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Published in U.S. 1 Newspaper on February 9, 2000. All rights
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Fighting Dubious Malpractice Claims
When a doctor makes a mistake, the patient can file
a claim for medical malpractice. Some claims will have merit —
and some will be questionable, says Peter Leone, vice president
for claims at Princeton Insurance Companies. He thinks that his firm
has brought investigating these claims down to a science; it has
enlisted
the aid of a software program, Forensic Abstract.
This software initiates a fact checking process on every claim, and
this process often uncovers enough information to make the claimants
change their minds about whether they want to pursue the case.
Sometimes
the additional information can get a case tossed out or mitigate the
damages. Alternatively, getting the scoop on a claimant can influence
a jury to be less sympathetic.
Piling up the results of questionable claims has produced a
proprietary
database available to Princeton Insurance staffers. “We have had
a lot of success protecting pocketbooks and reputations,” Leone
says. For every 10 claims filed, for instance, three will list an
employer who does not exist, and at least one will have a bad address.
“In a significant number of instances, people tend to exaggerate
their claims,” says Leone, a 1976 alumnus of Rutgers who has an
MBA from Fairleigh Dickinson (609-452-9404, https://www.pinsco.com).
“You don’t get complete fabrication, but they tend to overstate
it. In the past, you would do a background check, hit or miss. But
now in every instance we do a simple background check: Social Security
number, accident records from the motor vehicle departments, and liens
in civil court.” The claimants name are checked on both sides
— for claims made against them and for claims they are making
against someone else.
Even such simple checks can raise a significant red flag. “If
you find someone using a different Social Security number you might
want to look out for other things they are doing,” says Leone.
“For the motor vehicle check — perhaps they didn’t admit to
having had a previous auto accident, and you find they had a
pre-existing
injury.
“Any time I get someone young, in their 20s, 30s, or 40s, and
they say they can’t do something any more, that is a red flag,”
says Leone. He tells of a woman who said she injured her wrist and
would not accept the insurance company’s offer. “We found she
was in four different bowling leagues, and we caught her the night
she picked up her trophy.” The tales continue — the man with
a shoulder injury was found in a Texas gym pumping 250 pound weights,
the man who had foot surgery was carrying 100-pound doors in front
of his house, and the woman who couldn’t play tennis but managed 36
holes of golf per week.
The software program, Forensic Abstract, was devised by Dennis
DeMay of Adams Safeguard in Toms River (732-286-0800 E-mail:
“We have proven we save money six different ways,” says DeMay.
The Internet has enabled him to grow his business yet drastically
reduce his staff from 400 agents to 12, plus part-timers. He believes
that fraud checks could identify fraudulent lawsuits sooner and unclog
the courts. He also thinks more employers should make similar checks
before they hire a new employee.
In New Jersey he can check instantly by name in every court. But in
a state like Florida, most of the courts are not online, and so he
hires an agent to hand-search names in each of 3,700 counties. Though
people must do the search, the software keeps track of it — with
semiautomatic reminders to complete a form, notifications of new
information,
and so on.
Demay has his own war stories. In one case, someone said he had a
work related injury “and then we found that he owed $7,200 to
Sherwin Williams. The store owner knew that the man was injured
because
he had fallen off the roof.” Police records might reveal that
the police were called when someone fell on the ice at his home.
“I
am in my 50s,” says DeMay, “but I still have that little boy
in me, and when I get a major hit I get excited.”
Points to remember on the “honesty is the best policy” theme:
Keep your credit record clean. Don’t be paranoid about your own record
— check to see what’s there. Be very cautious about whom you talk
to. Do at least the simplest reference check on a new employee. And
don’t file any lawsuits unless your own record is squeaky clean.
— Barbara Fox
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This page is published by PrincetonInfo.com
— the web site for U.S. 1 Newspaper in Princeton, New Jersey.
