Encounter with creative ‘patients’ out to fleece insurance companies

ILLUSTRATION | J NYAGAH The lady who takes the cake tried to pull a fast one after a pelvic fracture. She complained of infertility as a consequence of her injury.  NATION MEDIA GROUP

By YUSUF K. DAWOOD

 

In the Daily Nation of Tuesday 12 March, I was highly amused to read the article by Aggrey Mutambo about the ingenious ways we Kenyans devised to beat the long queues at our recent General Election.

Apparently women faked pregnancies, a claim difficult to verify, certainly in its early stage. Others carried babies in an attempt to jump the queue. This did not last long because officials found out that babies were being loaned at a price to facilitate lawful queue jumping. They, therefore, decided to mark the poor little infants with indelible ink so that they could not be “used” again and again.

Not to be outdone by women, men also resorted to audacious methods, like coming in a wheel chair, hobbling on crutches or donning dark glasses until our smart IEBC officials created a line for the disabled!

Two incidents mentioned in the write-up tickled my ribs to no end. One was a mock fight staged to disrupt the queue so that unauthorised voters could sneak in. The other was a man feigning a fainting attack so that he and three of his mates could be let in the voting room for resuscitation. Our clever police force saw through it, cocked their guns and the “collapsed” man ran faster than his friends in an attempt to escape a bullet!

Apropos of that article and with apologies to my fellow-columnist Aggrey, I am sharing my experiences as a surgeon to prove that the creativity of our people is not confined to voting queues only. In fact I don’t have to wait another five years to see these antics again for I see them everyday in the medico-legal section of my practice.

This part of my work is a junctional zone between law and medicine and a professional meeting point for lawyers and doctors. Also known as medical jurisprudence, surgeons are sometimes summoned by the bar and the bench to give expert evidence and assist the court in dispensation of justice.

Medical expertise

The need for this collaboration between surgeons and our “learned friends” arises in cases of murder and suicide, assault and accidents, rape and disputed paternity where medical expertise assists the court to reach the right conclusion. Because of the high rate of road accidents and industrial injuries, the bulk of my medico-legal practice concerns assessment of permanent and temporary disabilities caused by them.

An accident victim likes to claim the maximum compensation while the insurance company prefers the disability verified by a surgeon and pay only what is recommended after assessment. The insurance companies, the lawyers on both sides of the divide and judges have no knowledge about surgical injuries or their permanent impact on the patient. They have to depend on a surgeon’s report.

Thus by making a fair and honest assessment, the surgeon plays a crucial role in the court arriving at a fair settlement.

For various reasons, I greatly enjoy this part of my work. Firstly, it is a refreshing change from the mask and the cap. Secondly, with three elder brothers who practised law, I have a sentimental attachment to the wig and the gown. Furthermore, on the very few occasions when I have to attend the court to testify in person, I enjoy the excitement of legal battle, the thrust of examination and cross examination by the advocates and the cool composure with which our honourable judges conduct the trial.

Finally, I thoroughly enjoy the insight into human nature that this part of my work gives me. Luckily for me, time consuming court visits are rare because having established a reputation of assessing disability without fear or favour, irrespective of who has engaged me to make the report, insurance company or accident victims, I am very rarely required to attend court. My reports go in by common consent, which in lay terms means that by and large they are accepted by both parties and the court.

Like the trick of faking pregnancy and carrying babies, there are two common disabilities faked by accident victims. Men often complain of loss of libido and sex drive, both symptoms extremely difficult to verify. As one of my lawyer friends remarked, these complaints can only be verified by the wife or a prostitute.

In the case of the former, being a spouse, her testimony will not be accepted by the court. In the case of the latter, no lawyer would go to that extreme to prove a point!

In the case of older men who complain, it becomes obvious on questioning that they make no concessions for their advanced age and expect to possess the same zest that they had on their honeymoon and the same sex drive that their children now enjoy.

In this context I remember the case of a man who claimed to have developed impotency following a crush injury to his crotch. His compensation claim could have sailed through but for the fact that this occurred before the recently introduced judicial reforms took effect. It took seven years before the judgment was delivered.

In the meantime, the victim’s wife produced two babies and the lawyer of the insurance company who had kept a tab on her found it out and presented the evidence to the court. The male victim was in a tight spot because if he contradicted the clear-cut proof he ran the risk of being labelled a cuckold husband. On hindsight and in fairness to the man, I do think that a DNA test should have been done on the two children to verify their paternity!

Women also have discovered their own sex-related disabilities but before I embark on them, let me mention another novel attempt to dupe an insurance company, which I encountered recently. The company’s legal manager rang me and said. “A bus insured by our company was involved in a road accident, while driving from Meru to Nairobi.

“All 30 passengers travelling on it were injured. This is just to inform you that we have instructed their lawyers to make an appointment for their clients to see younShare


Since examining these cases can be time consuming, my secretary books no more than two patients a day. In this case too, she did precisely that. It was in her interest too because it is tiring to type more than two lengthy reports a day! She brought it to my attention when the 34th victim was being booked by the injured persons’ lawyer and I rang the insurance company to that effect. “I thought you said the bus carried 30 passengers,” I reminded.

“Please stop booking any more,” the legal manager instructed. “We are sorting the matter out because we understand that 20 extra disabled people who did not travel on this bus have joined the gold rush and have collected P3 forms from the police to claim compensation for injuries they sustained some years ago in other accidents!”

Normal passage
As mentioned earlier, our women are no less clever. They claim compensation for abortions, painful sex and inability to deliver through the normal passage, especially if the injury even remotely involves their pelvis. To outwit the course of justice, abortions almost always occur at home, an occurrence difficult to verify. Painful sex in a woman is more difficult to disprove than impotency in men!

Finally the story of the lady who takes the cake, for trying to pull a fast one after a pelvic fracture. She complained of infertility as a consequence of her injury.
“How many children have you already?” I asked.
“Five” replied Mrs Mauludi. “Three boys and two girls.”
“What’s the age of the youngest?” I inquired.
“Four years,” she replied.

I looked up the date of the accident. It was three years ago. So far so good, I reckoned. I examined her and apart from a couple of tiny scars on her lower abdomen, which she attributed to her fractured pelvis, I found nothing else. I made a report in which I said: “There are many reasons for secondary infertility.

To my knowledge, pelvic fracture is not one of them. If it is, it must be at the bottom of the list.

However, to be fair to Mrs Mauludi, I suggest a gynaecological opinion. If I might, may I suggest that she is examined by Dr Jowi.”

That was the saving grace. I met Dr Jowi a couple of months later in the hospital corridor. “I wonder if Mrs Mauludi came to see you,” I asked and gave him all the medical details about her, including the insurance claim.

“She hasn’t and she won’t,” Dr Jowi said. As I waited for an elaboration he added: “I have done a laparoscopic tubal ligation on her. Naturally she can’t conceive.”
“How come you remember her so well and so readily?” I asked.

“I was just starting my series of laparoscopic tubal ligation and she was my first case. Also, she is the only one I have sterilised after a pelvic fracture. The indication for surgery was that she had five children, three boys and two girls.”

Dr Jowi had sealed the fate of Mrs Mauludi. I promptly wrote an addendum to my original report in which I said that the pelvic fracture was not the cause of her infertility.

“Because of her sterilisation operation,” I added for good measure, “Mrs Mauludi is in a happy position where her factory can run full blast with zero production and no need for her to deliver the goods!”