The thirty story building blended into the skyline with many of the tall skyscraper’s towering high overhead. Just an average office building in Chicago’s down town section. Ronald Gibson accepted a new position with Metro Life Insurance Co., with offices on the 19th floor of the thirty story high rise. Ron, a little nervous as he pushed through the rotating doors, turning to keep out the cold and wind, he would be reporting to a Mr. Jim Langston. As he entered the elevator and scanned the floor buttons for the 19th floor, he noticed that the numbers went from 12 to 14, skipping the number 13. Curious he began counting to himself as the floors flashed by, one thousand and one, one thousand and two, one thousand ad one, one thousand and two… then between the 12th and 14th floors it took and extra second. “There is a 13th floor after all.” He said out loud, alone in the elevator.
The elevator slowed down and stopped on number 19. As the doors opened Ron slowly stepped out into the lobby. The large letters over the reception desk read Metro Life Insurance Co., He knew he had found the right address.
“May I help you?” Came a soft female voice from behind a computer screen.
“I’m Ron Gibson, and I have an appointment with Mr. Langston at 9:00 AM.”
“Please take a seat, and I will let him know you are here.”
“Jim will be with you shortly, would like a cup of coffee while you wait?”
“That would be great, black, no sugar, please.”
“Here you are, if there is anything I can get for you while you wait, just let me know.”
Ron couldn’t get his mind off the missing 13th floor. He had worked in construction as a young man, floor space as a draftsman and knew that a lot of buildings did not have a thirteenth floor, or they used it for heating and air conditioning equipment. Floor space on the thirteenth floor is hard to lease. One building he recalled had nothing on the thirteenth floor, just open air, no walls or access. The wind and birds just flew through. However most buildings just skipped the number 13 saving money.
While Ron waited he looked over the job description again.
Fraud Specialist- Investigator
Performs specified investigative steps in response to client and/or customer complaints of suspected fraud perpetrated against the company, our clients or customers. Utilizing independent judgment and discretion, plans and initiates the appropriate course of action for the purpose of resolution and restitution of high dollar amounts. Determines and acquires information pertinent to and impacting each situation investigated. Prepares reports to expedite tracking and reporting of investigations. Prepares evidence packages for referral to third parties including contract holders, state insurance fraud bureaus and law enforcement agencies. Interfaces and coordinates investigations with appropriate State and Federal law enforcement agencies. Responds to subpoenas and requests for information from law enforcement agencies and State Departments of Insurance. May represent company as a witness in judicial proceedings when appropriate. Performs special projects requiring expertise in fraud detection, investigation, claim auditing and other areas related to Special Investigations. Works independently receiving direction and guidance.
Through interviews, analysis, and investigation, resolves allegations or suspicions of fraud against our customers and company. Must comply with reporting requirements, subpoenas, and requests for investigative assistance, while, at the same time, protecting our customers PHI, Protected health information. This position requires significant contact with Metro Life clients and customers as well as other business areas and outside agencies, such as Law Enforcement, Attorneys, and Departments of Insurance.
Related experience in insurance investigations and/or claims processing strongly preferred
Computer skills are required
Strong communication skills, both written and oral, are required
Must be able to adapt to changing priorities
Bachelor’s Degree in Criminal Justice or related field strongly preferred
Minimum 5 years’ experience in insurance investigation/audit strongly preferred
"Good morning, Ron, Jim Langston, just call me Jim. Come on back and bring your coffee, think I will have one to, Helen, the usual."
"Nice office you have, great view."
"Wait till you see where you will be working, you can see the lake from your window. Have a seat. Thanks for the coffee Helen. Helen will be a great help for anything you need, she knows where everything is around here."
"Thank you Helen, you've been a big help already."
"Did you find a place to live?"
"Yes. We’ve found a nice home in Oak Brook, only about thirty minutes away. Carol and I will be moving in this weekend, and she may already have a job."
"Great, as you may know insurance fraud is a huge problem, our sales people are under a lot of pressure to find new clients, so they often overlook the obvious warning flags. That's where you come in, we will start with letting you review new clients to see if they plan to de-fraud the company. Checking to see if they are taking out insurance on high risk strangers, and maybe even prevent a murder now and then."
"Certainly sounds like an interesting job, looking forward to getting started."
"Just one word of warning, the PHI of our customers is our first priority. It would only take one lawsuit to ruin our reputation. I am afraid that a violation of this rule would result in dismissal."
"I understand completely, any records I view will not leave this office."
"Let me show you your office, I will let you get settled in and have Helen bring you the first list of new clients to review. One other thing, your bonus each month will be biased on how much you save the company, I don't think you will have any trouble earning a nice bonus each month."
"By the way we have a nice restaurant on the first floor, lunch at twelve?"
Ron tried out his new chair, and took in the great view of the lake while he waited for Helen to bring in the files. He had no idea what he would be in for.
