insurance

Pete and Repeat Hired the Wrong Employee

We have Clients who have shared their experiences in hiring employees for their company.  The first line is “You wouldn’t believe what this employee did?  We had no idea they were remotely engaged in that activity.  They interviewed so well”. Although we hate to hear this, we are very familiar with a hiring practice that does not include background research.  With an unemployment rate as of July 2018 at 3.9% employers are finding it difficult to fill positions.  And as a small business owner with less than 50 employees, health insurance to the employee is not a requirement, which makes the hiring process even more difficult for an employer. As a result of just those two factors, employers tend to overlook one of the most [...]

Insurance Fraud Stacks Deception on Top of Desperation

There are so many different aspects to insurance fraud. Besides fraudulent claims and falsely-acquired settlements, money may be a motivator for other types of insurance fraud. Take, for example the case of a man who lost his job. He had a wife and three children and suddenly found it impossible to find employment. He was desperate so he faked a slip and fall accident at the local mall. He claimed his slip and fall injuries were significant enough to prevent him from working and because it is difficult to prove or disprove soft tissue injuries, the insurance company was reluctant to settle quickly. His situation grew direr because now he was unable to even look for a job because it would show he was faking [...]

Medical Provider Fraud Surprises Innocent Patients

You might be surprised to learn that not all insurance fraud is uncovered because of a personal injury investigation, workers compensation fraud investigation, product liability investigation or a long term disability insurance fraud investigation. No, it’s not always the “patient” who is being investigated. Sometimes it is the medical care provider! Not every doctor, physical therapist or chiropractor is committing medical insurance fraud, but some are. Investigators were called in regarding insurance claims coming in from a specific chiropractor. The insurance company noticed that the number of claims had significantly increased from this particular service provider and the services were long-term and fairly extensive. It was the change in the claim history and types of claims that triggered one of those “red flags” for adjusters. [...]

Fishing For Long Term Disability Insurance Fraud

Long term disability (LTD) cases are not decided and then set aside. In many cases, LTD claims are reviewed, especially if an investigation was completed previously but was not conclusive one way or another. Such a case came into an investigator. In this situation, the claimant had been receiving LTD benefits for several years when an adjuster reviewed the file and decided that it was time to take another look. The claimant was a man who had physical restrictions regarding the number of pounds he could lift and the amount of physical activity he could safely engage in at any time. A previous investigation had not been absolutely conclusive that he was committing long term disability insurance fraud, but the adjuster had a feeling something [...]

Full Service Investigators Bring It All to Insurance Fraud Cases

Part of the reason why insurance companies, attorneys and self-insured companies hire a private investigator like is because we can uncover the truth in a wide variety of situations. For example, in one case where a car was allegedly stolen and recovered completely burned out, the insurance company asked us to investigate the owner. The insurance company did not share their file, which is not uncommon, nor did they share why they were asking us to investigate. We were provided with information about the claimant and simply were asked if we could investigate to see if he had been involved in burning the car. After getting the details of the location where the car was burned and the location of the claimant’s home and work, [...]

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