After months of doctor-supervised physical therapy, the overall outlook and prognosis was that Tommy should have surgery to remove exposed tissue; repair the vertebrae exterior; and examine the cavity for small objects, such as bone chips or vertebrae particles, that could be irritating surrounding nerves.
Tommy and I met multiple times to discuss his condition, possible remedies, and his future. His days as a carpenter were likely over; also out of reach was any job requiring physical agility and exertion due to the possibility of further injury, which could lead to partial or full paralysis. He was now on full disability, which paid him about 90 percent of his pre-injury gross earnings per week ($3,850 per month), and was attending classes at the community college, which would eventually lead to a degree in construction management.
His operation was scheduled several weeks in advance. Ten months had passed since the injury had occurred. Tommy—and everyone in his social circle, including me as his former employer of 11 years—viewed the procedure as a “potential miracle” that could get him back to his normal physical condition and restore normal body function and activity.
Tommy eventually graduated from Northern Arizona University with a degree in construction management. His disability payments had been supporting him for nearly 52 months. They also covered his education, tuition, books, and related expenses.
The Rest of the Story. I was in the contractor sales section of my lumber supplier having a discussion with my sales rep about an upcoming lumber order. The room is open, with the desks arranged as they might be in a school classroom. Everyone can see and almost hear everything being said in the room. Nearby I saw two carpenters laughing out loud and slapping their knees, apparently reacting to a story they were discussing. At one point I overheard the comment, “and no one ever knew that he faked his back injury, and that workers’ comp paid for him to go to college and graduate.” So I eavesdropped a little more and eventually heard my company’s name mentioned.
I walked over and asked the two young men what they were talking about, and they started to repeat the story, all the while laughing. I asked for the name of the carpenter who had “faked his injury,” but at that point the two became aware of the circumstances of their banter and got up and left. I asked my sales rep for the names of the two carpenters, which he didn’t know, but we were able to determine who they were rather quickly by talking to their salesperson.
I then contacted my workers’ comp representative and communicated the story I had overheard. At first he was skeptical, asking me outright, “What do you want me to do?” Of course, my reply was simple: “I want your investigators to look into this!”
Epilogue. An investigation into possible workers’ comp fraud began with interviews with the two carpenters. It turns out that one of them was Tommy’s cousin. After threats of arrest and conspiracy charges, the cousin told the story that Tommy had been up at Lake Powell with another cousin on the Sunday prior to the Monday-morning injury. They had been using steel pry bars to roll large stone boulders off of cliffs for the thrill of watching them plummet and “landslide” hundreds of feet into the lake. Tommy had tried to pry up a boulder weighing several tons and then fell to the ground in pain. The back injury was caused by his overexertion trying to lift the boulder. Because he was injured on a Sunday and didn’t have health insurance, he planned to fake the injury early Monday at work so he could see a doctor and be free of monetary responsibility for the self-inflicted accident.
Tommy later was confronted by investigators. He admitted to the fraud but was never arrested or charged.
Dennis A. Dixon is an author, contractor, and speaker with 23 years of experience in the building industry. He can be reached at dixven@aol.com.
