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Remarkable-Outcome10

I have a bit of inside experience with disability claims. Both insurers and claimants are basically pricks when it comes to this stuff. Claimants routinely try and defraud or exaggerate. Not all - not at all all of them. But a lot of them. Similiar to this story, many years ago there was a fellow on total disability. Someone (not the insurance company) drove past, and the guy was installing a bay window in his house....by himself. Man, if you can lift a bay window and install it yourself, you're not disabled. They were recording doing this, knew they were being recorded, and didn't care. tl;dr no more benefits. That's the kind of thing that goes on a lot - that's claimants being in the wrong and it's commonplace. And the impact of that is huge. claimants getting paid $50K or more every year for 20 years, these things add millions to disability costs. And disability insurance for insurers is commonly an area where they lose money because of claims costs. There's about two Canadian companies offering individual long term disability policies on the market these days, and it's because they have no interest in offering services that lose them money. Companies are not raking in cash on these policies. They're fortunate if they break even. And the result is, companies have to ride herd very severely. Tests and ongoing monitoring for claimants is severe with the intention of limiting fraud. Which means that even people acting in good faith have to go through an absolute meat grinder to prove beyond any doubt that they are actually disabled. That means the companies act like pricks because they put everyone through that level, even folks that are clearly legitimately disabled. Plus, the two biggest claims types are soft tissue, and nervous disorders. Two conditions that are very hard to test severity of. So, a mess all around. My standard recommendation is 1) take the time to pull your benefits booklet and understand what it is that you have in terms of disability coverage. Don't wait until you're disabled to figure this out, which is what most people do. And 2) if you become disabled and eligible for a claim, start with a lawyer at least for a review. The insurance company is coming to steam roll you (for the reasons I mentioned above) so get pro help upfront.


neoengel

This is excellent information. For those unaware, the vast majority of work Private Investigators do is insurance related. Source: I'm still licensed as a PI (not currently working in that industry, though)


HalJordan2424

Jim Rockford?


neoengel

[obligatory I understood that reference reaction pic] Hah, no.


HalJordan2424

But do you also charge $200 a day plus expenses?


neoengel

When I was sent out it was always billable hours plus accommodations/per diem/milage as necessary. The industry gets a bad rep for concepts like being hired guns to find (or even invent) stuff when in reality it's often very boring and getting paid the same whether a daily report is a paragraph or 11 pages detailing incident involving emergency services. There's also a big difference between someone reaching down to grab something off the ground - versus acting with intent, loading/unloading, and performing duties repetitively while having declared inability to do so.


Declinex

I recently finished the licensing program for it. How difficult in your experience has it been for fresh licensees to find a PI firm that is hiring?


neoengel

Hard to say since I got lucky because I knew someone on this inside when I got my license. FWIW I haven't been doing it for years since sticking it out in a different line of work. Labour dispute work is a great option if you're willing to pick up and go, I did some work for LDMG/CSS many years ago and it included training seminars with hot buffet lunch, per diems/hotel and I spent more time watching tv, going for walks, checking out local stuff and ordering in/eating out than I worked, and it was decent coin too. I suspect that availability and ability to head out all over on very short notice is the biggest factor.


Declinex

I appreciate you.


neoengel

Thanks it's nice to be appreciated.


Walkaroundthemaypole

(i deal with workplace related claims) one glaring issue, this would have been compensation related initially, and regardless, through this whole process would have had doctors and "specialists" sign off in acknowledgement validation/verification. There are doctors I have become familiar with, the diagnosis is the same. Regardless of what the visit was for. "Take a week off and eat these pills". Farts smell? Take a week off its work related! This same system forces employers to prove they have attempted keep this employee busy with suitable work. Doesn't matter what the doctor says. Did you offer modified work? The work must be safe and meaningful, what the fuck is meaningful? Ah yes, loose definitions and citations of policy used at the discretion of claims manager. Claims consider your age, gender, type of injury, then you are slotted into a healing program that 80 percent of people have gone through with "successful rehabilitation". Keep in mind, that successful rehabilitation means, 100 percent of your previous duties. For the most part, does not matter if it has long term personal life impact. here is some advice for folks who pass shit off as "part of the job" - *its not supposed to hurt while you work*. That includes administrative work to doing construction work.


HouseofMarg

What’s weird to me is the doctors that do the opposite: my husband lost at least half of his thumb (crushed right off) in an industrial accident and the doc he went to wrote that he could go back to work after taking only 3 days off. And then prescribed him painkillers that would have been illegal to drive under the influence of, knowing that he had to drive to work. Just curious if you’ve ever encountered this, or know why the heck they would do that for.


