Multiline Insurance, SIU, Property, Casualty, Life and Health Investigative Services

We are licensed to a principal private investigator, our founder, and operate as a licensed private investigation agency. Our goal is to ensure that our clients have access to the best-in-class private investigator. The cornerstone of our investigative services is Workers’ Compensation fraud investigations and insurance-related SIU. That is a review of motor vehicle accidents that have been deemed suspicious; or employment-related accidents that arise out of employment or continue during employment, statements, and employers. Subrosa surveillance to determine the claimant activity level, and in-depth subrogation investigations.

We have a clear understanding of what it takes to provide actionable information to expose exaggerated and patently false claims. Our sophisticated insurance investigations are a tried-and-true defense designed to identify potentially fraudulent and/or abusive claims.

We recognize fraud occurs in simple and complex schemes of intentional misrepresentation or concealment. Unlike errors or mistakes, fraud is deliberate and maybe intentionally hidden. For this reason, we use creative strategies to determine the presence of deception, which is intended to achieve financial or personal gain at the expense of a victim. Every investigation is unique, and there is no one-size-fits-all approach. We work directly with the examiners, attorneys, and management to conduct the services around a key or significant claim activity. Each insurance investigation is tailored towards the unique needs of a particular client and designed on a case-by-case basis to uncover the nature and extent of the deception and expose fraudulent and/or abusive claims. 

INSURANCE CLAIMS INVESTIGATIONS & WORKERS’ COMPENSATION FRAUD SERVICES

Background Investigations

Hospital & Pharmacy Canvass

SIU Insurance Investigations

Subrogation Investigation

SUBROSA SURVEILLANCE

We provide Subrosa Surveillance for insurance clientele’s claims investigations to determine the Claimant’s current home address, activity level, and if their activity level is consistent with their statements and medical restrictions. Our Subrosa surveillance and insurance defense services encompass all aspects of Insurance investigations, Workers’ Comp, Subrosa Surveillance, Caregiver integrity investigations, 4-hour activity check, and daily monitoring. In order to determine if a Workers’ Compensation claim is fraudulent, Underwriters, Auditors, Claims Adjustors, and employers have to establish fraud indicators, or “red flags.”  If there are several “red flags” on a single claim, it warrants a further review of the claim.

AOE/COE INVESTIGATIONS

Our AOE/COE Investigations are conducted by professional investigators and are extremely thorough. In order to claim a work-related injury, there must be some causal link to employment. The cause of the injury must be determined in order to process a workers’ compensation claim. Our on-the-job injury investigations include every possible detail about the accident scene, any recreational injuries, occupational diseases, and other unusual circumstances. Our clients will receive a copy of the recorded statements, photos, sketches, signed a medical release, and all relevant personnel records. Stryker’s private investigators gather factual information and provide a careful search of social media sites, Google searches, news releases, media releases, press statements (if any) followed by physical surveillance if authorized by the client’s agreement. All investigative services are conducted by experienced private investigators.

MEDICAL CANVASSING

Our Medical Canvassing are conducted by professional investigators and are extremely thorough. Our medical canvassing investigation is a comprehensive search of all hospitals, clinics, and pharmacies around the Claimant’s residence on the date of loss or injury. No matter the line of insurance involved the objective is to discover other medical providers involved and be able to further validate or discover other medical providers involved in treating the Claimant. Every investigation report has the same basic objective…even the canvass reports. Our objectives are to collect, assemble, and preserve evidence. Find facts known to be true and those that may be presumed from all the evidence. Gather the best available evidence with the least possible delay and make determinations and recommendations for administrative disposition. 

PERSONAL INJURY SCENE INVESTIGATIONS 

Accident Scene Inspections / Personal Injury Due Diligence. Personal injury due diligence is the part of tort law processes that allows for the plaintiff to make claims of negligence against a defendant. In the United States, a complex number of laws, statutes, and codes govern the body of law known as tort, or civil law. Personal injury claims fall under the broader category known as tort law, which requires a specific process for verifying and validating claims, then assessing damage awards to plaintiffs when applicable.

An efficient due diligence investigation is about producing valuable, usable results in determining comparative negligence and facilitating an informed evaluation of the claim. It is imperative to conduct an onsite inspection as soon as possible for witnesses, and secure video camera footage at or around the area that might have captured this loss, measurements and photos of skidmarks, and point of impact (POI) debris, police reports, and obtain available law enforcement records: 9-1-1 audio, CAD report, Body Worn Camera and dash camera video footage, scene photos, and supplemental weather reports. Our Investigator will summarize all of the material findings on a topic-by-topic basis.

Due Diligence Meaning:  Due Diligence is a process that involves risk assessment and compliance checks, conducting an investigation for unknown facts, unidentified persons,  review, or audit to verify facts and information about a particular subject.

CARGIVER INTEGERITY INVESTIGATIONS

Caregiver Integrity Investigations. Do you suspect Caregiver Fraud? Do you suspect caregivers are not arriving as scheduled at the patient’s residence? Do you suspect the caregiver of billing for the time they were not providing care? Do you suspect neglect, poor conditions, elder abuse, the theft of Rx medications, or missed treatments?  A licensed private investigator can conduct surveillance to confirm that caregivers adhere to their schedules and best practices.

There are many caregiver professionals who go above and beyond; unfortunately, there are those who do not have the best intentions. Trust is a fundamental part of any relationship, especially those between seniors, their family members, and professional caregivers. Establishing trust takes time, but most care providers and receivers do not have the luxury of getting to know one another well before their relationship begins. Can installing cameras help to strengthen or undermine the trust a family places in professional caregivers and long-term care facilities?

Identify any risks of HIPAA  violations while surveillance cameras. Prior to the installation of any surveillance or monitoring device, a risk assessment should be conducted by a private investigator who specializes in privacy rules and guidelines and knows what to look for. The risk analysis will identify any potential risk to patient privacy using while using video and audio recording devices. There are several benefits that video equipment can give aside from it is an inexpensive means of addressing the ever-increasing security concerns in a residential care facility, hospital, and at the patient’s residence. As a representative, a private investigator has the right to visit and check on the care of the patient.

ALIVE & WELL CHECK / PHONE INTERVIEW / IN PERSON

We can validate your Claimant’s current health status, medical treatment, and present address with an Alive and Well Check, and ensure the Claimant is, in fact, alive and well and they are receiving benefits. Our investigator will ask for verification of employment and/or disability status, social security number and date of birth verification, telephone number, spouse, and children information, and photographs of the claimant at his residence. Our investigator also inquires about the subject’s day to day activities, how their property and residence are being maintained, and we determine their next of kin contact information. We can also accommodate any specific questionnaire forms that the client may require.