It is now my view from hearing enough testimony, that it was Coast Plaza Doctors’ Hospital in Norwalk, California, that was the catalyst to this criminal case which opened AIG’s eyes.  Jane Gerisimola received a Subpoena in her office in New York from Coast Plaza in February of 2007 demanding AIG records for their Civil Case against Rene Montes and Hector Porrata.   That case was filed on August 11, 2006. 

According to her testimony, Jane looked at 50 transactions that were at issue.

One of the things she thought was “very significant” in her investigation was that the defendants had worked together in the past. 

“Did you review their resumes?” DA Thomas Schultz asked the Witness.

“Yes, I did.  I wanted to see their prior employment,” Jane answered. 

“What observations did you have?” the DA further probed.  “What was significant to you in terms of the Fraud Investigation?”

Jane went on to say that it was very significant to her that all of the defendants had worked together in the past and specifically they had all been together at Sedgwick CMS.  She implied that to her this was a real indication of possible collusion and conspiracy.

I smiled to myself.  I knew Jane was from New York and is the general investigator of internal fraud for AIG Nationwide.  Therefore, she is not initiated into the clique society of California Workers’ Compensation claims.   So, she wouldn’t have a clue.  In any other industry, professionals working together in the past might be a more unusual thing, but not in California Workers' Comp claims. 

It is more common than rain for California Workers’ Compensation claims professionals to work with one another over and over again at multiple companies throughout the span of their careers.  Jane doesn’t know that when Supervisors or Managers leave a company they are well known to hire many of their previous examiners from their prior company to come to work for them again at their new company.  Back before the Recession, which is generally thought to have started in 2007, Work Comp examiners in California moved around like a game of musical chairs and reunited with one another over and over again like going to a perpetual Homecoming event.  So this is almost never a sign of conspiracy. It's just a "clique". 

If every adjuster who had worked with several other adjusters over and over at different companies were suspected of conspiracy and collusion, the whole industry would be under investigation.   So, I could see it being looked at, but in California Work Comp claims it's never "very significant" as a sign of conspiracy.

But, this wouldn’t be the first time I’d feel like speaking up at an attorney’s questions or the Witness’ answers.  Fred McBride, Rene Montes’ defense attorney, got really worked up and actually rather combative towards Jane with her inability to acknowledge an “Approved Vendor List” that Fred wondered if WCSC were on at AIG.  

McBride was really pounding this question of whether Jane looked to see if WCSC, Rene Montes’ company, were on the AIG “Approved Vendor List”.  Jane was just wilting in the Witness’ chair, and answering that no, she didn’t look up to see if WCSC were on the “Approved Vendor List”. 

I was cracking up silently because it was clear to me that Fred McBride does not understand the business.  Having a Lien Claimant on the “Approved Vendor List” is like having a Party Crasher on the Dinner Party Guest List, but McBride doesn’t understand this, so he just kept getting frustrated and pissed.  Jane is a young woman probably just 5 to 8 years out of college, so she clearly didn’t have much experience with being cross-examined by blow-hard attorneys.  Thus, she could only manage to answer that WCSC was a Vendor because they had filled out a W-9 form.

Fred McBride:  Did you look to see if they (WCSC) were on the Approved Vendor List?

Jane Gerisimola:  No.  They're just in the Vendor Management System.

Fred McBride: So, how do they get in the Vendor Management System?

Jane Gerisimola:  A W-9 is submitted to AIG.

Fred McBride: What is a W-9?

It took all my self-control to prevent myself from laughing audibly.  By now McBride was very frustrated and hot under the collar.  I couldn’t believe he didn’t know what a W-9 form is, especially since he is no youngster. 

But I didn’t dare laugh because I have already come close twice to being held in Contempt of Court, have been scolded by Deputies for listening to my voice mail from my Blackberry during a break in Court Proceedings, for drinking a small cup of coffee during break, and for taking pictures of the outside of the Court Building from the public sidewalk.  And the list goes on. (I did win my case over my rights to take pictures of the outside of the Court Building.)   So, I didn’t want to give these lawyers and Deputies a final excuse to throw me out. Thus, I kept stone silent.

I thought Jane handled the heat from McBride really well.  Finally, she was allowed to retire the Witness Stand after she testified that Hector Porrata had worked in 10 or more places and that George Martinez had worked in 5 or more, according to their resumes.  This sounded about right to me in terms of the norm in the industry.

The next Witness will be Linda White from AIG again, who will be recalled to the Stand. 

To be continued…

Readers may write to writer Lonce LaMon at lonce@adjuster.com