When it Comes to Fraud Don’t Settle for Less Than FHM

At FHM, we take an aggressive stance on overstated and fraudulent claims. Recently, we proved our point to a maintenance worker whose claim got “out of hand.”

While assisting with laying irrigation pipe, the employee twisted his left wrist, resulting in a fracture and sprain/strain injury to that wrist. After being referred to a hand specialist, the employee’s wrist was put in a cast and physical therapy and steroid injections were prescribed. Claiming no relief from the pain, the employee underwent surgery.

Shortly after surgery, the claimant suffered a stroke. His physician alleged the stroke was related to his high intake of anti-inflammatory drugs for pain control, and was leaning toward pronouncing the claimant permanently and totally disabled. To speed conclusion of the claim, our adjuster asked for and received approval for private mediation. Based on case information, our adjuster also got authority from FHM’s General Counsel to settle for $185,000.

All seemed set until a few days before the mediation date, when an FHM surveillance investigator captured indisputable film of the claimant working on his car, wielding a wrench in his left hand for an extended period of time.

At the mediation table, the film was shown to the claimant and his attorney. The reaction was immediate. Settlement demands were dropped to $13,000 plus payment of some minor medical bills. Once again, FHM’s aggressive fraud investigations paid off – this time with savings of well over $150,000.

A Policy to Control Fraud – Case by Case

  • Aggressive pursuit of potentially fraudulent and overstated claims
  • Savings of over $150,000
  • Improved employee morale by keeping abuses to a minimum

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