Claim Rep Doing Own Sub Rosa (California)

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Claim Rep Doing Own Sub Rosa (California)

Postby stewshe on Fri Apr 09, 2010 6:05 am

My last 28 years were spent working as an applicant attorney's legal assistant or paralegal. However, prior to that I worked 8 years as first a "Claims Representative" (and later "Supervisor" of w/c claims)for an insurance co. The work involved, "all lines," but as I gained experience I was given more serious claims. Many were w/c claims with my job involving initial investigation and later follow-up to see if people were really hurt as badly as they claimed. One claim in particular really bothered me. It involved a construction worker with a non-surgical back who had been off on TD for over a year. The PTP kept extending TD, reporting low levels of ability to do the simplest physical activity, he could barely walk, not able to bend at the waist at all, etc.

I was asked to perform an "activity check," which involved basically going to visit neighbors, asking about his activity, and seeing what gossip I could pick up about him, as well as seeing if I could spot him doing anything which would contradict his TD status. The point was to see if the claim warranted a sub rosa investigation to get film on him. I drove by his house several times and finally saw him getting into his car and then drive off. He went to his daughter's school where he pushed her on a swing, kicked a soccer ball back and forth with her, even ran a bit and bent over several times to pick up the ball. I got photos of him with a still camera and telephoto lens. He saw me with the camera so I drove off. He followed me for several blocks, but I was able to "lose" him. He made a dramatic recovery when he saw his doctor a few days later! He was finally able to bend, stoop, walk normally, etc. & was returned to "try" working!

This was without a doubt the most "fun" I ever had while working as a claims rep! Now, does anyone else have a sub rosa story? I'm sure most people reading this do! Why not post them?

Stew
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Re: Claim Rep Doing Own Sub Rosa (California)

Postby rbaird on Fri Apr 09, 2010 2:23 pm

Years ago, when I was a claims examiner for a self-insured and self-administered employer, my supervisor was suspicious about a cannery worker and ordered substantial sub rosa. This was so long ago that the investigators used a panel truck and a 16 mm. camera with a telephoto lens. Anyway, they got a lot of footage of the employee slopping hogs, lifting small bales of hay, bending etc. etc. on his truck farm. The late Ed Leonard represented and the worker's attorney bailed out, so our guy was in pro per. Ed showed the film which totally contradicted his testimony about excruciating pain and asked a single question on cross: "Well?" The guy got a panicked expression and blurted out: "That ain't me!" The WCJ could hardly keep a straight face, and the take nothing followed in due course. Swear, that's the way it happened.
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Re: Claim Rep Doing Own Sub Rosa (California)

Postby stewshe on Fri Apr 09, 2010 6:11 pm

Judge Baird,

I had a similar case where films were shown at a depo and the Applicant said that the guy in the film wasn't him...it was his twin brother! The DA said something to the effect of, "Yeah, right!"

He wasn't so smug on the day of trial when the two of them showed up, dressed identically! Needless to say, the DA caved on his film. I don't know to this day if it was our guy or not. Just because he had a twin it doesn't mean it wasn't him in the film...it just makes proof a bunch more difficult.

On another occasion we had an applicant with a knee injury who was a dead ringer for her daughter. Both were "dishwater" blond, heavily tanned, a bit overweight, and wore their hair in pony tails. The defendants got photos of the daughter playing tennis. The client was happy, but when she found out, the daughter was really upset to be mistaken for her mother!

When you saw the two of them together and then the film, it was clearly the daughter playing tennis.

The last case was a lady in her early 70's, walking with a cane in the park...suddenly the film switched to another day and you could see her walking very fast, swinging her cane around and almost jogging! When she saw the film she said the first part was her, but the second was her neighbor who walked in the same park. You had to look at the two very closely to see the difference. The neighbor was about 10 years younger!

Anyone else have a good sub rosa story?

Stew
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Re: Claim Rep Doing Own Sub Rosa (California)

Postby davidd on Sun Apr 11, 2010 12:58 pm

As a young attorney I had one of those rare depositions where the claimant practically lied about everything, including about the "house moving" on which I had films. Of course I had viewed the films prior to the deposition and the claimant was very specific about how she couldn't move boxes, or load the van, etc. to my very specific questions on these topics since I knew what the films depicted. Judge Mandeville was the applicant attorney at the time. After the deposition I let Joe know about the films. I then showed him the films. That case settled very, very quickly.
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