Rodeo-Riding Claimant Has Lucrative Scam

For five frustrating years, a Spokane contracting company has pressured state workman’s compensation officials to stop payment on a claim the company charges is a costly scam.

The alleged ripoff involves a dump truck driver for the company who claims he suffered a disabling neck injury when the truck hit a bump and his head hit the roof.

That in itself - hitting your head on the roof of a dump truck passing over a bump - would be well nigh impossible to do, the company insists. But this case verges on the unbelievable in many ways.

“The driver in question was, at the time, involved in rodeos and bull riding,” says safety officer Jackie Michielli of Circle M Construction Co. “His claim has paid over $120,000 and has involved two surgeries, vocational rehabilitation, and disability payments.

“The claimant has a history of at least five prior claims,” she goes on. “While collecting time-loss (compensation checks) on this claim, this man participated in at least one rodeo, was a rodeo clown for two years in a row, drove a demolition car, opened a welding shop, and was known to be working as a ‘cowhand’ on a large cattle ranch.”

But if that sounds extreme, says a veteran fraud investigator for the state, “I have handled cases a lot worse.”

The sleuth for the Washington State Department of Labor & Industries agreed to talk only on condition of anonymity, which is completely understandable it seems to me, given his line of work.

He divulged that “60 to 70 percent” of the investigations he is involved with produce evidence pointing toward fraud. But there’s a world of difference between the appearances and proof. And, thus, scammers get away with murder.

Businesses are getting hammered, he says.

“But the cost to society doesn’t end with employers,” he says. “Because the pool of funds established by employer premiums to pay both the valid and the fraudulent claims is money that actually ends up coming out of pockets of consumers.”

Though employers are nicked directly, the state insurance premiums and the settlement they pay are a large part of the cost of doing business. And it all gets passed along ultimately to customers. It isn’t itemized on your restaurant tab or grocery reciept or the bill from the washer repairman, but the cost is in there somewhere. “And,” says the investigator, “the cost is astronomical.”

Countless reports estimate that bogus claims account for 20 or 30 percent of the total. But based on his 30-plus years of investigating fraud, he says, “I think the percentage is higher.”

How do crooks get off?

Well, take Jackie Michielli’s situation.

“This man claimed to be so disabled that it took him two days to drive from Spokane to Colville,” she says, “and (he) was not able to hold down a job as a radio disc jockey because he could not reach a 2-by-10-inch control board.

“The sickening part,” she says, “is that we have a witness, to whom this individual bragged about how he had ‘scammed’ the state out of so much money he was able to buy a race car and hire a driver.”

“The state says we have no fraud case,” she laments. “Is there something wrong here?” Most definitely.

First off, case manager Paul Zimermann told me employers have 60 days to challenge the validity of an action by the state. Or it’s irreversible.

In this case, there may be extenuating circumstances - somehow Michielli didn’t receive timely notice. She suspects skulduggery, but not by the state. Whatever, all agree the necessary protest wasn’t lodged in time.

So now, the alleged culprit is draws permanent disability payments.

Nothing can be done. But Michielli still wants her problem exposed as a means of focusing attention on the need for better outcomes than this.

Remarkably, my anonymous investigator, who handled this case, agrees it may help to, as he puts it, “light a fire under L&I.”

Though he would not comment on this particular case, he says the state has too few investigators to even “scratch the surface of the problem.

“Fraudulent claims are out of control,” he says.

Maybe this is something lawmakers could look into to save business and consumers money.

, DataTimes MEMO: Associate Editor Frank Bartel’s column appears on Monday, Wednesday and Sunday.

The following fields overflowed: CREDIT = Frank Bartel The Spokesman-Review