A 40-year-old man alleged multiple injuries arising from his job as a plumber while lifting heavy machinery. He underwent hernia surgery and later felt pain in his lower back that radiated to his neck and legs. He was taken off work and remained on disability for six months.
After a year of treatment following the work-related injury, the medical records report continued complaints of high pain levels and the use of a cane. At his deposition, he testified that he is unable to work until he becomes well and has not worked for anyone else since the injury. In a Qualified Medical Evaluation (QME), he used a cane and walked with a severe antalgic gait. He had significant difficulty rising to stand up from sitting. He constantly grimaced, suggesting he was in pain.
Due to increased concern about the nature and extent of the injury and prolonged recovery time, the ICW Group Claims Examiner requested the Special Investigations Unit (SIU) perform surveillance to determine if the plumber was engaging in any activity that might impede his recovery.
Here’s Where it Gets Interesting
Over the course of three days, the former plumber appeared to work as a security guard. Dressed in a black uniform and not using a cane, he worked upwards of 9 hours each day, walking the perimeter of an apartment building and showing no visible signs of injury. Outside of working hours, he was seen inconsistently using a cane while walking to and from his vehicle.
Following the surveillance, which appeared to contradict his statement and medical reporting, the QME physician reviewed the current medical reporting and the surveillance videos. The physician noted a significant difference in his symptoms compared to the video and recommended releasing him back to full duty at work.
Due to what appeared to be a gross exaggeration of symptoms and denial of employment, the ICW Group SIU team referred this case to local authorities, who are currently reviewing it for possible criminal charges.
