Copyright 2013, The Oklahoman
Told by her doctor she needs surgery on her knee, the young woman gets a job at an Enid ice cream store and on her third day fakes falling.
The newest worker at a Shawnee manufacturing company deliberately slices her finger with a utility knife, bleeding all over the restroom, to make a superficial cut look much worse.
The fired Oklahoma City hotel manager slowly hobbles in on a cane to see a doctor. He tearfully reports being so hurt from a fall months before that he can't walk, get out of bed, bathe or dress without assistance.
Hours later, he is seen without the cane at a pool hall shooting pool.
Those are just three of the more blatant examples found in court records of ways people cheat the state's workers' compensation court system.
In the last three years, prosecutors at the Oklahoma attorney general's office have filed more than 50 workers' compensation fraud cases. And Attorney General Scott Pruitt wants businesses and insurance companies to send him more.
“No fraud is too small,” Pruitt said.
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.
“There's a lot of types of fraud,” said Vincent Antonioli, a veteran prosecutor in charge of a special unit at the attorney general's office that files workers' compensation fraud cases.
Antonioli, an assistant attorney general, said the most prevalent kind of worker fraud involves the worker who has a legitimate injury, but later exaggerates or makes false and misleading statements about his medical condition or physical limitations.
Commonly, such fraud occurs a couple of years after the injury when a patient has had medical treatment and should be getting better. Instead, the patient persists in saying the pain is still too debilitating to return to work.
The second most prevalent kind involves a worker who lies about how he was injured, Antonioli said. The worker will report he was hurt in the scope of his employment when he actually was hurt during horseplay, such as racing forklifts, he said. Other times, the worker actually will suffer some injury at home and then claim it was on the job.
Another kind involves a worker who lies about his medical history. In some cases, the worker will report injuring a body part, but not disclose he had hurt the same body part years before.
Employers also commit fraud, the prosecutor said. Some make false or misleading statements to obtain workers' compensation insurance and some operate illegally without it.
How much fraud exists is up for debate.
One workers' compensation judge, Bob Lake Grove, said he believes fraud is minuscule.
“I think most injured workers are honest,” the judge said.
Still, fraud is suspected enough to keep private investigators busy across Oklahoma.
One of the biggest firms, Winston Services in Norman, has nine investigators watching people on workers' compensation disability. Owner Robert Cox estimates the company gets 15 to 20 new cases a week.
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.