insurance fraud Archives - Page 2 of 3

Business Owners, Insurance Companies and Private Investigators Work Together to Eliminate Insurance Fraud

As our clients know, earned our excellent reputation because we are results oriented. Definitely, we think outside the box, approaching every case with a willingness to use whatever skills and resources necessary to gather evidence. Even the best of scam operators can't slide past our investigative tools since those tools and research skills are also mixed with persistence and the highest level of confidentiality. These facts about our agency bring insurance companies to our door. Recently a claims agent called because one of the business owners the company insures came to them with some concerns. He was certain that at least one of his employees was fraudulently collecting workers compensation benefits. But he had recently heard gossip about a second employee who was also drawing [...]

Is it Pain or is it Workers Compensation Fraud?

When their employee of less than six months claimed that her back was severely injured during a fall at work, Mary and Ted were alarmed. After all, their entire company was built on safety. In more than two decades of being in business, an employee had never been hurt on the job. But soon after the woman claimed to be too injured to return to work, Mary and Ted began to smell a rat. They spoke to other employees about the incident. Unfortunately no one had seen the woman actually fall. There was no video to review since Mary and Ted had never seen cameras as a necessity in their place of business. Shortly thereafter, the employee filed for workman’s compensation. Following that, Mary and [...]

Private Investigators Prove Insurance Fraud with Surveillance Video

When Wanda fell on a wet floor at work, she claimed to have suffered multiple injury-related problems. She quickly filed for workers compensation and sued her employer for millions of dollars in damages. Because they had no access to a videotape of Wanda’s slip and fall accident, her employers had no way of proving that she was lying – and committing insurance fraud. They heard a few grumbles around the community from Wanda’s co-workers and a few of her neighbors too, stating that Wanda was not only pretending to be injured, she was bragging about how she had her previous employer pinned to the ground like a bug. Frustrated and aggravated by the continuous stack of medical bills arriving in a thick manila envelope every [...]

When Your Quest is Truth; Hire a Private Investigator

Law officers and ambulance drivers, emergency room doctors and defense attorneys often boast that they see the weirdest of the weird. But sometimes the weird stories can be added to the discussion by adjustors for insurance companies. One particular story involves an adjustor in Colorado and her claimant, who insisted that her vehicle had dropped into a vertical mine shift. Knowing that the police department had no time to search endless acres of rocky terrain in the area of Baily, Colorado, the adjustor called on a private investigator. She asked the private investigator to do everything they could to locate the missing vehicle and solve the fishy-sounding story. After many long hours and long days of searching the rough terrain in off-road vehicles, the investigators [...]

Computer Forensics Investigations Reveal Truths – Wanted or Not

Computer forensics is not only used for criminal cases, but for civil cases as well. One illustrative case involved a worker who was placed on unpaid leave and then terminated. He filed a lawsuit against his employer alleging violations of the anti-retaliation provision of the False Claims Act and the Americans with Disabilities Act as well as the laws of the state of the occurrence. He told his attorney that several supervisors had conspired against him and that there were emails he had seen to prove it. The attorney obtained subpoenas for the computers of the supervisors and the terminated employee for computer forensics analysis. When the certified computer examiner began the process, he created a digital copy and found something unusual. The unallocated file [...]

Investigations and Social Security Numbers

Few people think much about their social security number, other than protecting it from identity thieves. But the actual number was – in the past – very telling. conducts a lot of investigation of specific people for a wide variety of reasons: A missing person investigation An identity theft An asset search Due diligence for personal or professional reasons Insurance fraud And a social security number can be a source of leads and information. But a relatively recent change adds some new challenges – and opportunities. The first three digits of a social security number used to stand for something specific. Each state had a certain series of numbers and other groups, like railroad workers, their social security number always began with digits from 700 [...]

Don’t Become a Victim of Vehicle Accident Insurance Fraud

It was reported at Bankrate.com that fraud is an element in one out of every 3 auto insurance claims in New York City! That is incredible and officials say that this fraud adds an estimated $241 million to premiums every year. New York City is not alone. The article reported that the top five states for auto insurance fraud are California, Florida, Texas, New York and Maryland. Is it no wonder that insurance company claims adjusters are always looking for red flags? When there is something that makes the adjuster question the legitimacy of a claim, they often call an investigator in on the case. A vehicle accident investigation can result in determining one of the following staged crashes has occurred: Wave down: requires two [...]

Car Arson – Insurance Fraud or Criminal Case? Could be Both

You would think calls to regarding car arson would be from an insurance company representative saying that arson was expected regarding a claim. But experienced investigators never jump to a conclusion – they listen to the whole story before moving forward. And since investigates so many different cases, they know there are many directions a call can go. This particular story began with the attorney representing the accused. Sure enough, the insurance company wanted to deny a claim because of arson and the municipal police investigating were supporting the District Attorney’s decision to prosecute the car owner for arson – with insurance fraud charges on top of that. There was no need to be concerned about getting the accused man’s cell phone, he was happy [...]

Insurance Fraud Investigations Also Uncover Forgery

In the course of insurance fraud investigation, Internal Investigators has uncovered a trend that accompanies some claims – and that is forgery. Product liability cases can involve anything from a vehicle, to a food product, furniture, building materials and everything in between. When a claim is made about a product that might require relocating or acquiring rental cars, campers or the like, fraud and forgery can go hand-in-hand. Case in point is a pending case in New England. A man has been charged with insurance fraud and forgery in connection with a claim made to his insurance company. There was a problem with his vehicle and he said it could not be driven. He submitted more than $500 worth of receipts for a rental vehicle. [...]

Medical Service Providers Caught in Insurance Fraud Investigation

If you want to understand why insurance companies hire private insurance fraud investigators, consider this quote from the NorthJersey.com, the online home of The Record: "Three former chiropractors from Bergen and Passaic counties were sentenced to five years of probation Monday for setting up a fraudulent practice in Paterson and cheating more than 30 insurance companies out of what prosecutors say was millions.” Yes, you read that correctly – MILLIONS! The three medical services providers received sentences and were ordered to pay a total of $250,000 in restitution. But they cost the insurance companies millions of dollars, in fact it is reported that the three generated $2.8 million in fraudulent billings. When is called into a case like this, we know that it often results [...]