At the 2017’s CWC and Risk conference a panel discussed some of their oddest, weirdest, and most bizarre claims they have seen in their careers.The panel included:
· Danny Flores, Global Associate Coordinator Workers Compensation, Whole Foods Market
· Kurt Leisure, Vice President of Risk Services, The Cheesecake Factory, Inc.
· Laurie Wenyon, Senior Manager, Claims, MasTec, Inc
· Rich Lenkov, Partner, Bryce Downey & Lenkov (moderator)
Kurt Leisure – December 2012, a woman comes into Cheesecake restaurant in California. Bus boy drops and breaks a wine glass. She claims that a piece of glass hits her left eye and then travels to her right eye. She is sent to ER and they do not find anything. Gave her pain meds and flushed her eyes. She was diagnosed with a cornea scratch. Three months later reaches out to Cheesecake Factory and she tells them that they remove ceramic glass out of her eye. 14 months later she is treated at an eye institute. They say her eyes are perfect. No she says she has floppy eye syndrome. She is alleging that she is losing her eye sight. Stating this all happened from the accident at Cheesecake Factory. She is now being treated at a blind center. They are treating and teaching her how to live as a blind person. Even her family does not believe that she is blind or losing her eye sight. Medical bills are $68,000. She alleged PTSD, anxiety and depression all from the wine glass accident. She continues to work this and it is going to go to trial. She asked for $1 million and they offer her nothing. Cheesecake does not believe this is a case that needs to go to trial but think they have a great chance of winning. Cheesecake looked into her history. She sued a supermarket for hot juices from a rotisserie chicken burning her foot. CCF was ready for trial but they end up offering $35,000 just to see what the claimant will say. She took the deal for under $50,000. Post trial – her mental exam results were overwhelming in support of somatic disorder, she was probably not faking the disorder. If the testing was correct, the symptoms will not go away. CCF’s brand and reputation is very important and word of mouth is everything for CCF.
Danny Flores – 55 year old team member found passed out under a desk apparently under the influence/intoxicated. Team member secured services of an attorney who proceeded to file a 2 CT claims after termination. Next day she comes back in and they terminate her. She quickly found an attorney. Psych claim for the trauma of being fired and then back, shoulder and wrist claim because she fell under her desk. Claim was denied and they decided to fight it because of lack of medical evidence. From 2002-2015 she had repetitive trauma and psych disorder. Claimant stays at home most days, pain to extremities, fitness enthusiast but can no longer do that. So they decided to investigate her. Started with a social media check and found out she was part of a biking community and is still biking, she was seen at the gym working out. This surveillance was taking over two week time period. She was part of a high speed chase while she was intoxicated and was caught by the cops. Demand was $50,000 and offer was $5,000. Claim was settled for $7,500. Whole Foods investigated and found all her medical history and social media check and surveillance to be able to get the claim closed at the best possible outcome for all involved.
Laurie Wenyon – 28 year old male installing a satellite dish on a customer’s roof. He was stung by a bee. Employee immediately made a call to his supervisor to let him know he was stung. He passed out a minute later and the customer called 911. He was taken to the hospital. He went into a coma and then later passed away. This claim was compensable. Employee was single but living with girlfriend for 7 years. The girlfriend claimed to be husband and wife by common law. Girlfriend began using his last name after the death of the young man. She stated she was the beneficiary. Then his mother disagreed with all of this and stated she was the beneficiary. Mother stated her son never referred to his girl as his wife. Hearing was set to determine beneficiary. It was determined that girlfriend was the spouse. Girlfriend was awarded death benefits. Decision was appealed but was not turned over. Currently paying death benefits to girlfriend. They continue to do social media checks to see how the girlfriend is holding up. She is currently in a new relationship.
Each company wants their employees back to work. This modified work for each injured workers. There is benefits to getting the employee back at work and with their team. This helps them return to their job more quickly. After an injury, if that injured worker can walk and talk, they will return to work. Each company makes it their mission to get their employees back to work.