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Hunting down comp fraud pays off for Maine insurer

Posted On: Nov. 4, 2001 12:00 AM CST

CORONADO, Calif.-When seven workers compensation recipients, with what they claimed were disabling injuries, applied for permits to hunt moose in Maine, it drew the suspicion of Maine Employers Mutual Insurance Co.

The insurer discovered the connection by comparing a published list of permit holders against its claimant database.

"We had seven people claiming they were totally incapacitated. Yet they were well enough to go out into the woods of Maine in the cold of November and shoot a moose and then drag 700 pounds of meat out onto the back of a pickup truck and take it home for the winter while they sit there collecting their weekly check from companies like mine," said John Leonard, the insurer's president.

The insurer put a squad of investigators on the claimants' trail, with some of them even posing as hunters.

Four of the seven claimants were successful in their moose hunt, and each of them was recorded on videotape dragging away their heavy kill, according to Mr. Leonard.

In one case with which the undercover investigator was asked to assist, a claimant was recorded as saying, "How good it was to be out on workers comp. You can go out in the woods like this, and nobody will ever see you."

Mr. Leonard used the example of the moose hunt sting during a panel discussion to illustrate how public information can be used to spot workers compensation fraud.

The discussion, held during the Ninth Annual Business Insurance Workers Compensation and Disability Management Conference, held Oct. 22-24 in Coronado, Calif., also covered prosecution strategies, the use of pre-employment screening and premium fraud by employers.

Other speakers on the panel included Tim East, manager of the risk management business process for the Walt Disney Co. in Burbank, Calif.; Pat McGrath, deputy district attorney for San Diego County; and Tim Fargo, president of Omega Insurance Services of St. Petersburg, Fla., who served as moderator.