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: Sat Mar 14, 2009 01:49 pm Post Subject: insurance
Also...something that concerns me. The OP stated she hasn't had a Dr's appt/Medical Treatment in 2 months. Does the OP KNOW this as fact? Maybe the relative IS going to Medical Treatments and not telling anyone. As I said, we really don't know ALL that is being done 'behind closed doors.'
Posted: Sun Mar 15, 2009 01:21 pm Post Subject:
Exactly! but without knowing you run and think you are ''ratting'' out your own kin that has been suffering (emotionally as well as physically) with breast cancer? :roll: pure jealousy if you ask me..
Posted: Sun Mar 15, 2009 01:25 pm Post Subject: insurance
Everyone deals with Medical issues n their own way........they can be 'open' about it ( telling family, friends, etc.) OR very 'private' with it. i would just assure the relative that you are there if she needs anything.
Posted: Mon Mar 16, 2009 10:45 am Post Subject:
My Aunt had breast cancer and I will say that the emotional pain is just as big as the physical. She started doing all kinds of things she never did befoer. She also got her life straightened aroung and went and became a nurse. Give this lady a chance to find herself and some stable ground. No one can even begin to imagine the effects cancer has on another persons life. Even all the close family members are effected. One walk down that road and this post would not even exists. It takes a VERY strong person and their outside support ( faily members, counseling, support groups) to come through something like this. What is the old saying...oh yeah..do not judge someone until you walked a mile in their shoes.
Posted: Mon Mar 16, 2009 11:52 am Post Subject:
amen sister
Posted: Mon Jun 14, 2010 10:47 am Post Subject:
STAY OUT OF YOUR SISTER'S BUSINESS. JUST BECAUSE SHE'S ILL DOESN'T MEAN SHE FEELS BAD ALL THE TIME & JUST BECAUSE SHE NEEDS $ TO LIVE DOESN'T MEAN SHE'S GOING TO SPEND IT ALL ON BILLS. IF SHE'S WORKED & PAID INTO THIS POLICY, SHE'S ENTITLED TO USE AS LONG AS SHE CAN. BE HAPPY THAT GOD HAS BEEN GOOD ENOUGH TO YOU & THE REST OF YOUR FAMILY MEMBERS NOT TO HAVE ANY MAJOR ILLNESS & THAT YOU ARE BLESSED TO BE ABLE TO GO OUT & STILL WORK. PEOPLE ALWAYS THINK THAT IF YOU'RE REALLY ILL THAT YOU HAVE TO LOOK LIKE IT AND LIVE LIKE IT; NOT SO. TEND TO YOUR OWN BUSINESS
Posted: Fri Jul 02, 2010 02:09 am Post Subject: Fraud
Yeah she can go to jail and or pay fines for this. There would definitely be a consequence. Did you tell her how you feel? That she can get into alot of trouble and even though she is making more money now, later she will get caught and it is not worth it. She could even loose her job and during recession this is not wise we all know that. I would talk with her as a friend and family member. Make her think a little. Money can cloud our judgment alot.
Or you can hire someone to take pictures and follow her discreetly then when she is caught she won't suspect it was you.
I think if you go with this I would not talk to her though like my first suggestion then she would probably suspect that you did something b/c you spoke w/ her first.
I also believe in Karma if you choose not to do anything at all what might happend is the Insurance company will tell her to go to the doctor to see if she is still not able to work. So you can wait for something to happend naturally and just take it's course. IF she is doing something bad it will come back. It always does
Posted: Sat Aug 28, 2010 02:54 pm Post Subject: Wow
You should be ashamed of your self. What a family!!
Posted: Wed Jul 11, 2012 05:28 am Post Subject: Please be grateful you are healthy
'"What is the old saying...oh yeah..do not judge someone until you walked a mile in their shoes"
This is exactly all what this is all about. You never know anything until you experience it yourself. Just be grateful and thank God you are healthy. Yes, physical injury is as worse as depression & others or I would say even worse as I am in this situation at this time.
Some people make assumptions that you have to be in bed & crippled "physically" to show you are disabled to work. And that's not true. You can even go to work better with a cast & walker on than if something is killing you inside. If your brain doesn't work, nothing else work. Hope this helps:( :arrow:
Posted: Tue May 21, 2013 02:35 am Post Subject: Cancer insurance
How ridiculous a post is this? Cancer is cancer...she had treatment? She's disabled. Now stop hating and get over it. I can't believe someone could be jealous of a cancer survivor! An anonymous phone call on your relative/friend? With friends like you.....who cares how she spends her money or her time? Kind of makes perfect sense she'd want to visit people and travel and buy a treadmill...I would want to lead a healthier life and travel if I had cancer too!
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