Carol and Ron met ten years ago when Ron served in the Army, and they got married after he left the service. His past experiences with criminals helped him as he became an investigator, working as an independent contractor. Now he had a full time job with an office.
Helen returned with a stack of file folders about six inches high, and place them in Ron's in basket. "Enjoy the reading, let me know if I can help."
"Thank you, I am sure I will have some questions."
Ron picked up the first folder and starting reading, why would anyone insure their three month child for a fifty thousand dollars? The more he read the more concerned he became about the child's safety. The father had a good job and the mother also worked, so why the need for so much insurance? The life insurance on each of the parents amounted to only one hundred thousand each!
The next three files seemed harmless enough, then when he opened the last one, it seem strange that a new policy for an elderly person would be taken out totaling seventy-five thousand dollars. All of the policy files where from the same salesman in Atlanta, Ron decided he should talk to Mr. Simpson to, and find out more about him.
Ron made notes on the two files under suspicion and returned the files to Helen. "Helen, I will need to make some calls on a line that does not reveal where it is coming from, do we have such a line?"
"Line four is unlisted for privacy, the calls are also recorded in case you need the information later. Let me know if you me to send you a copy of the call."
Ron made his first call, to the home of the couple that insured the young child.
“Hello, my name is Ron, I am new in the neighborhood, and we had a break-in, I am just checking to see if anyone else has had any problems?”
“Hu, no, my husband is not home now, sorry but I can’t help you.”
“That’s Okay, just keep a watch out and keep the doors locked. Sorry to bother you.”
“I will, thanks. Goodbye.”
The next call he made to a rest home, to see if Mr. Simpson lived there and if he could talk.
“Hello, Pleasant Valley Rest home.”
“Yes, how is Mr. Simpson doing today, it’s been a while since I have checked on him.”
“He is fine.”
“If I visit him can he talk?”
“I believe so.”
“Thank you, Goodbye.”
Over lunch, Ron started discussing the cases he had reviewed. “Jim, two of the cases I viewed looked suspicious. I think that I should fly down to Atlanta and check them out. I know that I just started, is that Okay.”
“Sure, that’s what we hired you for, stay in touch with Helen. I will call you if we get something new for you to check out while you are in Atlanta. I appreciate your getting involved so quickly, fraud is our greatest problem in the insurance business.”
"I am really concerned about the safety of this young boy. The father insured for fifty thousand, why would anyone need that much insurance for an infant."
"We do try to avoid that, and some states have tried to pass laws limiting the amount, but where do you draw the line, after all this is a free country!"
"Thank you for Lunch, next time it's on me."
“Helen, I will be on the road for a few days, you have my cell phone, text me if anything changes on those two cases I flagged. I will be looking into them.”
“Okay, should I make reservation for you?”
“That would be great, Round trip to Atlanta with an open return, and a motel room on the north side of town.”
“Okay, I will text you with the details, you will need a rental car, what do you prefer?”
“Whatever is available will be fine.”
“Here is your company credit card, try to use it for all your travel expenses, it makes it easier than filling out an expense report.”
“Hello, Carol I wanted to let you know that I will need a bag packed for a few days, got to go down to Atlanta and check out a couple.”
“Okay two days enough?”
“That will be fine, when do you expect the movers?”
“They called and said they will be here tomorrow, so I will be busy unpacking, have a safe trip and hurry home, love you.”
“Love you too, this could be a very interesting job.”
Chicago O’Hare made it easy, being close to Oak Brook, and the middle of the week resulted in light traffic.
As the plane left the runway, Ron thought about the 13th floor that he ordered by mistake and had to return all that material to the factory, what a mess that turned out to be, and one of the biggest mistakes he had made. He now hoped that his feelings about this young boy would not be true.
The two hour flight passed quickly as the plane level out for a long slow approach into Hartsville International. The Atlanta skyline looked great out the right side passenger window. Just before the Delta plane touched down Ron dosed off and didn’t wake up until they taxed up to the gate.
He drove up Interstate 75 to the northern suburb and checked into the motel. Concerned that he might be too late, he drove out to the subdivision and located the couple’s home, found a house for sale that looked empty and parked in the driveway where he could see the front of the house.
Around six that afternoon the wife pulled into the drive way, unbuckled the young boy from the back seat, took the baby in and turned the lights on in the home. About thirty minutes later, the husband pulled in, and transferred the baby carrier from the wife’s car to his. Ron watched the house until the light went out before returning to the motel.
Ron placed a wakeup call for Five AM to make sure he could get back to his lookout before they left for work. The wife left first, without the boy. Then the husband brought the boy out and buckled him into the back, pulled a blanket over his head to keep the light out of his eyes. “He must be still sleeping,” Ron thought.
