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A close relative is milking her short-term disability for thousands of dollars...how can it be proven?

A close relative of mine went on short-term disability leave back in September right before having early-stage breast cancer surgery and has been receiving short-term disability payments from her employer's insurance company ever since. Following surgery and subsequent radiation (she didn't need chemo), more and more "stuff" started appearing at her house that she'd been buying with the insurance money--new clothes, a new sofa, she's talking about getting a treadmill, etc.--and spending hours online looking up genealogy-related stuff, which is a big hobby of hers. She's also taken a number of trips to see relatives around the state and has gone with them on hobby-oriented excursions for several days at a time (some of the relatives are self-employed while others are retired) and apparently having a grand old time. Meanwhile she's had no medical treatments in nearly two months--she finished radiation in January--but she says she still doesn't feel well enough to go back to work, and oh yeah, she also mentioned out loud on at least one occasion that she's making more money from short-term disability than she does from her job. But she feels really lousy and can't go back to work because she's not ready, yadda yadda yadda, but you wouldn't know it from the way she's been acting and the way she's been spending money on things she doesn't need to live. I'm waiting to hear back from her insurance company on an anonymous call I placed to their fraud hotline, but it got me to wondering...I and many other relatives are seeing her do all of these things, but she's apparently still giving her doctor this line that she's not ready to go back to work, etc., and besides the fact that she's stealing from the system, it's really creating major tensions within the family. So what I'm asking is, once I give the insurance company the details of what I know and what I've observed, how can it be proven that she's milking the system and what can be done to stop her? In the back of my mind I'm thinking it could even get her arrested if this sort of fraud is deemed serious enough, but not having dealt with anything like this before, I'm not sure how this plays out. Anyone have any insight on the process in reporting insurance/disability fraud and how insurance investigators go about proving something like this? I realize people can't give legal advice on here, but I'm just trying to understand how the system works and anything else that might be a consideration. So tell me, Melissa, when did fraud become legal? I'd bring up the fact that it's unethical, too, but you wouldn't understand, obviously... SunAngel, I grew up in the same house as this person and see her several times a week, so I'm a very close relative... Maybe I should send her over to your place to rob you instead, Katherine. Just because she's not robbing me but robbing the system doesn't make it right. In fact, yeah, I'll send her over to your place to steal all your stuff because she's entitled to do so if she wants. Unless of course you believe she shouldn't, but it really doesn't matter what's right or wrong as long as it doesn't affect you, right?

Public Comments

1. She's not doing anything illegal, if she was they'd make her pay it back. She didn't create the system she's benefiting from. Mind your own business. Your family sounds really nice.
2. From what you see, she may be fine, but how close are you to her to understand what she is going through both physically and emotionally. I think what you did is wrong. You are really out of place. Short term disability is an insurance that either you or your employer pays. So receiving that benefit is not using the system. Thank goodness you are not a "family" member of mine.
3. Ok, so she's commiting fraud and you reported her. Why are you so caught up in this? She's cheating the system, but she's not cheating you. Maybe it's time to focus on your self more and other people less.
4. She is not doing anything wrong as long as her medical "team" is signing off on the appropriate paperwork for her to continue disability. You have to have proof that her physicians are lying...good luck with that one. FYI: the impression that you give is that you are bitter and jealous...quit hatin.
5. Based on the feedback you have gotten so far and your question, I believe it is safe to say that your relative has not done anything wrong. Has it occurred to you that maybe your relative is just finally putting herself and her needs first. Many times people who have been diagnosed with life threatening diseases come to realize that life is finite and that they want to enjoy being with their loved ones and doing the things they love. How do you know how your relative feels on a physical and emotional level? Are you a doctor or psychologist? Have you been with her on her doctor's visits? Has it occurred to you that maybe your relative is just trying to voice positive things to keep her spirits up? I can assure you that the short term disability she is receiving is significantly less than her salary since it is usually a percentage of the salary about 60 to 70%. In addition her medical team is signing off on her disability as medically necessary which not only encompasses physical but also emotional health. Having breast surgery is quite painful on both a physical and emotional level. She is dealing with not only the knowledge that her life is finite but also a direct affront to her femininity. From your statement I can assure you that her behavior is totally normal! Since you have posed the question my advice on this situation is as follows: 1) Please try to tap into some compassion for your relative instead of judging her 2) Please consider visiting a therapist or minister to analyze and discuss why you are feeling so deprived that you feel the need to judge your sick relative and make this situation about yourself 3) Try reading about people who have suffered cancer 4) A good book to read about developing compassion in general--"the Kindness Handbook--a practical companion" by Sharon Salzberg. I hope you will have the chance to use your relative's illness to develop compassion for yourself and for everyone around you. I wish you and your relative the best!
6. Depending on exactly what type of insurance benefits she is getting and what their requirements are for claim, this might not be anything fraudulent at all. In most cases, disability insurance is not a reimbursement insurance, meaning if you are eligible for a claim, they just cut you a cheque....you do whatever you want with the money. It all depends on the definaitions of her insurance policy. I know personally with mine, as long as I can not do my own exact occupation, I get paid a claim. I can go out and get another job of some kind (IE: teaching at a college about financial matters, etc) and still get paid my disability insurance income for not being able to do my current job ontop of the money I am earning from my new job. This is clearly stated in the definitions, is within the 'rules' and completely legal. I also have a long term care policy where if I dislocate my shoulder or have something more severe, I will earn almost twice as much money on claim as I am working. Again, clearly stated in the definaitions, within the 'rules' and completely legal. They are just great products and I'm taken enough time to understand them and know what is and isn't covered. Just because she's getting a free ride, doesn't mean she's using or abusing the system. Sometimes proper/smart planning entitles you to good things. What you need to do is find out what the definitions are in her policy (is it "own occupation", "regular occupation" or "Any occupation"). That's where the difference will determine is she is actually defrauding a company or not.