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Insurance Fraud


Workers Compensation fraud

Insurance Fraud Investigation Experience

we are recognized as a leader in the field of insurance investigations. With national partners and international capabilities sought after by insurers, self insured corporations and insurance defense law firms, We continue to set the industry standards that others admire and attempt to duplicate.

We have over 20 years combined experience in Insurance Fraud, Corporate Fraud, Criminal Investigations, Civil Investigations, and Occupational Fraud Investigations.
Our team of specially trained investigators works with the legal staffs and executive committees to process insurance fraud claims and will testify during trials about their discoveries during their insurance fraud investigations.

Falsifying or exaggerating the facts of an accident to an insurance company to obtain payment that would not otherwise be made includes common types of insurance fraud ie: staged accidents, exaggerated injuries, and inflated medical bills

We actively handle ground investigations of potentially fraudulent claims with an emphasis on claims where there appears to be a likelihood of making a positive impact on the claim resolution.

We direct ground investigative services for high exposure claims, in addition to providing consulting and advisory conferences to our field investigators. Our investigators conduct interviews, statements, scene investigation and documentation, lead development, evidence gathering and prosecution packaging.


Our Promise
A Team - Investigations would like to thank all of the new partners that have placed their confidence in us this year and we understand your risk factors when trying a new surveillance company. Our goal is simple; allow us the opportunity to provide you with the finest work product available in the industry today,
You will be delighted to find this "Client comes first" philosophy will not disappear after the first assignment. We appreciate your trust and confidence by letting us provide you with the best work product available in our industry.
Our investigation staff can help you with verification of alleged injuries reported for workers' compensation claims, liability claims, auto bodily injury, disability claims, and other litigated claims.

We do know that fast and efficient service is your number one priority.

Some investigation companies are unable to provide quick and efficient TAT and you should consider making a change right now!

We will get information rapidly on each case and relay this information on a timely basis to your SIU unit so they can begin closing caseloads in an efficient manner.


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Here is an example of a claimant's movements. The face is not shown and this video clip was not used for evidence purposes. It is a sample of obtaining Workers Compensation evidence that could be used in court and presented for evidence.

PLAY WORKMEN'S COMPENSATION SAMPLE ONE VIDEO

PLAY WORKMEN'S COMPENSATION SAMPLE TWO VIDEO

IN ADDITION TO THE ABOVE SERVICES conducting medical related investigations to determine if there has been any previously undisclosed medical treatment rendered to the claimant prior to the date of loss which may have a direct impact on the status of the claim.

Life Insurance Scams:

Fraudulent Death Claims

To obtain reimbursement for life insurance, a death certificate is required. However, phony death certificates are not difficult to obtain. The person might be very much alive and missing or the person might be dead, and the death is past posted. With small settlements, death claims are not closely scrutinized and paid relatively easily.

Murder for Profit

This scenario involves killing (or arranging to kill) a person in order to collect the insurance. The death is usually made to look like it was an accident or a random drive by shooting.

Factors of Life Insurance Frauds
(Few Examples)

Red flags of life insurance fraud may include any of the following:

Concealment of Facts 
Fraudulent disclosure of Particulars 
Inefficient collection of facts by an officer or agents 
The insured may have a history of many insurance claims and loses 
Information on a life application is very vague or ambiguous as to the details of health history, dates, place of treatment, name of physicians or hospitals, or specific diagnosis 
And much more appeared during the course of our investigations

Hospital & Pharmacy Checks 

Medical Investigations

The purpose of conducting medical related investigations is to determine if there has been any previously undisclosed medical treatment rendered to the claimant prior to the date of loss which may have a direct impact on the status of the claim.

With a signed medical authorization, we can investigate services such as:

1. Date(s) of treatment/prescription
2. Type of visit (emergency room outpatient, and/or in-patient)
3. Prescriptions written, and;
4. Reasons for treatment and/or prescriptions
5. Hospital Checks
6. During this investigation a maximum of 10 hospitals are searched within a 60 mile radius of the claimants residence.

The objective is to gather evidence which may validate or show conflicting information around the date of loss or injury and furthermore, ascertain if the claimant was treated in a hospital.

The investigation may verify alleged injuries reported for workers compensation, liability, auto bodily injury, disability, and other litigated claims.

We also verify whether injuries appear to have occurred outside the scope of employment or if the claimant has a prior history of injury type claims. A check is also done to confirm the claimants social security number, address history, and phone number.

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Pharmacy Checks

An investigation will check up to 10 pharmacies within a 60 mile radius of the claimants residence on the date of loss or injury to determine whether prescriptions were obtained in the claimants name which may identify the severity or nature of the claim.

The Investigation also verifies whether the claimant was receiving prescription drugs for a pre-existing condition and sometimes assists in identifying the duration of the claimed suffering.

Verification of the claimants National Identity Card, address history, and phone number is also included.

