Adjuster X

The Unexpected Detective

By: | April 7, 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]

Ray Simpson, the claimant, reported two days previously that he picked up a box and felt immediate, severe pain in his back.

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I drove over to meet with the plant manager and Simpson’s supervisor, who told me Simpson was about 6-foot-2, 220 pounds and very fit. I lifted one of the boxes Simpson had been unloading from a pallet and noted that it weighed about 25 or 30 pounds — not especially heavy, but still capable of causing an injury if it was lifted incorrectly.

Simpson was directed to the local ER for treatment, and later called his supervisor to see which doctor he should follow-up with.

I called Simpson at home, but there was no answer. So I called the doctor’s office, and they told me Simpson had an appointment that afternoon. When I called the doctor’s office again, the nurse told me the doctor diagnosed Simpson with lumbar strain and sprain. He recommended bed rest, pain medication and muscle relaxers, and authorized a week of lost time. The nurse noted that the doctor did not have objective findings to substantiate Simpson’s subjective complaints.

The next morning, I called Simpson’s house again, but there was no answer. In order to complete 24-hour contact, I had no choice but to go to his house unannounced. I wasn’t happy about it — Simpson lived in a neighborhood with a high crime rate.

On the steps of Simpson’s brownstone were several men who eyed me warily as I pulled up to the curb. I soon realized that my trench coat made them think I was a detective. I asked if any of the group knew Simpson.

“His apartment’s on the second floor. Don’t know if he’s in,” one of the men on the steps said.

As I made my way up, I wondered how well Simpson could climb those stairs with his bad back. There was no answer to my knock.

Back down on the steps, I asked again. One of the men said Simpson might be down at Ace’s Garage, which was two blocks away.

I parked there, and inside, I saw a group of men gathered around. One yelled, “The man’s here!” after which they scattered, leaving behind a pair of dice. I had inadvertently broken up a craps game.

On the way back to Simpson’s apartment, I saw a man fitting Simpson’s description approaching the building. I called out to him and he stopped, looked at me, and said, “Aw, come on, man. You’re not gonna bust me for gambling instead of all those other dudes who were in the game too.”

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“Let’s go for a ride and talk about it,” I said.

As I drove, I told Simpson I was a claims adjuster investigating his comp case.

“I thought you were a cop!” he said.

I replied that it didn’t take a detective to notice that his ability to bolt from the craps game indicated he wasn’t in a lot of pain.

Simpson agreed.

“With the pills Doc gave me, and some rest, it got better. In fact I’m feeling really good, and I’m ready to go back to work.”

And he did the next day. The claim wound up involving no compensable lost time. As for me, I decided my trench coat was a valuable fashion accessory.

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