The SUV backed out and Ron followed at a distance. A temperature of close to ninety would be reached before the end of the day, and Ron had a bad feeling. The SUV stopped at a QT for gas and the husband left the boy in the unlocked SUV and went inside for coffee. Returning to the car he drove to his work place, a large business complex with a large parking lot. He did not even look back, as he left the car and boy, slowly walking toward the building.
Ron could hardly wait for him to get out of sight, before calling 911.
“911, what is your emergency?”
“I have found what may be a baby in a locked SUV, there is a blanket over the car seat, so I’m not sure, but I thought I saw movement.”
“Please remain there, I have your GPS location and EMS team will be there shortly. Do you have anything to break out the driver’s side glass?”
“Yes, I should have a tire tool in with my spare.”
“How long has he been in there?”
“I don’t know.”
“Feel the glass and see if it is warm.”
“No, it’s still cool.”
“Okay, give the EMS a few minutes to get there, they can unlock the vehicle. Don’t hang up, stay with me.”
“I just witnessed the blanket moving again. I think he is Okay. I hear the firetrucks coming now, and the police.”
“Stand back please.” As the fireman slid the flat metal hook down the side of the glass and popped the lock up on the SUV. They removed the baby and checked him out.
“Do you know who the owner of the SUV is?” Asked the police woman.
“No, I just walked by and spotted the bundle in the back seat. I have an appointment, can I go now?
“Yes, 911 has your mobile number if we need any more information, thank you so much, you know you just saved this baby life don’t you.”
Ron headed out for his next stop, the rest home where the elderly Mr. Simpson lived to check on his condition.
At the front desk he asked for Mr. Simpson.
"I'm sorry Mr. Simpson passed away this morning in his sleep."
"Could I see the next of kin?"
"He did not have any relatives, no one ever visited him, and you are the first I know of to ask."
Ron immediately drove to the county coroner's office. "Evening, my name is Ron Gibson, with Metro Life, I would like to report a possible Insurance fraud in the death of Mr. Simpson at the Pleasant Valley Rest Home. Could I speak with the medical examiner?"
"One moment, Bob, there is a Ron Gibson here to see you."
"Hello, I'm Bob the medical examiner, how can I help you?"
"Have you determined the time and cause of death of Mr. Simpson who died at the Pleasant Valley Rest Home this morning?"
"No, I have not had a chance to examine him yet, is there some wrong?"
"Yes, a large life insurance policy just went into effect and I need to know if he died prior to the policy being taken out."
"Let’s go see, come with me. Could I have your name again?"
"Ron Gibson, with Metro Life."
"I just placed his body in the cooler, let's check his internal body temperature, which will give us a clue. Wow, his internal body temperature is colder than our cooler. That’s bizarre."
"Why is that?"
"He must have been in a very cold place, or on ice for a long time, no way to tell how long he has been dead."
"Could you contact the Sheriff's office for me, I can give you the name of the beneficiary on the insurance policy for seventy-five thousand dollars, looks like someone may have insured a dead man!"
"Yep, we will be investigating this one, thanks, what brought you down to check on this so fast?"
"Someone took out an insurance policy on Mr. Simpson only last week, and I did not feel good about it. I happen to be in town and thought I would talk to Mr. Simpson when I found out about his death. They claimed he died this morning."
"No way, he would have still been warm, a lot warmer. I will start on him right away."
"Here is my cell phone number, call me when you know more, thanks."
Ron, waiting at the airport for his flight home, when his cell phone rings… “Mr. Gibson, this Bob at the coroner’s office.”
“What did you find out?”
“Simpson died of natural causes, cancer of the liver. I can only be certain that he’s been dead at least two days or longer. I would guess much longer and that someone put him in a freezer. I have already contacted the police and they are going to investigate the Pleasant Valley Rest Home.”
At the Delta terminal, as he waited for his flight, Ron got out his laptop and wrote his report. Glancing up from his notebook, he thought he noticed the passenger across from him, staring, his eyes suddenly shifted when Ron looked up. At first he did not think anything of it, but as he thought about the face, there was something familiar, if only he could remember where he had seen that face before.
As they boarded the flight, Ron became a little unnerved when the stranger followed him so close as they went down the Jet way to the plane, and when he took his aisle seat, the stranger took the aisle seat one row behind him on the other side. Ron did not open his notebook again, realize that the stranger would be able to read it over his shoulder.
The Delta flight landed at O’Hare in good weather after a smooth flight. Ron caught the shuttle bus to the parking lot and picked up his car for the short drive home. Pleased that they found a home so close to the airport, knowing that he would be making a lot of flights.
As he parked the car, it hit him. That face. Hair parted high on the side, wet looking, and a square flat chin, he saw him on the flight down! Sitting in the same position, behind him.
“Carol, I’m home.”
“I’m in the kitchen unpacking the dishes. Did you have a good trip?”
“Very good, give me a hug, love you.”
“Love you back. What happen down in Atlanta?”
“I prevented one death, and uncovered another insurance fraud by a rest home.”