Everyone has heard of these cases, we have seen lots of them here at : the ones where a person (the claimant) has slipped or fallen and claims to have injured themselves in a restaurant or store. What you might not know is that there is a huge contingent of repeat claimants.
One of the first things an insurance company does when it receives a claim is to run the claimant through an industry database of all insurance claims filed. Only people in the insurance industry have access to that database and when a person comes up as a repeat or a serial claimant that throws up a huge red flag. Many insurance companies and companies who are self-insured have special investigative units (SIUs), but not all. So when that red flag pops up, they contact private investigators like to perform a slip and fall investigation of the case and the claimant.
Our goal is to provide the objective facts and we do that through surveillance and videotape. Nothing provides evidence of slip and fall accident fraud better than actual footage of a person in the course of their regular activities. We use that to answer two basic questions from an adjuster:
- Is the claimant working elsewhere for cash, a W-2 (employee) or 1099 (sub-contractor)?
- What is their general level of activity?
We handled a slip and fall fraud investigation where we videotaped a claimant going to see a physical therapist early one morning. He made a short 10-minute stop there and then went to a public phone to make a call. While he was on the phone, he changed into a work shirt, hung up and drove to a construction site. Once he got there, he took a tool belt out of the trunk and went to work on the roof of a house. Because the footage is all date and time-stamped, we were able to pinpoint the time of the call, which corresponded to a phone call to the claims adjuster whom he was telling the therapy was not working and that he was confined to home and bed.
Needless to say, the footage proved otherwise. The man’s attempt to defraud the insurance company was uncovered by the slip and fall injury investigation and benefits stopped. With experience, investigators know what to look for and how to go about getting the evidence needed to show the truth of the matter. That way, the clients can make an informed decision regarding the claim.
-Brenda McGinley, CEO, All in Investigations, All in Investigations