| Insurance fraud is an exploding problem in America. | | | | apparent difficulties. Hmm. |
| Most consumers dont realize that 25 percent of their | | | | Within seven days of bowling, Mrs. Free and Easy |
| insurance premiums are used to pay fraudulent claims. | | | | turned into Mrs. Drama Queen again, with another |
| But some are fighting back. Some investigations | | | | ambulance transport to the hospital, once again |
| companies like DMA Investigations ( are working hard | | | | screaming and hollering. Once again in the ER she said |
| to uncover insurance fraud and bust the perpetrators. | | | | she injured herself, again by herself with no witnesses, |
| In many cases, this involves someone who has filed a | | | | and once again demanded her specific heavy pain |
| claim for partial or total disability. We then conduct | | | | medication. Doctors noticed that the type of |
| surveillance on that person to see if they really are | | | | medication demanded seemed inconsistent with the |
| disabled, and often we film them in the act of doing | | | | degree and type of injury. |
| something that a totally disabled person definitely could | | | | More surveillance was indicated. A week after the high |
| not do. When that happens, that claim goes away and | | | | drama ride to the ER, we got an anonymous tip that |
| oftentimes that person will be prosecuted for fraud. | | | | the subject had a wedding anniversary coming up, and |
| When we bust a fraud perpetrator, that helps | | | | had a big shindig scheduled at a rented hall. We |
| everyone, because it helps to bring insurance | | | | suspected she might have been bragging about her |
| premiums down. This is a case from the DMA | | | | time off on the company dime, and that angered one |
| Investigations archives, Part 1 of the Fraud Chronicles. | | | | of her friends enough to tip us off. Anyway, our |
| Dance with Me to the Hospital Darling | | | | intrepid investigator managed to get an invitation to the |
| By Jim Smith, Deputy Director, DMA Investigations | | | | party! |
| Through years of investigations, I have often found it | | | | So we attended the party, and surprise, surprise. We |
| to be true that a fraudulent claim is a solution to a | | | | found, and filmed, our subject dancing the night away |
| problem, and if you find out what the problem is that | | | | for two hours. No screaming, no hollering, no |
| the person is having, you have the solution to your | | | | ambulances. Party Queen instead of Drama Queen. |
| fraudulent claim. | | | | Shortly thereafter, the subject was interviewed by her |
| Something didnt seem right. A nurse had claimed a | | | | employer, and confronted with the film we had taken, |
| significant knee injury. She returned to work, then had | | | | and the fact that she appeared completely normal |
| to take off again, then back to work, then off again. | | | | with no knee difficulties (while out on a Workers Comp |
| Your trusty investigator was called in to do some | | | | claim), other than during her hysterical trips to the |
| surveillance and try to find out what this woman was | | | | hospital. Someone who is so injured they cant work, is |
| doing while off work on a Workers Comp claim, with | | | | not usually found bowling and dancing for hours at a |
| her significant knee injury. | | | | time. |
| We observed and filmed her doing a wide range of | | | | She finally confessed to the fact that she was |
| normal activities, such as shopping, driving, and taking | | | | addicted to painkillers. She had a prescription for these, |
| her kids to school. | | | | but when the prescription would run out she would |
| The fact that the subject showed no signs of bodily | | | | fake another injury or relapse, along with a highly |
| distress the knee was not wrapped, no cane or | | | | dramatic trip to the ER, so she could get another fix. |
| crutches, plus the fact that she was conducting normal | | | | So the problem (addiction to painkillers) caused her to |
| activities with no apparent difficulties was the red flag | | | | fake a claim. Our film of inconsistent behavior broke |
| that justified more surveillance. | | | | the case and elicited the confession. We heard she |
| Shortly thereafter we filmed the subject being | | | | was in rehab shortly thereafter. |
| transported by ambulance to the hospital Emergency | | | | Another victory for truth, justice, and lower insurance |
| Room, screaming and hollering and making a fuss. In | | | | premiums. |
| the ER, she claimed she had slipped in the shower, and | | | | Tom Reitze is President of DMA Claims Services ( an |
| demanded a specific heavy pain medication, which she | | | | independent investigations and claims adjusting |
| was given. | | | | company with 42 offices in 16 states. |
| Within a week, we got film of the subject out bowling | | | | . |
| with hubby and friends for two hours, again with no | | | | |