Fraud Investigation

Private Eye Omission Sinks WC Fraud Case

An investigator's decision to skip details ruined his credibility with the court, leading to a ruling against the employer.
By: | July 13, 2017 • 3 min read

Employers who consider hiring private investigators need to know their PI will give them all of the information they need to make informed decisions on their own — rather than manipulate the findings to make a case.

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The Louisiana 1st Circuit Court of Appeal ruled in favor of an injured worker after the private eye hired omitted key details from his report. By omitting information, the PI invalidated his own findings, and the court found his submitted video footage not credible.

Is It Fraud?

Randolph Brown was employed by Alsco Inc., a linen and uniform rental service company. In October 2014, while unloading dirty linen hampers from his work truck, Brown felt a sudden, searing pain jolt through his back, neck and shoulders. He decided to keep working despite the discomfort, hoping it would subside. However, by the next day, the pain persisted.

Brown reported the incident and began receiving workers’ comp benefits from the claims administrator, Alternative Service Concepts. An MRI revealed Brown had a tear in his right rotator cuff, and a visit to the neurosurgeon proved Brown incurred a right-sided herniated disc.

The tear was repaired surgically in February 2015. Brown needed an anterior cervical discectomy and fusion for his herniated disc in August of the same year, and after the procedure, a physical medicine and rehabilitation specialist monitored Brown’s work restrictions.

Alsco, in the meantime, hired a private investigator to tail Brown’s activity. On September 17 and 18, 2015, the PI set off with video camera in tow.

By omitting information, the PI invalidated his own findings, and the court found his submitted video footage not credible.

On September 29, 2015, Alsco notified Brown that his workers’ comp benefits would be terminated, citing that Brown had allegedly committed fraud. Brown filed a disputed claim for compensation against Alsco and Alternative Service Concepts on the same day.

In June 2016, the case went to trial before a workers’ compensation judge, who ruled in favor of Brown.

The Risk of Hiring a PI

Alsco appealed the judge’s ruling, and on June 29, 2017, Brown vs. Alsco Inc., went before the Louisiana Court of Appeals.

The court reviewed video surveillance obtained from the PI. In the film, Brown was seen riding a bicycle to and from the grocery store, washing an elliptical machine outdoors and then moving it back into his home, and attending a doctor’s appointment to which he drove himself.

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The part under most scrutiny was the doctor’s visit. He could be seen parking his car, waiting for and then greeting an unidentified man, then allowing the man to sit in his car’s driver seat while Brown attended the appointment.

This, Alsco claimed, proved Brown committed fraud. The company alleged that Brown convinced the unidentified man to act as his driver and make it look like someone had to bring Brown to his appointments. Alsco believed Brown was purposely making misrepresentations and false statements to the company to receive workers’ comp benefits.

Brown explained that he had his son in the car with him that day, and instead of bringing the boy inside, he had asked his cousin — the unidentified man from the video — to sit with his son while Brown saw his doctor.

When pressed, the PI admitted there was, in fact, a child in the car. The PI did not include the child in the video or document him in the written report. He had no explanation for the omission.

Cite: Brown v. Alsco Inc., No. 2016 CA 1670, 06/29/2017.

Autumn Heisler is a staff writer at Risk & Insurance. She can be reached at [email protected]

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