car going to the doctors office. I was seen walking out my back door and down 4 steps and then walking back up these same steps to get back into my house. FRAUD Why because I bent my knee. Where do you draw the line when a person is on WC. I think it is completely rediculous. So how am I supposed to live my life? This is a true story not made up at all. Can you beleive that all this activity is being called fraud? It is because of true life stories like mine that make people angry and abuse the system.I don’t condone that at all I am being accused of WC FRAUD. SO I really am looking forward to hearing your comments. Especially if you are a doctor or an insurance claims rep for a workers comp company. I bet they don’t have the guts to comment. Or of course they will say it is absolutely fraud and I should never be aloowed to collect benefits ever again.

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