Disproving Workers Comp Fraud by Dying
Fraud is something that is discussed a great deal in our industry. Indeed, it is a matter of great concern, and at times is not pursued as aggressively as we might wish. Still, we occasionally come across a story that should serve as a lesson to us all; that allegations of fraud are simply that, and that improperly conducted investigations and false accusations of fraud can destroy innocent people's lives.
A man in Tampa, Florida recently demonstrated the potential pitfalls of misguided fraud prosecution, and he did so in the most dramatic way possible. He died from the condition he was accused of lying about.
That's one way to get out of your trial.
David Brownell's trial for insurance fraud was scheduled to begin December 2nd. He was arrested last November, accused of faking a respiratory illness and cheating the state of Florida. His claim was centered on exposure to rats and rat feces while he worked for the Glades Correctional Institution. He claimed that he developed breathing problems as a result of that exposure. The state accused him of misrepresenting his physical abilities, while collecting more than $2.7 million in benefits since 1995.
Video surveillance used against him showed that he was not oxygen-dependent as he claimed; this according to the Florida Department of Financial Services' Division of Insurance Fraud. They alleged he was able to play guitar in a band, attend a concert, drive and smoke cigarettes. His wife disputes that, saying the cigarette claim is patently false. Candace Brownell says, “He never smoked a day in his life”. She admitted that they did ”occasionally go out to dinner, drive, watch bands and [he] even played his guitar”, adding "We didn't realize they just expected you to lay in bed and die”.
At any rate, Brownell proved all the naysayers wrong by dying of lung failure on October 16, 2013. He had been diagnosed with idiopathic pulmonary fibrosis, and was recently placed on a waiting list for a lung transplant. He was 48 years old.
The state seems to have pinned his case largely on the claim that he required oxygen around the clock. They claimed in the arrest affidavit that “He told his treating physicians he needed oxygen 24/7”. Video evidence shows him functioning without his oxygen tanks. His wife, on the other hand disputes that, saying he did not need it 24/7, and in fact was following his doctors advice that it not be used in that manner.
His wife claims Brownell was targeted for what amounts to simple confusion and medical side effects. She also alleges that fraudulent methods were used to drum up a prosecution, saying "They edited the (surveillance) tapes and only showed ones of him without oxygen. Where's all the videotape of him with oxygen or throwing up in the front yard because he couldn't quite make it home — or all the trips to the hospital?" She also indicated most of the money over the years went to medical providers, while the state seemed to allege that he personally profited from the money.
I don't know all the details of the case, but I do find it disturbing. Also disturbing is the response of the agency responsible for the prosecution. Instead of simply issuing a statement extending sympathies, they seem to be attempting to justify pursuing legal charges against him, by saying, "The investigation was never about whether he was ill or not, but rather the contrast between how he was representing his physical limitations to doctors and what he was actually capable of doing."
That may be a valid point, but dying in a hospital while awaiting a lung transplant certainly casts a few aspersions on that view. Perhaps they would be better off pretending it never happened. Or they could pin their defense on the “idiopathic” portion of the diagnosis, since that indicates a disease of no known cause. In other words, he may have had what he said he had, but you can't prove it was us – it was simply an odd coincidence, and for that he should have spent up to 30 years in prison (that is what the charge could have resulted in). The state may claim that they were only pursuing differences in how he represented his limitations, but he was still ultimately charged with faking an illness that in the end resulted in his demise.
The video claims to me are the most disturbing point of the story. Proper video surveillance involves the entire experience cycle to get a true picture of what may be happening in a claimant's life. If indeed it is true that video was edited to exclude those actions lending credibility to the claimant then we have a bigger problem in this state. After all, you shouldn't have to die to prove your innocence in a matter.
I am not a “soft on fraud” guy. I in no way support fraudulent activities. I condemn crooks and liars, and expect our authorities to hold fraudsters accountable for their actions.
I just don't expect similarly fraudulent actions to be used to pursue supposedly fraudulent claims.
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About "From Bob's Cluttered Desk"
Robert Wilson is President & CEO of WorkersCompensation.com, and "From Bob's Cluttered Desk" comes his (often incoherent) thoughts, ramblings, observations and rants - often on workers' comp or employment issues, but occasionally not.
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