Adjuster X

As Time Goes By

By: | February 18, 2014

This column is based on the experiences of a group of long-time claims adjusters. The situations they describe are real, but the names and key details are kept confidential. Michelle Kerr is the editor of this column and can be reached at [email protected]

Richard Cochran, a driver for Goodwin Employer Messenger Service, claimed he broke his right arm on the last run of the day when he slipped and fell getting back into the van. I arranged to meet the owner, Bill Goodwin, and we went over the routes Cochran had been assigned for the day. The weather that week had been dry and sunny, so it certainly wasn’t a case of a rain-induced slip and fall.

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Goodwin told me that after falling, Cochran had gone to the local ER, where an X-ray confirmed the broken ulna, and he was casted. Cochran was right-hand dominant, but he drove the van back to his residence for the evening and then called Goodwin to let him know.

I called Cochran to set up an in-person interview, but first I wanted to speak to the people at the printing company that was Cochran’s last delivery that day.

The receiving clerk who signed for the delivery recalled it was about 4:45 when Cochran arrived. She had noted it because it was just shy of closing time. She admitted she had not seen Cochran get back into his vehicle because she was rushing to finish her paperwork for the day.

I checked the street in front of the print shop and didn’t notice anything unusual such as construction or road work.

I then went to Cochran’s home to take his statement. He went over the route for the day, and how he fell while getting back into the van at approximately 5 p.m. He said it hurt so much that he decided to go to the ER for treatment and that he had arrived at the ER after 6 p.m.

I asked why it took over an hour when the ER was only 15 minutes from the print shop. He said there was rush hour traffic, he had originally started driving to his home before changing his mind, and that he was driving slower than normal because he could only grip the wheel with his left hand.

All of this made sense. I thanked him and headed directly to the hospital where Cochran had been treated. The ER report appeared normal, but the time of processing was listed as 7:15 p.m. That seemed odd. My antenna was up.

The next morning, I went back to Cochran’s home with only 30 minutes’ advance notice. I asked him to explain the gap between leaving the print shop at 5 p.m, and showing up in the ER at 7:15 p.m. He stared at me blankly but remained silent.

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I finally said, “After leaving the printer, you went somewhere else before you went to the ER. Where was it?” More silence. I said, “Look, if you tell me the truth, we can prevent the authorities from investigating the claim under the insurance fraud statutes, but you have to be honest with me.”

He finally said, “I went to The Rathskeller (a local tavern, about five minutes from the ER) to play a quick game of darts.” I asked how many drinks he had while there. He said, “I swear I only had two beers. When I was getting back into the van, I slipped and fell on my right arm. I wasn’t drunk. But I was afraid of what would happen if Bill found out I had the company van with me.”

I advised him that I was denying the claim under workers’ comp for obvious reasons, and that I was going to call Bill Goodwin and explain everything to him.

Telling the truth spared Cochran from criminal charges, but — not surprisingly — Goodwin terminated him for lying and for unauthorized use of a company vehicle. I shook my head as I mused that Cochran should have embraced the axiom that honesty is the best policy.

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The R&I Editorial Team can be reached at [email protected]