Chiropractic/Dental Checks

Depending on the type of claims, the investigation will search up to 10 chiropractors and dentists within a 60 mile radius of the claimants residence on the date of loss or injury to determine if the claimant was treated prior to the reported injury.

The purpose of the investigation is to verify the alleged injuries are not the same as those for which the claimant may have been treated previously. It is also assists in ascertaining if the claimant has a history of prior claims.

Contestable Death Claim Situations

In the case of contestable death claims a search of records may result in the discovery of a pre-existing illness which may not have been disclosed at the time the policy was written

Public Record Investigations

We also have access to comprehensive database services used to provide access to history and factual information, public records, and private record service providers gives us an investigational advantage.

Our investigators have extensive industry experience and work with our information suppliers to provide accurate and concise information in a timely manner.




Complete story is here...

Press Release:
02/12/2009
CFO SINK JOINS DFS DETECTIVES FOR INSURANCE FRAUD ARREST IN TAMPA

DIF February 2009 Arrest Sweep Subject List


DIF – 69 arrests as of 11:00 AM, 02/12/2008

ARRESTS BY JACKSONVILLE FIELD OFFICE

1. Sherry D. Malloy, D.O.B. 01/24/1968
Charged with Arson & Burning to Defraud the Insurer
2. James Castle, D.O.B. 04/30/1962
Charged with Workers’ Comp. Fraud, Grand Theft and ‘Doctor Shopping’
3. Anthony Raila, D.O.B. 07/10/1965
Charged with Insurance Fraud and Forgery
4. Gonzalo Rivera-Mendel, D.O.B. 01/10/1967
Charged with Workers’ Compensation Fraud
5. Angela Purvis, D.O.B. 01/05/1967
Charged with Insurance Fraud

ARRESTS BY TALLAHASSEE FIELD OFFICE
6. Melisa Cain, D.O.B. 12/04/1968
Charged With Insurance Fraud and Grand Theft

ARRESTS BY PENSACOLA FIELD OFFICE

7. Robert Griffin, D.O.B. 12/10/1954
Charged with Workers’ Compensation Fraud
8. Clayton Eugene Palmgren, D.O.B. 09/22/1972
Charged with Workers’ Compensation Fraud

 

ARRESTS BY TAMPA FIELD OFFICE

9. Robin Broadnax, D.O.B. 05/22/1977
Charged with Uttering, Forgery, Grand Theft
10. Luis Alberto Duarte, D.O.B. 07/10/1973
Charged with Patient Brokering
11. Edelberto Morejon, D.O.B. 02/24/1960
Charged with Conspiracy
12. Nilda Rodriguez, D.O.B. 06/19/1972
Charged for being Unlicensed to Practice a Health Care Profession
13. Rafael Colina-Nicolau, D.O.B. 02/04/1974
Charged with Insurance Fraud
14. Shambrey Slaughter, D.O.B. 10/22/1988
Charged with Insurance Fraud
15. Roland Barton Jr. D.O.B. 10/22/1987
Charged with Insurance Fraud
16. Lewis Cameron, D.O.B. 11/22/1967
Charged with Fraudulent Motor Vehicle Insurance, Identification Card
17. Cynthia A. Bonilla, D.O.B. 11/15/1975
Charged with Workers’ Compensation Fraud, Grand Theft

 

ARRESTS BY ORLANDO FIELD OFFICE
18. Melanie Tola Spencer, D.O.B. 03/31/1979
Charged with Insurance Fraud
19. Jose Desravines, D.O.B. 12/22/1964
Charged with Application Fraud
20. Gislene Laurere, D.O.B. 11/28/1961
Charged with Application Fraud and Grand Theft
21. Jacqueline Stile, D.O.B. 12/15/1970
Charged with Filing a False Report, Grand Theft
22. Daniel R. Dougherty, D.O.B. 11/25/1956
Charged with Workers’ Compensation Fraud, Grand Theft

 

ARRESTS BY ST. PETERSBURG FIELD OFFICE
23. Brian I. Rothman, D.O.B. 01/22/1967
Charged with Official Misconduct, Theft
24. Dequan Baker, 09/10/1987
Charged with False/Fraudulent motor vehicle insurance card
25. Kenneth Reynard Brown, D.O.B. 12/08/1956
Charged with Workers’ Compensation Fraud, Grand Theft
26. Christopher J. Edbrooke, D.O.B. 09/17/1967
Charged with Forgery

 

