Frauds find variety of ways to cheat workers' comp system

Workers, employers and even lawyers get accused of workers' compensation fraud, The Oklahoman found from interviews and a review of dozens of court cases. In the past 13 years, Oklahoma judges have ordered restitution payments totaling more than $2.5 million in such fraud cases.
by Nolan Clay and Robby Trammell Published: March 3, 2013

Investigators rely on stealth, observing claimants from afar, to see what they are capable of doing. Investigators use video cameras to record evidence and they often work long hours. One company uses covert cameras that look like sunglasses, eyeglasses and ballpoint pens.

Most often, they are hired by insurance adjusters.

Cox said 30 to 40 percent of the time his investigators will get good video of people “engaging in activities that are inconsistent with their alleged disabilities.”

“All we're looking for is: What is the truth?” Cox said. “That's all the adjusters want. … They don't put any pressure on us to get them doing anything. They just want to know what they're doing.”

Investigators all have their stories of blatant fraud.

At Winston Services, one of their favorites is the Oklahoma City woman who used the wheelchair only at the doctor's office.

“You don't think you're going to get anything,” recalled Lance West, who supervises investigations at Winston Services. “They're saying, ‘She's in bad shape. … Just go out there and make sure everything looks on the up and up.' … Well, she comes trotting right on down out of her house to go to a doctor's appointment, just fine.

“She gets in her car, gets to the doctor's … and the next thing you know she's coming out of the back of that thing in a wheelchair. It was a machine they built for her to get her out of her own car. And, as soon as she left, she was fine.”

Also memorable was the worker caught on video removing braces from his hands, moments after leaving the doctor. The worker had claimed he had carpal tunnel syndrome.

“As soon as he gets to his car, he takes them off, polishes off a Coke, squishes the can, crunches it with his hand and slings it,” West said. “It was just amazing.”

Attorneys are to blame for some of the fraud, said Jim Kent, owner of Claim Research Services, a Tulsa-based company with seven investigators.

“A guy gets to an attorney and … says, ‘I hurt my elbow at work.' And the attorney says, ‘Well, is your back hurt? … We can get a lot more money if your back hurts.'” Kent said. “I'm not going to say they're all like that. Clearly, there are good men on both sides. But, over the years, it seems that … patterns develop.”

Most of the workers' compensation fraud cases filed in Oklahoma in the past three years involved employees accused of deception. Many pleaded guilty to a felony and were put on probation and ordered to pay restitution.

Before becoming a judge, Grove oversaw fraud investigations at CompSource Oklahoma, a major provider of workers' compensation insurance.

“We didn't just have employee fraud. We had employer fraud as well. … Fortunately, not many, I don't think. But it did happen,” he said.

Employers sometimes threatened to fire injured workers if they filed workers' compensation claims, he said.

“They would demand that the employee file on their personal health or accidental policy instead of applying for workers' compensation,” Grove said.

CompSource Oklahoma sometimes would drop businesses as customers for such violations, he said.

by Nolan Clay
Sr. Reporter
Nolan Clay was born in Oklahoma and has worked as a reporter for The Oklahoman since 1985. He covered the Oklahoma City bombing trials and witnessed bomber Tim McVeigh's execution. His investigative reports have brought down public officials,...
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by Robby Trammell
Assistant Managing Editor
Robby Trammell is news director for The Oklahoman and NewsOK.com. During his 41-year career, he has received numerous reporting awards and civic honors. With The Oklahoman’s investigative team, he won a first-place spot news reporting award for...
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