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.
FREE QUOTE AND CONSULTATION
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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.
FREE QUOTE AND CONSULTATION
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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.
FREE QUOTE AND CONSULTATION
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Send us an email.
We will contact you during business hours -
or by email 24/7
Donald Metz - CEO
Donald Metz Phone: 954.593.1629 Fax: 954.565.8364
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