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