Editor's note: The self-insurance industry, born a quarter-century ago when Congress authorized the Employee Retirement Income Security Act, has grown and now insures about 70 million out of the 131 million people with private-sector insurance in the United States. With more companies choosing to self-insure, many are hiring third-party administrators to manage their claims. Davida McCloskey, vice president of claims with Birmingham, Ala.-based Attenta, a claims-management vendor, reflects on the bizarre claims that she and her colleagues have had to deal with in the past 12 months.
Q: What kind of unusual claims have crossed your desk?
A: We had some claims where the person working for the trucking company called the dispatcher and said he had lost his truck, that everything was gone and that he was in the middle of Dallas.
It turns out that his ex-wife was after him and had him attacked in the parking lot after he was on a drug buy. The guy had worked there (at his employer, a trucking company) for two days. He was in the middle of a drug buy, then they stole the whole truck, the trailer, the load.
You have one of those claims that start out appearing legitimate. The investigation turns up it was a personal issue. The wife was out to get him, knew exactly where he was, and in the middle of the drug buy, these other people show up and they steal his truck.
Then we had another trucker claim. He had stopped and called the dispatcher from out in the middle of Nevada, and the driver had a load of olives. He had been to California to pick up the olives and said that he had fallen at the truck stop when he was fueling up.
He calls up saying, "I have no money. Can you send me money for a hotel?" They sent him something like $50, but his hotel is like $8.95 (a night) so you can tell what kind of hotel (we're talking about).
It turns out there was another team driver that he didn't realize was in the area. They (the trucking company) dispatched this driver to go pick up the load. They get there and they see the truck, and it turns out that the guy had stayed for the whole weekend there and had not pursued any medical treatment. In fact, he was in one of the little casinos there and had traded off the palettes of olives for gambling money.
Then we had the claim where a route salesman (for a local bottling company) had been employed a long time. He got attacked in the parking lot outside the corporate office.
What happened was, it was actually one of their customers who attacked him because he had had an affair with the customer's wife. That turned out to be a personal issue. The guy didn't pursue it because he knew better, but it was work-related.
We had one that turned out the guy had sprained his back, and he worked for a large gas company as a meter reader. He was out and pulled his back.
We had information that he was a bodybuilder and he had probably done it bodybuilding. So we did a surveillance (on him), and it turns out he's out with his mother and gets all dressed up and they get in a car and go to a bar that's actually a public bar closed for a private party. His mother was his p.r. person who planned his stripping. It's a private party, and he lifted this 280-pound woman over his head in the process of his dance.
We showed it to the doctor, and the doctor gave him a 280-pound weight restriction on return to work. So the doctors do read those things, and they do have a sense of humor.
We have some claims where the husband is talking to you and you get this whole sob story, and it turns out that they are not even living in the same house anymore and they are using the claims money to do other things and they want you to pay them for independent care.
Q: What sectors have you found yield some of the most unusual claims?
A: Some of the funny parts of this (contractor) claim were that he was injured under bizarre circumstances to begin with, and they had him under surveillance and they caught him going to his neighbor's home, stealing a riding lawn mower, and following him to the pawn shop where he pawned the lawn mower. The guy had numerous claims. He was disabled totally, and there were other bizarre things on this claim.
Then I had one from the poultry industry. We had a mentally challenged man (a couple of months ago in Alabama)--he was a little slow--and he was saving a chicken headed to the kill floor and he threw himself under a cage weighing approximately 2,000 pounds. He did have a back injury with a three-level fusion, dislocated clavicle and cervical fractures.
We had a spider bite. It's been a rash of spider bites. We've had a bunch of them, and this particular one (claimant) immediately went to the emergency room for treatment. They kept sending her home. On the third visit, she was admitted for renal failure and acute anemia.
We've had four or five of those things in the contracting business, with the poultry business and the lawn-care (business). I don't know what it was. It was the whole Southeast. These last few months, we've had terrible spider bites.
There's a spider here called the brown recluse. If you get a regular spider bite and you're allergic, you might have a problem. But these brown recluse (spiders) will start eating away till where we've had amputations.
It's poison, and it just starts eating away at the skin. The skin just turns black. It's horrible. Some people, if they have the allergies, it's even worse. On this one, this woman did survive. But it's heavy-duty. These claims will cost thousands of dollars because of the antibiotics.
We've had two or three warehouse claims where we're starting to see these mold claims from Hurricane Katrina. Hurricane cleanup was required, and they clean up the warehouse and there are mold claims. They are not injured, they are alleging. It depends on the jurisdiction.
We actually just had one of our adjusters that just filed a mold claim. She had a pre-existing allergy to mold. It's going to be the new thing.
We have a lumber industry claim. He (the claimant) was hit by a machine as it turned to deposit its load and this employee stepped into the path of the machine, and he was thrown several feet and landed on his neck. The bizarre thing about this claim was that he was actually diagnosed as a quadriplegic, and now he's back doing his regular job with no residual problems.
He just healed. It's amazing. He was a total quad but it was a temporary situation. It was one of those "football claims," where they can't move on the field and these logs just hit him in the right place, and he came out of that. That's not exactly funny, but it's an amazing kind of claim. We had thousands and thousands of dollars on this claim, and its closed. And that was over a period of two months.
CYRIL TUOHY is managing editor of Risk & Insurance®.
December 1, 2005
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