I heard of a claim where a company was paying an structured settlement to a worker that was unable to read or write. He had worked out an agreement that he could cash his checks using his fingerprint on the back of the checks to endorse them. During an audit of the file it was determined that the individual had lived well past his anticipated life span yet continued to cash the checks. An investigator was sent out and it turns out that the individual had died many years earlier but his descendants had cut off his finger and kept it in a jar so that they could continue to endorse the checks!
Submitted By: Neil on April 29, 2016
A female corrections officer filed a claim for workers’ compensation benefits due to her work at a state prison. She also filed a pregnancy discrimination case because the employer had a policy under which employees injured on the job were eligible for light-duty assignments, defined as clerical and other duties that would not aggravate the employee’s condition, according to the ruling. Her doctor recommended she work light duty, but the employer denied the request. As for her workers’ compensation claim, she alleged that her “injury” was her pregnancy because she became pregnant after having a consensual affair with one of the prisoners. She is stating that her pregnancy is the injury and that it is legitimate because it happened while she was on the job. The claim has been denied and we are moving forward with the case. We still cannot figure out why an attorney would ever take this workers’ compensation case!
Submitted By: Jefferson on April 28, 2016
A woman claimed injury as a result of being hit by our insured’s son with a baseball. The adjuster did some digging when investigation revealed that the young boy wasn’t even home at the time of the alleged injury, but was at school. Weather reports from the area on the date and time of the injury were remarkable. It turned out there was golf ball sized hail hitting and damaging cars in the area. The claim was denied. We believe strongly that Claimant’s alleged injuries were from golf ball sized hail.
Submitted By: Crazy on April 27, 2016
A nursing supervisor commuted to work from another city in the northeast. One afternoon while working an ice storm hit the area. The supervisor clocked out but was unable to leave because the police had closed the roads. She decided to stay in the hospital until conditions improved.
Another supervisor offered to let the supervisor to stay at her house until the weather conditions improved, and the supervisor agreed. They left the hospital and walked to the parking lot where they had parked, which was also open to the public. The supervisor went to her own car to drop off a bag she was carrying. She put the bag in her car and shut the door, but when she turned to go to the second supervisor’s car, she slipped on the ice and fell, breaking her leg and sustaining other injuries.
She filed a workers’ compensation claim, which the hospital denied. The workers’ compensation judge found that the injury was not compensable. The ice storm was not the kind of condition that subjected the supervisor to any greater risk than the general public. The court pointed out that the slip and fall occurred in a parking lot designated for employees but also open to the general public. The supervisor did not establish that her accident arose out of and in the course of her employment.
Submitted By: betty on April 26, 2016
A couple filed a claim against their Homeowner’s coverage for the loss of the husband’s wedding ring. The story goes that they were involved in a specific sexual activity and the husband lost his wedding ring. The wife was taken to the hospital and testing was done to determine if his ring had fallen off in the course of their love making. Nothing found. The couple went home and checked their video camera to see if they could figure out where the ring went. They had been filming their encounter. The video clearly showed him wearing the ring at the outset of their tryst, but it was inconclusive as to when the ring disappeared, or where. They have now filed a claim for reimbursement and the carrier is mulling over the need to see the video…
Submitted By: Neil on April 25, 2016
We received a claim for a back injury from a woman working in a downtown high-rise. She claimed that she tripped getting onto the elevator and hurt her low back. No one in her company witnessed the incident, but she stated that a man who worked two floors above was a witness. During the course of our AOE/COE investigation statements were taken from not just the injured worker, but also the man who witnessed the incident. His statement was slightly different so the investigator contacted the building management and obtained the video tape from the elevator. Both the claimant and witness were indeed seen getting on the elevator together. But… the video showed them stop the elevator for a lengthy amorous moment. The video did show the claimant injure her back… when in the middle of their love making he dropped her… Denied!!!
Submitted By: Neil on April 22, 2016
Plaintiff was trying to rescue her cat, which walked onto a portion of a roof, which was under her balcony of her condo. She stepped onto the roof and her weight caused it to collapse. The cat jumped back onto the balcony, but Plaintiff fell to the unit below, causing serious injuries. Plaintiff sued the condo association, claiming they were negligent in the construction and design of the building. At trial, the condo association prevailed, because the jury found Plaintiff to be comparatively negligent more than 50%.
Submitted By: SoftKitty on April 22, 2016
Plaintiff sued a restaurant after an allergic reaction to a pasta dish, which resulted in a hospital admission and significant bills. After obtaining Plaintiff’s past medical records and doing some investigation, it was discovered that Plaintiff had been hospitalized on multiple occasions for kidney problems that had no relation to food allergies, but she had sued several restaurants making such claim. The previous lawsuits had settled with the insurance companies paying. Now, we’re onto the scam and this case could go to trial.
Submitted By: Insanity on April 21, 2016
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