This is the first of a multi-part series. Subscribe to our feed to be updated when new entries in this series are posted.

The objectives of this series are to teach claims adjusters and managers the proper use of  surveillance, research and other investigative techniques, and to help them identify and investigate fraudulent claims.

Each year, consumers are victimized by fraudulent claimants. These crimes cost billions of dollars in additional insurance premiums, legal and medical services, and loss of productivity.

For many years, insurance adjusters and insurance defense attorneys have depended on the results of surveillance to assist them in making certain decisions in relation to a claim. No doubt that a successful surveillance, that is, one in which the claimant is found to be employed or is recorded doing the things he claimed he couldn’t do,  remains a powerful tool in the settlement of claims. But if not properly conducted and kept within the legal parameters or if conducted by inexperienced investigators, it may turn out to be a wasted effort, often times a very expensive one.

Investigative research has often been underestimated and underutilized in the investigation of fraudulent claims. However, research can produce incredible results when properly utilized.

What is Fraud?

Any misrepresentation of a material fact. To knowingly make or cause to be made, any false, fraudulent or misleading oral, or written statement, for the purpose of obtaining or denying any benefit under Florida State Statute 440.

Definition of Surveillance

Surveillance can be defined as the secretive, continuous or periodic observation of persons or groups, for the purpose of obtaining information concerning the activities of said persons or groups.

What Does Surveillance Usually Accomplish?

• Assists claims adjusters, examiners and others in determining the validity and extent of an injury.
• Can be used to get the claimant back to work or to light duty.
• Good results can be used by defense counsel as leverage during negotiations
• Claimant’s activities may be shown to doctors so that they may decide if taped activities are consistent with their diagnoses and claimant’s complaints.
• Can be used as evidence.
• Can be used to document the activities of an individual or group.
• Uncovers associations or relationships previously unknown.
• Provides evidence to corroborate or refute other information.
• Can be used as an intelligence gathering tool. 

 

To Be Continued In Part 2

 

ICDA Investigations, Inc. is proud to announce the launch of our new website.

The redesign will make it easier for our clients to access the services they need and creates the framework on which we will be releasing our new Case Management system. If you have any questions or comments about the new website, please let our webmaster know via email at webmaster@icda.com.

As always, if you have any questions about any of our services, please email us at info@icda.com or feel free to give us a call at 1-305-634-5555

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1) Use private investigative services anytime you need to find out what the facts are regarding an individual, a group, an entity, or a particular situation, ideally before you are aggrieved.

2) Don’t rely on your attorney, accountant, or other service professional to recommend, or even encourage you, to use investigative services. Evaluate the situation and make the decision yourself; occasionally, a service provider may not be interested in recommending the services of an investigator that may solve the case prematurely. Delays can cost you and/or your business money, aggravation, prestige or customer goodwill. If you need the situation investigated, consider a reputable private investigations agency.

3) Check that the private investigations agency you want to hire is properly licensed and insured. Most states provide this information to consumers for free by phone or online.

4) Make sure that the PI firm you are considering is qualified in the area of expertise you need. Not all investigators are equally trained or experienced.

5) Verify professional qualifications. Some investigators tend to overestimate their qualifications and their agencies’ capabilities.

6) Preferably, hire an established PI firm that has been in continuous business for a number of years. Longevity demonstrates a certain degree of stability

7) Understand the specific terms of your fee agreement with the PI firm and ask for a Retainer Agreement or Proof of Deposit.

8) Expect to receive a report, video for surveillance cases and any other evidence discovered by the investigator, as allowed by law

9) Weight the investment you make to hire an investigator against the benefits that you can reasonably expect to derive from the investigation. A professional investigator should be honest and forthcoming about the realistic expectations of your particular case. Establish a clear objective prior to commencing the work and ask for recommendations that will help you achieve that objective.

10) Follow your instincts and use common sense. If it sounds too good to be true, it probably isn’t. Call us and we’ll be glad to answer your questions.