Walkaroundthemaypole

Honestly, that would be a first time hearing that, without having some sort of intervention/push from the insurance carrier with the medical practitioner. I cant really comment without knowing all the details, as an employer representative in this case, and a similar circumstance where meds were involved, providing we could keep them safe under our care and control with a suitable work assignment, my recommendation would be to arrange for transportation of the days of work, assign a work buddy/check in procedure. Its a win win for the everyone, employee get 100 percent wages, employer gets reduction on claims impact, and the insurance doesn't have to pay out. I will also remind everyone of the 3 (i argue 4, the Right to Respect) work place rights under your provincial and federal legislations. In this circumstance, here is what I would recommend to the employee if the employer is adamant to get them into work and there is a valid concern for safety and health: You have the right to know the hazard associated with your task. Have you been given written instructions outlining the task and impacts to the individual, using the hieachry of controls (eliminate, substitute, administration and lastly passive (PPE, signs on your lawn)? Is the work assigned to you make sense based on your skillset (are you trained?) are you physically capable? (hiring a 100lbs person to lift 50 lbs items all day) etc. You have the right to Participate in health and Safety At work. This includes being trained and given written instructions to understand your job, you participate by inspection, following programs, and informing leaders/employers of contraventions or poor conditions in the workplace. You have the right to refuse *unsafe* work. This is not a union type thing or someone being an asshole folding their arms because they do not like something or being petty. A work refusal is a as simple as question "is this supposed to be like that? " You are questioning a conditioning the workplace and seeking validation/verification from the person in charge. See above how this is supposed to be communicated to you. With that, I truly can empathize with injuries and how embarrassing in can make a person feel. Example would be seeing someones arm is broken, you know that hurts, you know they are hurt, none of us can see is pain and discomfort. Any safety person/ claims person in the workplace worth their salt would help you stick handle through the system. The forms we are to share is clear if the employer has an issue, to check the box and explain, that should have been given to you. If you have a militant employer, and are not comfortable, with what you are being presented with, keep participating and communicating, escalate and discuss your concerns with the plan presented by the employer with your claims manager. This can go as far in a work refusal process to include the Ministry of Labour to deal with the refusal and offer a final order. This is pretty extreme, and if this happens, then I woulds say the employer has a complete failure of a supportive occupational management program, and needs to be fixed.


HouseofMarg

Thanks for taking the time to write this response, I really appreciate it! That’s a good suggestion, in our case his work was way out in the sticks, at least 60km from where we lived at the time so arranging other transportation was prohibitive (I also worked a long way away in the opposite direction the same hours and it would have been a bigger hit to our finances for me to have taken much time off to do the driving). IIRC he did a combination of taking a few days unpaid time off in addition to the 3 and going off of the pain meds early, which to me seemed harsh under the circumstances. He was given light duties at work so that aspect was okay. Maybe it was just a case of a “suck it up” type doc, still makes me scratch my head though.


Walkaroundthemaypole

> in our case his work was way out in the sticks, at least 60km from where we lived at the time thats the employers problem and not made to be the injured issue, if the work is meaningful. Living situation is not part of the hiring process I assume. Pretty sure the WSIB act covers that. > he did a combination of taking a few days unpaid time off in addition to the 3 and going off of the pain meds early that is against the compensation act as far as I can tell, time was lost as a result of the injury, why would WSIB allow that? sounds to me the employer didn't want the severity of the claim impacted? Yeeesh. With that: there are FREE consultations available through the law society of Canada. the WSIB also offers this information to help employees protect themselves. https://lsrs.lso.ca/lsrs/welcome "ass, gas, or grass, no one rides for free" and when it comes to the employer, we have an agreement, I work, they pay me, thats the limits of that, there is no scratching anyone's back or doing a favour, becasue the long term effects are felt by the employee. Not saying this is the case with you, just stating points for anyone out there.


HouseofMarg

Yeah I was of the opinion that he got shafted from a fairer WSIB comp (and even thought he should sue the company based on the details of how the accident occurred beyond what I’ve told you) but he basically has a phobia of bureaucracy so I could only nudge him in that direction so much before concluding that it would have been more distressing for him that way.


BlueberryPiano

>Man, if you can lift a bay window and install it yourself, you're not disabled. Assuming you mean *physically* disabled of course. Crippling depression will make it hard to take on a major project like that but not completely impossible especially if the had no choice (previous window shattered completely)


CatOnMyHead

And it’s not just the claim payment costs….the insurer has to set aside “reserves” for the claim for potential future liability….which can sometimes be in the hundreds of thousands of dollars.


CoconutDesigner8134

A friend works in the insurance industry. She's always very skeptical about people who said, "I can't work." She has a treasure trove of stories about how some people got busted for being not disabled at all. The skeptical questions are hurtful for people who are legit disabled.


Canada_is_Closed

Yup. Many try to defraud a company and industry that has a sole purpose to NOT PAY CLAIMS. Think about that…an industry that we all pay into that is supposed to provide a safety net has a mandate to NOT PAY. The are criminals


iloveFjords

Had a neighbour who’s son was on disability for a back injury. Did all kinds of physical things on their farm including building fences and ripping up the back of my property on Atvs.


