NOT A ONE-TRICK PONY

Claimant dreams of insurance-derived wealth can complicate the most simple of claims. It may not be in my own interest to view such dreams with a critical eye, since the carrier’s need for an adjuster in the field Is a common result of an inconsistency between facts and demands.

Trucking accidents seem to generate a disproportionate number of such claimants and so I have dealt with more than a few. In this particular case our insured was clearly liable – he was rolling to a stop at a red light and failed to stop before rear-ending the claimant. The result was minor damage to the rear bumper of claimant’s pickup truck. At the scene the claimant does not seek medical attention or complain of injury.

But it was not long before he has a “I could have had a V-8 (or in this case a really big check)” moment and claims whiplash, headaches, upper back/shoulder/neck pain. My assignment is to get claimant’s statement, medical authorization and photograph the vehicle. Based on the facts available, the carrier asked me to negotiate settlement and gave me reasonable authority. But a simple settlement was not to be. Despite specials well under $1,000 the claimant had a much larger figure in mind and would not settle either the PD or BI claim.

Some months after the last treatment and after turning down a slightly increased offer, the claimant claimed recurring back and neck pain and physical limitations impacting him in life and on the job. I sense a personal injury attorney will appear in the not-too-distant future.

When one makes a career in claims working in the field outside metro areas, gaining expertise in multiple lines and a variety of investigation procedures is a necessity if one wishes to maintain a normal lifestyle. Over the years through study and experience, I have acquired many skills. One of these is surveillance and the timing seemed right to mention this investigative step to the examiner with whom I worked at the carrier.

And so, within a week of the claimant’s expansion of the claim, it came to pass that I was sitting in a park with my wife and daughter on a blanket. I had determined that the claimant would be arriving with a Cub Scout Den on a field trip this afternoon and I arranged to have a ringside seat at the playground with the perfect cover for a video camera in plain view.

The claimant is by far the most active parent in the group. He can bend over to the ground. He can lift well-fed children. He can turn his head and neck a full 90 degrees. And he can crouch, then leap high into the air extending his arms above his head. His dexterity and stamina are impressive – no physical limitation on view whatsoever.

The video goes to the carrier. The claimant does not accept the carrier’s offer and time passes. My olfactory senses are proven correct when the rep letter arrives from the PI attorney. The carrier took it from there and – with video in hand – got the earlier offer accepted. Not a big pay day for the attorney, and our claimant’s dreams of big money took a turn for the worse when his legal representative absorbed one third of what he could have had in full.

Central California adjuster/investigator
David Morse & Associates

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