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]

More from Risk & Insurance

More from Risk & Insurance

Risk Management

The Profession

After 20 years in the business, Navy Pier’s Director of Risk Management values her relationships in the industry more than ever.
By: | June 1, 2017 • 4 min read

R&I: What was your first job?

Working at Dominick’s Finer Foods bagging groceries. Shortly after I was hired, I was promoted to [cashier] and then to a management position. It taught me great responsibility and it helped me develop the leadership skills I still carry today.

R&I: How did you come to work in risk management?

While working for Hyatt Regency McCormick Place Hotel, one of my responsibilities was to oversee the administration of claims. This led to a business relationship with the director of risk management of the organization who actually owned the property. Ultimately, a position became available in her department and the rest is history.

R&I: What is the risk management community doing right?

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The risk management community is doing a phenomenal job in professional development and creating great opportunities for risk managers to network. The development of relationships in this industry is vitally important and by providing opportunities for risk managers to come together and speak about their experiences and challenges is what enables many of us to be able to do our jobs even more effectively.

R&I: What could the risk management community be doing a better job of?

Attracting, educating and retaining young talent. There is this preconceived notion that the insurance industry and risk management are boring and there could be nothing further from the truth.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

In my 20 years in the industry, the biggest change in risk management and the insurance industry are the various types of risk we look to insure against. Many risks that exist today were not even on our radar 20 years ago.

Gina Kirchner, director of risk management, Navy Pier Inc.

R&I: What insurance carrier do you have the highest opinion of?

FM Global. They have been our property carrier for a great number of years and in my opinion are the best in the business.

R&I: Are you optimistic about the US economy or pessimistic and why?

I am optimistic that policies will be put in place with the new administration that will be good for the economy and business.

R&I: What emerging commercial risk most concerns you?

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The commercial risks that are of most concern to me are cyber risks, business interruption, and any form of a health epidemic on a global scale. We are dealing with new exposures and new risks that we are truly not ready for.

R&I: Who is your mentor and why?

My mother has played a significant role in shaping my ideals and values. She truly instilled a very strong work ethic in me. However, there are many men and women in business who have mentored me and have had a significant impact on me and my career as well.

R&I: What have you accomplished that you are proudest of?

I am most proud of making the decision a couple of years ago to return to school and obtain my [MBA]. It took a lot of prayer, dedication and determination to accomplish this while still working a full time job, being involved in my church, studying abroad and maintaining a household.

R&I: What is your favorite book or movie?

“Heaven Is For Real” by Todd Burpo and Lynn Vincent. I loved the book and the movie.

R&I: What’s the best restaurant you’ve ever eaten at?

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A French restaurant in Paris, France named Les Noces de Jeannette Restaurant à Paris. It was the most amazing food and brings back such great memories.

R&I: What is the most unusual/interesting place you have ever visited?

Israel. My husband and I just returned a few days ago and spent time in Jerusalem, Nazareth, Jericho and Jordan. It was an absolutely amazing experience. We did everything from riding camels to taking boat rides on the Sea of Galilee to attending concerts sitting on the Temple steps. The trip was absolutely life changing.

R&I: What is the riskiest activity you ever engaged in?

Many, many years ago … I went parasailing in the Caribbean. I had a great experience and didn’t think about the risk at the time because I was young, single and free. Looking back, I don’t know that I would make the same decision today.

R&I: What about this work do you find the most fulfilling or rewarding?

I would have to say the relationships and partnerships I have developed with insurance carriers, brokers and other professionals in the industry. To have wonderful working relationships with such a vast array of talented individuals who are so knowledgeable and to have some of those relationships develop into true friendships is very rewarding.

R&I: What do your friends and family think you do?

My friends and family have a general idea that my position involves claims and insurance. However, I don’t think they fully understand the magnitude of my responsibilities and the direct impact it has on my organization, which experiences more than 9 million visitors a year.




Katie Siegel is an associate editor at Risk & Insurance®. She can be reached at [email protected]