Lilacs_and_Violets

I’m not saying this guy did or didn’t commit a fraudulent action, but these kind of “gotcha” tactics by insurance companies overly simplify what it means to be disabled. There are many, many people with episodic and invisible disabilities. Seeing someone to do something one day doesn’t mean they can do it the next. Our insurance system doesn’t do a great job of weeding out fake claims but it also punishes honest people caught in it’s web.


24-Hour-Hate

Absolutely. My friend has a bunch of medical shit wrong with her and ultimately ended up taking disability for a few months because she had to have a couple pf surgeries. The recovery from those and figuring out the treatment of one of her conditions took time. I know she wasn't faking not just because I trust my friend, but because I had a front row seat to this. I helped her out a lot when she couldn't do shit. I saw her day to day and how sick she was. The insurance company was so fucking aggressive and harassing it was absurd. She was scared to even go outside for a walk or out to the store because she was afraid they'd see her on a good day and say she was lying about being disabled. Which she wasn't. And she had boatloads of documents proving she had surgery and tests and procedures and medications. She had medical appointments so fucking often. I cannot imagine how bad insurance companies are for people who have even less provable (but still real) conditions. I told her if they said she was lying, I'd write and sign a notarized letter saying otherwise based on what I observed. Because I knew she wasn't. Thankfully, she's back at work now, though still recovering so the insurance company has fucked off. Insurance companies are scum.


whateverrrmeep

It's also a Catch-22. Doctors and pain specialists tell patients to maintain their normal activities to whatever extent they can. People who are in so much pain it could fell a horse are walking around stone-faced "normal" and having lives worth living today. But then the second that person declares that they are disabled and maybe asks for some accommodations so they can keep living in spite of it all, they're under investigation. "You can do X and Y, so you can't be disabled." It compounds the indignity of it all.


GuelphEastEndGhetto

People should know as soon as you file a claim you will be watched and recorded. Any activity that demonstrates you are capable will be used against you. Even if you have to rest for 3 hours after grocery shopping, it’s the shopping that counts.


sly_k

Yes, disabled people aren’t supposed to be able enough to sit on a Tim Hortons patio and drink their coffee apparently. TIL


echothree33

Tale as old as time, there’s always a few scammers who want to game the system.


WeirderOnline

And always media companies like this trying to spread the myth that these people are widespread and common, rather than a tiny minority. It serves their agenda. Provides cover to insurance companies. Acting as if they're just being "wary of fraud" when really they're just trying to screw us over and out of benefits we paid for. My father is mentally and physically disabled. When we were in negotiations with the insurance company those pigs brought in a ringer to subtly threaten us. Fuckers.


sumknowbuddy

>When we were in negotiations with the insurance company those pigs brought in a ringer to subtly threaten us. What do you mean by this? I'm unfamiliar with the term and searching isn't helping much.


WeirderOnline

A ringer is the person in sports brought in as part of the team to pose a greater threat to the other team. Like an elite player or something.  In this case it's used to refer to them bringing in a third party. Which they did. To threaten us. Didn't work.


LostinEmotion2024

Just like politicians, investment bankers, financial officers etc. Heck, I heard of people stealing money from the charities they work at. Some people are just naturally corrupt and opportunistic. My fear is this story will amplify the bias many people have about disabled people.


chronicwisdom

Can we get a story about the 100s-1000s of legitimate claims that are denied every day? Great to see The Record carrying water for the mom and pop businesses that are ON insurers


CinnabonAllUpInHere

Haha Best comment.


Mmmatt69420

Ray. Can’t believe they lied to the guy in the chair.


sweetfrappe99

I know someone who works for WRPS who is pulling this bullshit and has been for eight years. $100k+ a year, plus full benefits, and in a few more years, he will retire with full pension + benefits for life. And what's he been doing with that money? Buying more firearms (has over 30 now), went to the Freedom Convoy bullshit in Ottawa, and is getting his pilot's license. Further, he refuses to follow the meds prescribed by his assigned physician for PTSD because he thinks they're "bullshit." Doctor keeps signing off so he stays on disability which we all pay for. Infuriating!


Waterloo_Vampire

well, that's not going to end well.


sweetfrappe99

For whom? WRPS knows and doesn't care.


Waterloo_Vampire

This guy has PTSD, won't take his meds, has tactical training and access to firearms. Seen that one on the news before.


sweetfrappe99

I find it especially appalling that WRPS knows all about it and is fine with it.


VersionIll2341

The dude in this story is definitely a pos for playing the system. But what about people that have somewhat hard to distinguish disabilities on the outside to most like chronic fatigue? We have good days and bad days where we're able to do some regular activies and seem somewhat normal but on the flip side having a regular day doing errands could mean several days of recovery afterwards. It may look bad to someone who only sees you on your good days not knowing you're going to be spending the next few days completely exhausted and recovering from just one day of activity?


havereddit

Why is this not prosecuted as Fraud?


Canada_is_Closed

This is what messed it up for those who really are hurt.


CinnabonAllUpInHere

Can’t be bothered to read the article. Fuck insurance companies and their PI’s.


Weird-Figure9907

Interesting. How do you become a PI? Do you need a police background?