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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, http://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:

dld@adamsafeguard.com).

"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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