Injured Worker and Family Take a Claim Too Far

A pest control technician is suspected of magnifying his symptoms to obtain disability benefits and receive unnecessary medical treatment. It is further believed that the injured worker’s family members are colluding with these attempts to be paid for caregiving services.

In 2021, the technician fell off a roof and was admitted to the hospital for several days for a left arm fracture. It was noted that he had a brief loss of consciousness in the ambulance but improved upon arrival at the hospital. The CT scan of the head was negative.

Following his discharge from the hospital, he attended medical appointments independently and appeared mentally and physically functional from September 2021 to April 2022. Eight months after the injury, he worsened into what appeared to be a catatonic state. Although offered, he declined home health care, and his family members became more involved. He began attending medical exams with family, who claimed to be his caregivers and speak on his behalf. They claimed he was incapacitated and dependent upon them since his injury. Despite an MRI showing no signs of impairment or injury, doctors reported he presented as developmentally impaired, confused, and had difficulty engaging in the exams.

Due to the sudden decline in his condition and with no medical evidence supporting this change, surveillance was deployed by the ICW Group Claims Examiner and Special Investigations Unit. Contrary to what was being reported by his family and how he presented to doctors, surveillance showed him walking slowly at his medical appointments, assisted by family members and would arrive at his appointments as a vehicle passenger. He would later be seen driving himself and others to various locations. He would converse with family members despite them reporting that he couldn’t speak and walk to and from his vehicle without assistance.

The case was referred to law enforcement for further investigation.

Teresa Chandler
Teresa Chandler
Teresa Chandler is a Senior Special Investigations Unit Investigator with ICW Group. She served in the U.S. Navy as a Gunner's Mate for over ten years, with two deployments during Operation Enduring Freedom. She obtained her BS degree in Criminal Justice Administration and was a claims adjuster for over three years before coming to ICW Group in 2017. She is a native San Diegan, the oldest of six siblings (two Marine brothers), a world traveler, a cat mom, and an occasional dog foster mom. She also loves hiking and event planning.

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