ARRESTS BY WEST PALM BEACH FIELD OFFICE
27. Nicole Kasten, D.O.B. 04/19/1972
Charged with Insurance Fraud
28. Erwin Mejia, D.O.B. 03/30/1979
Charged with submitting a fraudulent social security card number to obtain employment
29. George Zelaya, AKA Jorge Elisee Elvir, D.O.B. 03/17/75
Charged with submitting a fraudulent social security card number to obtain employment
30. Eveline Paul, D.O.B. 07/12/1970
Charged with Insurance Fraud
31. Judner Joseph, D.O.B. 11/02/1988
Charged with Insurance Fraud, Grand Theft
32. Mimose Jerome, D.O.B. 07/25/1962
Charged with Insurance Fraud, Grand Theft 
33. Daniel Tapia Rivera, D.O.B. 11/16/1972
Charged with Insurance Fraud
34. Frantz Vibert, D.O.B. 1/12/1979
Charged with participating in a staged crash, Theft, Fraudulent Insurance Claim
35. Ricardo Mejia, D.O.B. 10/28/1984
Charged with Workers’ Compensation Fraud
36. Eric W. Moem, D.O.B. 07/23/1965
Charged with Workers’ Compensation Fraud
37. Luis O. Martinez, D.O.B. 02/15/1984
Charged with submitting a fraudulent social security card number to obtain employment
38. Mayra A. Cortes, D.O.B. 10/12/1986
Charged with submitting a fraudulent social security card number to obtain employment


ARRESTS BY FORT MYERS FIELD OFFICE

39. Manuel Feliciano, D.O.B. 03/24/1966
Charged with Workers’ Compensation Fraud


ARRESTS BY PLANTATION FIELD OFFICE
40. Francisco Nogareda, D.O.B. 05/28/1964
Charged with Staging an Accident, Grand Theft
41. Frank Nogareda, D.O.B. 09/15/1985
Charged with Staging an Accident, Grand Theft
42. Ana Nogareda, D.O.B. 09/07/1965
Charged with Staging an Accident, Grand Theft
43. Dayana Nogareda, D.O.B. 06/08/1987
Charged with Staging an Accident, Grand Theft
44. Zachary Castro, D.O.B. 04/05/1987
Charged with Insurance Fraud
45. Antoine McGee, D.O.B. 08/08/1987
Charged with Insurance Fraud
46. William Baines, 01/21/1985
Charged with Insurance Fraud
47. Juan Carlos Chavez, D.O.B. 12/04/1955
Charged with Fraudulent Insurance Card, Uttering Forged Instruments, Insurance Fraud
48. Eddie Dunbar, Jr., D.O.B. 06/08/1982
Charged with Insurance Fraud
49. Ahyxza Rivera, D.O.B. 06/21/1972
Charged with Uttering a Forged Instrument
50. Geoffrey Goodyear, D.O.B. 09/16/1969
Charged with Grand Theft

 

ARRESTS BY MIAMI FIELD OFFICE
51. Jean Castellano Aman, D.O.B. 03/10/1975
Charged with Staging an Accident, Insurance Fraud and Grand Theft
52. Maibys V. Garcia, D.O.B. 08/20/1978
Charged with Staging an Accident, Insurance Fraud and Grand Theft
53. Alfonso Davila, D.O.B. 09/10/1987
Charged with Staging an Accident, Insurance Fraud and Grand Theft
54. Antonio Rodriguez, D.O.B. 10/24/1956
Charged with Staging an Accident, Insurance Fraud and Grand Theft
55. Diaren Rodriguez, D.O.B. 09/271970
Charged with Insurance Fraud and Grand Theft
56. Eduardo Torres, D.O.B. 11/22/1960
Charged with Workers Compensation Fraud
57. Gustavo Martinez, D.O.B. 09/21/1955
Charged with Workers Compensation Fraud
58. Bernard Goldstein, D.O.B. 05/28/1953
Charged with Workers’ Compensation Fraud
59. Hymy Maorguin, D.O.B. 08/11/1979
Charged with Workers Compensation Fraud
60. Henry Demayo, D.O.B. 12/16/1948
Charged with Grand Theft
61. James Dyson, D.O.B. 07/26/1985
Charged with Staging an Accident, Insurance Fraud and Grand Theft
62. Jonathon Dyson, D.O.B. 10/16/1987
Charged with Staging an Accident, Insurance Fraud and Grand Theft
63. Jorge Reyes, D.O.B. 08/08/1969
Charged with Insurance Fraud, Grand Theft, Organized Scheme to Defraud, and Patient Brokering
64. Waldo Gonzalez, D.O.B. 11/16/1971
Charged with Insurance Fraud, Grand Theft and Organized Scheme to Defraud
65. Mayori Garcia, D.O.B. 12/11/1986
Charged with Insurance Fraud, Grand Theft and Organized Scheme to Defraud
66. Sandra Himley, D.O.B. 05/01/1959
Charged with Insurance Fraud, Grand Theft and Organized Scheme to Defraud
67. Jose Gil Rodriguez, D.O.B. 11/12/1966
Charged with Insurance Fraud and Grand Theft
68. Antonio Basanta Gonzalez, D.O.B. 08/04/1986
Charged with Staging an Accident, Insurance Fraud and Grand Theft
69. Wesley Ohenhen, D.O.B. 10/01/1965
Charged with Workers Compensation Fraud

 

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