by coffeeblack » Wed Feb 25, 2009 08:19 am
A close relative of mine went on short-term disability leave back in September right before having early-stage breast cancer surgery and has been receiving short-term disability payments from her employer's insurance company ever since. Following surgery and subsequent radiation (she didn't need chemo), more and more "stuff" started appearing at her house that she'd been buying with the insurance money--new clothes, a new sofa, she's talking about getting a treadmill, etc.--and spending hours online looking up genealogy-related stuff, which is a big hobby of hers. She's also taken a number of trips to see relatives around the state and has gone with them on hobby-oriented excursions for several days at a time (some of the relatives are self-employed while others are retired) and apparently having a grand old time. Meanwhile she's had no medical treatments in nearly two months--she finished radiation in January--but she says she still doesn't feel well enough to go back to work, and oh yeah, she also mentioned out loud on at least one occasion that she's making more money from short-term disability than she does from her job. But she feels really lousy and can't go back to work because she's not ready, yadda yadda yadda, but you wouldn't know it from the way she's been acting and the way she's been spending money on things she doesn't need to live.
I'm waiting to hear back from her insurance company on an anonymous call I placed to their fraud hotline, but it got me to wondering...I and many other relatives are seeing her do all of these things, but she's apparently still giving her doctor this line that she's not ready to go back to work, etc., and besides the fact that she's stealing from the system, it's really creating major tensions within the family. So what I'm asking is, once I give the insurance company the details of what I know and what I've observed, how can it be proven that she's milking the system and what can be done to stop her? In the back of my mind I'm thinking it could even get her arrested if this sort of fraud is deemed serious enough, but not having dealt with anything like this before, I'm not sure how this plays out. Anyone have any insight on the process in reporting insurance/disability fraud and how insurance investigators go about proving something like this? I realize people can't give legal advice on here, but I'm just trying to understand how the system works and anything else that might be a consideration.
I'm waiting to hear back from her insurance company on an anonymous call I placed to their fraud hotline, but it got me to wondering...I and many other relatives are seeing her do all of these things, but she's apparently still giving her doctor this line that she's not ready to go back to work, etc., and besides the fact that she's stealing from the system, it's really creating major tensions within the family. So what I'm asking is, once I give the insurance company the details of what I know and what I've observed, how can it be proven that she's milking the system and what can be done to stop her? In the back of my mind I'm thinking it could even get her arrested if this sort of fraud is deemed serious enough, but not having dealt with anything like this before, I'm not sure how this plays out. Anyone have any insight on the process in reporting insurance/disability fraud and how insurance investigators go about proving something like this? I realize people can't give legal advice on here, but I'm just trying to understand how the system works and anything else that might be a consideration.
Posted: Fri Mar 13, 2009 12:10 am Post Subject:
It sounds a lot like a similar situation I encountered with a former co-worker that was milking workman's comp with a back injury. He was getting paid his full salary since he was injured on the job (Paramedic) and was using the time off to complete home improvements. Unfortunately for him, a supervisor happened to be in his neighborhood and saw him up on the roof hauling a bundle of shingles up to the eaves. The digital camera on his phone came in handy needless to say.
As far as penalties, how somebody feels is very subjective and your relative can claim anything she chooses to her doctor. At the end of the day, if the doctor hasn't recommended she go back to work then she really can't get in too much trouble. If she was out for example for temporary blindness and she was caught watching movies, then there is something that can be proven and she could get in trouble. However, in her case all she has to do is state she doesn't feel up to it.
Although what she is doing sounds dishonest, I wouldn't be bold enough to judge and say that she couldn't possibly feel that bad if she was doing all these activities. Many people, when faced with cancer or the possibility of death, realize that life is limited...which could explain the traveling all around to see relatives, spending money, and doing things which she enjoys.
If I had to guess, and don't be too mad at me over this, I'd say your family members are a little bit jealous of the fact that they have to work while she stays home and plays. Just try and keep in mind that she may be suffering from depression or oter psychological issues. Sooner or later or disability is going to expire and she will have no choice but to go back to work.
Posted: Fri Mar 13, 2009 05:45 am Post Subject:
Hi All, I've couple of questions here.
she also mentioned out loud on at least one occasion that she's making more money from short-term disability than she does from her job.
Is it possible for someone to earn more from the disability compensation than their jobs? I guess the disability policy would only compensate a portion of the income earned.
