It’s hard to get away with workers’ compensation fraud if Paul Cefaratti is on your tail. That’s because Cefaratti, president of Cefaratti Investigation, is willing to do whatever it takes to bust those who think they can successfully cheat the system.
“We’re very aggressive in our investigations,” says Cefaratti, a former East Cleveland police officer who quit the force in 1993 and founded his private investigation agency. “We use ruses and pretexts when we’re not able to get results through normal observation.”
That may sound devious, but when you consider that workers’ comp fraud costs Ohio employers more than $100 million a year and the Bureau of Workers’ Compensation is currently investigating 1,800 suspected fraudulent cases with 125 investigators, it’s not a stretch to consider extra measures when you’re not happy with the state’s results.
“We once took a guy on a pheasant hunting trip,” Cefaratti says.
The man was walking with a cane and walker, claiming he was fully disabled because of an injury. The state had found his claim valid, but his employer had reason to believe otherwise. So the employer hired Cefaratti to pursue it further.
Cefaratti’s team staked out the man’s residence, followed him and phoned him, posing as a fake telemarketer. They had discovered he was a hunter with a penchant for hunting pheasants.
“We set up a fictitious wildlife organization and sent him free passes for a pheasant hunting trip,” Cefaratti says. “The man had to make the call to make arrangements for the trip. We just opened the door for him.”
What followed was a grueling six-hour hunt over several types of terrain, Cefaratti recalls. It was an excursion that was difficult for a physically fit individual and impossible for someone with severe injuries.
“Here he was, supposedly fully disabled and collecting workers’ comp money, claiming he needed a walker to move around, and he was running through cornfields, shooting down pheasants with a shotgun and bending over to pick them up on the run,” Cefaratti says. “It was pretty much an open and shut case.”
The fight against workers’ comp fraud can be a challenging one, says Cefaratti, but it doesn’t have to be a losing battle. Employers shell out millions each year to cover workers injured on the job. However, paying for workers who would rather cheat the system than play by the rules is another story, especially when the claim concerns lifetime disability, when injuries are ruled so severe that the person may never work again.
So spending $1,500 or $3,000 on an investigation of a fraud case looks like a bargain to employers who could be forced to provide hundreds of thousands of dollars, depending on the severity of the injury and length of the claim.
“We once watched this guy lift a 27-foot boat on a hitch and push it up a hill,” Cefaratti recalls.
When confronted with video footage in court, the man claimed he “had a good day,” Cefaratti says. “So we pulled out another video of him doing lawn work the following day. He offered to settle.”
Catching someone doing a physical activity they claim they can’t is just one way to catch frauds. Another tool is physical testing in a work simulator, such as the ERGOS at the Carnegie Clinic in downtown Cleveland. The ERGOS, and other work simulators, test people for mobility, strength, endurance and range of motion.
While the machines are useful in helping employers determine prospective employees’ physical capabilities in pre-employment testing, their purpose is twofold in regard to workers’ comp cases: To determine the extent of injuries and to reveal inconsistencies in what a claimant says and what the machine says.
Explains Matt Volansky, manager of the Carnegie Clinic, “People see it’s a machine and think, ‘I’ll beat it.’ But people don’t realize they’re using muscle groups they’d use on the job. If they can perform their work function, they can’t hide it from the machine.”
Machine tests such as the ERGOS are valid and reproducible, taking into account consistent effort, fatigue, injury and dexterity. All test results are admissible in a court of law as evidence during a workers’ comp claim challenge.
“Everybody who comes through the door is a blank slate, though,” warns Volansky. “We don’t assume anyone is faking it, we just do the tests and observe.”
Among the things Volansky observes is whether what someone says or does when they come into the clinic — such as walking with a limp or saying they have excruciating pain in their side — remains consistent once they start testing.
“We look for changes in compensation in movement. I’m like a reporter,” Volansky says. “I’m just documenting what I see and whether it’s consistent with what the person is saying. If someone comes in with the intent to fake the machine, they’re not going to beat me.”
The bottom line is that workers’ comp fraud is avoidable, often before an injury on the job occurs. One way is to conduct pre-employment screening through physical assessments, interviews and background checks.
Warns Cefaratti, “Be cautious hiring someone with previous multiple claims. The best way to avoid workers’ comp fraud is to prevent it.”
How to reach: Cefaratti Investigation, (216) 861-5523, www.cefgroup.com; Carnegie Clinic, (216) 426-0365
Dustin Klein ([email protected]) is editor of SBN.
Warning signs of fraud
How can you tell if an employee is seriously injured or trying to commit workers’ comp fraud? Paul Cefaratti offers this list of potential red flags:
- Employee would like a quick settlement. He or she is willing to take a lower amount to get it over quickly.
- Employee hires an attorney immediately and is not willing to talk with an adjuster without the attorney present.
- Claimant has prior claims that were disputed and/or rejected by the Bureau of Workers’ Compensation.
- Employee has bad credit and is in dire need of money.
- Employee is offered a desk job after the injury and rejects it, choosing instead not to work.
- Claimant has a divorce pending and may want to lower “reportable” monthly income.
- Injury wasn’t reported immediately after the fact.
- No witnesses to injury besides claimant.
- Employee has history of drug or alcohol abuse.
- Claimant’s attorney has his or her own doctor, who gives a drastically different report than the adjuster’s doctor concerning the extent of injury.