Let’s Have A Break

I often wonder how many of the injuries reported by employers to their employees are fraudulent. As there are no statistics in this regard it will, I think, always be a matter for speculation. Seeing that there are so many holidays during April and May, I thought we might as well join this festive mood and be less serious.

A few weeks ago I was watching an overseas news broadcast from England and I was quite amused by a video clip accompanied by a news item regarding a man who has been in receipt of an incapacity allowance for a number of years. That fact in and of itself is obviously not newsworthy, especially coming from England; what was amusing to say the least was that the video clip showed him refereeing a soccer match. The outcome of the affair was to my knowledge never revealed but I can just imagine that it must have had serious consequences.

The UK incident reminded me of several similar incidents that I have experienced during my career as Compensation Commissioner. I can share some of these cases with you but I will confine them to those where I am almost certain the parties are no longer in a position to surf the internet, if you get my meaning.
Back injuries, not mine, and a large number of them, have really contributed to my premature ageing.
You would not believe to what lengths people go to prove that they have injured their backs at work. Despite all the medical evidence such as radiological tests and the reports, orthopaedic examinations and related tests, etc. once the party focuses on the compensation for permanent disablement benefits for a back condition, he or she seldom gives up. At one stage we were so desperate that we decided to pay personal visits to claimants at home to discuss their cases before being heard at statutory formal tribunal hearings. Although we never intended catching anyone out, it was on more than one of these surprise visits that we found the “seriously disabled” individuals engaged in intensive gardening. Mowing the lawn could perhaps be forgiven, I mean after all it just guiding the lawnmower, but the spade work that some of them were up to could have been advertisements for pain killers. No-one would have believed these people were victims of disabling accidents. When introducing oneself the reactions were so colourful that I will rather not discuss them in this contribution. Should you want to become familiar with the vocabulary, I suggest that you watch one of the American movies which deal with this problem. Believe it or not, in the USA they have private eyes (PI’s) specialising in catching the claimants of fraudulent claims for injuries on duty and other accident insurance. It is real comedy.

Before concluding the back injury scenario which caused so many problems, just a few more interesting cases, again cryptically quoted as the claimants may still be around. A person who sustained a rather minor injury and who was declared medically unfit by his employer because of it, continue to play his regular weekly round of golf after he was “on pension”. The Compensation Commissioner repudiated the claim but lost the litigation that followed. Maybe the Compensation Commissioner’s medical advisors were mistaken, it is possible; but what is really amazing is how somebody who cannot work because of constant pain can partake in such a physically demanding sport. (Not the 19th hole!)

The last thought about backs is something that is a fact but has nothing to do with fraud or the so-called “compensitis”. I know of at least two people who have played Springbok rugby after permanent disablement benefits were awarded to them. I can not go into the details but it is possible. I however repeat that this was all above board and nothing underhand happened. It can still happen today but it is very unlikely, unless, the legal situation changes to the extent where it is decided by our courts that professional sport persons are “employees” in terms of the COID Act and that they are thus entitled to the benefits provided for in the COID Act. Watch this space, I have a funny feeling that this is not far off.

To conclude in this lighter vein I want to share with you an incident that happened during a formal hearing of a man who alleged that he had very little mobility left in his shoulder as a result of an accident at work. The Compensation Commissioner accepted the accident and liability for the medical costs but repudiated the allegation that the shoulder had become immobile. (The so-called “frozen shoulder”). As a result thereof, a formal hearing to adjudicate the injured man’s objection was held in terms of the COID Act. One of the assessors was a medical practitioner. He, with all due respect to him, was inclined to catch the injured objectors out during the hearing and, to his credit, it did work on several occasions. After having listened to the employee’s evidence about his “frozen” shoulder with a demonstration as to the fact that he could no longer lift his arm, he was requested by our doctor assessor to demonstrate to the tribunal how high he could have lifted his arm before the accident. Then the doctor got the surprise of his life when the witness responded (in Afrikaans): “Have you not listened to what I have been saying the whole morning!”
That was the last time that the dear doctor tried that ploy to catch a witness lying.

Till next time.