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Wednesday, September 4, 2013

One Claim Going OTOC

Today's post was shared by WorkCompCentral and comes from

By now you've likely heard of this claimant fraud case as reported in the
San Diego County News

Yolandi Kohrumel, 35, went to work for Staples about 10 years ago. After three months on the job she claimed a box fell on her big toe and broke it.
She received treatment and benefits.

But the big toe is connected to the foot bone, which is connected to the leg bone, which is connected to the hip bone, which is connected to the back bone....

An EAMS search on her claim reveals wrist, back, lower extremities, nervous system and "other body systems" claimed. The party service list is filled with very familiar names to those who do workers' compensation litigation in Southern California.

Eventually Kohrumel even got approval for 24 hour care, provided for, of course, by relatives - her husband at first and then her father.

You get the picture. Claim out of control. Which means either something is REALLY wrong with this lady, or it's fraud.

The claims administrator, ESIS, followed the law and did what it could to dispute elements of the claim that didn't add up - such as the 24 hour care provided by her South African husband who did not have a work permit (so dad stepped in to "provide care").

Surgeries, pain pills, lots of doctors, crutches, wheelchairs, lots of TTD payments. She even convinced the claims administrator that she needed a bigger place to live for her wheelchair access and the administrator went for it.

Well, that became Kohrumel's undoing because the...
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