2nd, aren’t the doctors required to perform the necessary tests to decide the progress of the patient and declare her fit at the right time? If only by claiming to the docs that she isn't yet fit enough to go back to work is sufficient for someone to continue receiving the benefits, soon many others will also take the same course to escape works.
Pinklady
Posted: Fri Mar 13, 2009 11:09 am Post Subject:
Is it possible for someone to earn more from the disability compensation than their jobs?
I honestly don't know. However.....I thought 'they' would take a % of your regular pay and that's what your Disibility would be. I have a 'personal' thought to this. Do you think your relative WOULD do something like this, COFFEBACK? I mean, 'play the system' ( sort to speak)? Also...Short-Term Disibility has to run out sometime.Posted: Fri Mar 13, 2009 12:21 pm Post Subject:
Although what she is doing sounds dishonest, I wouldn't be bold enough to judge and say that she couldn't possibly feel that bad if she was doing all these activities. Many people, when faced with cancer or the possibility of death, realize that life is limited...which could explain the traveling all around to see relatives, spending money, and doing things which she enjoys.
Chris, I couldn't agree more.... :wink: We don't know what goes on inside someone...many times thru my life I've had people say, 'well, lori I had no idea you ''acted'' fine'' (acted being the operative word here!)...If I had to guess, and don't be too mad at me over this, I'd say your family members are a little bit jealous of the fact that they have to work while she stays home and plays. Just try and keep in mind that she may be suffering from depression or oter psychological issues. Sooner or later or disability is going to expire and she will have no choice but to go back to work.
The only way I can imagine that she could 'make more' on disability is that she isn't spending what she normally would were she working. ie gas to and from work, lunches etc...i've not heard of a temp disability that paid more than 100% of your salary...
Also as mentioned temporary disability runs out (usually six months)...I have to say that I'm sorry but looks to me like there is a severe lack of compassion and empathy for this woman....she cannot stay off work unless her doc says so...so if there is a fraud being commited maybe it's her doc? which i also doubt....geeeeeeeeze give her a break she's been through a horrible ordeal... :roll:
I can't imagine what would make someone in a family (that is supposed to love you) report you like this...now if she were off for a bad back and was roofing, whole nuther' animal...but not for this...i think you did the wrong thing...sorry..
Posted: Fri Mar 13, 2009 03:31 pm Post Subject:
I have to agree with the lack of compassion. I thought as soon as I read the post "how could they be jelous of someone who was diagnosed with cancer?". Short term disability runs out soon enough so no matter what the case just let her be. I believe that she is taking a deep look at life and seeing it really is much too short so mroe power to her if she wants to try to get hers on track by visiting relatives and getting in shape.
My first hubby died of cancer and I can tell you he usually put on a good face when others were around regardless of how he felt. The word Cancer scares people away so imagine combining it with a bad or glum mood. No one would visit then. Believe me I know.
Posted: Fri Mar 13, 2009 06:07 pm Post Subject: insurance
I'm not saying she doesn't have Cancer.......I just asked if she did anything, like this, before? ...is there a history of this 'behavior'? Also..............ok..you said she is buying things she "doesn't need." What is she buying? How do you KNOW she doesn't need these things? I'm not defending either side, I'm just trying to get the facts. :roll:
Posted: Sat Mar 14, 2009 04:15 am Post Subject:
Also as mentioned temporary disability runs out (usually six months)...I have to say that I'm sorry but looks to me like there is a severe lack of compassion and empathy for this woman....she cannot stay off work unless her doc says so...so if there is a fraud being commited maybe it's her doc? which i also doubt....geeeeeeeeze give her a break she's been through a horrible ordeal...
That was my point.....she can't stay out of work only by choosing for it. Many a times a person seems okay to us when they are not actually. May be she is going out to scouting to keep her mind away from the pain, or, may be because, she has her days numbered.
Posted: Sat Mar 14, 2009 10:25 am Post Subject: insurance
PINKLADY...........I guess you can 'see' this situation BOTH ways. You DON'T know what's going on with her (Emotionally, Physically,etc.). However.........if she IS alot of pain, how can she go out and do all of these things?
Posted: Sat Mar 14, 2009 12:19 pm Post Subject:
All pain isn't physical especially with breast cancer....I can sure see how it would take time and distraction to get your head back on straight.
Posted: Sat Mar 14, 2009 01:07 pm Post Subject:
Hi all..
Remember, that we still don't know the reason why she's not being able to go back to work. There could be a number of other health factors associated with the nature of job that she's into. We shouldn't always draw a conclusion upon what's visible.
ArindamSenIndies
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