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Optimizing Casualty Surveillance

Posts Tagged ‘ insurance ’

Optimizing Casualty Surveillance

Monday, July 18th, 2016

In the most recent edition of the Michigan Chapter of IASIU’s newsletter, our Dan Klimek and Brian Coykendall, both subject matter experts in the area of surveillance and proper insurance claims investigations, authored an exceptional piece on three simple ways of optimizing casualty surveillance opportunities on insurance claims in Michigan. The article focuses on video clarity, video stability and proper surveillance positioning and how to maximize all three of these vital elements of great surveillance. We encourage you to give it a read and enjoy the benefits of optimizing casualty surveillance on your claims. Here is the newsletter url:

https://drive.google.com/file/d/0B2zip0DMWleId3A0MmVVUWFjdEk/view

Sherlock Investigations is recognized as the leader in providing superior casualty surveillance investigations for the insurance defense community in Michigan. Each case entails a sophisticated plan of action, based on known, verified facts, newly developed intelligence and precise asset selection to give our clients consistently better results than other investigative providers.

Brian Coykendall is the Lead Surveillance Investigator at Sherlock Investigations. Brian is not only a seasoned expert at conducting surveillance, he is also the lead trainer for the surveillance teams and works on improving surveillance processes and reducing related risks.

Daniel Klimek, MS – Intelligence Analysis, is the Investigations Manager at Sherlock Investigations. Dan has planned and overseen thousands of surveillance operations and works directly with both the investigators and clients to design  investigations for optimal outcomes.

The Importance of Verifying Where a Claimant Lives Before Initiating Surveillance

Thursday, July 14th, 2016

The Importance of Verifying Where a Claimant Lives Before Initiating Surveillance

In Michigan, the overwhelming majority of private investigation agencies that conduct insurance claims related surveillance have the same business model: use the lowest possible cost investigators to conduct the surveillance and use an administrative person to “set up” the cases and make the decisions on the when, where, whats of the investigation. Some advertise that they only use law enforcement personnel to conduct their surveillance, but this is almost always a part time side job for those employees, and again they are the cheapest available. This translate to no real advantage from using these people, many of who know nothing about insurance claims or surveillance without a badge and team of backup.

The one must consider who is actually planning and managing the surveillance. This is usually left to a clerical staff person who is trained to run some generic databases and instructed to schedule the maximum amount of time the client has budgeted for the case. Now comes the tricky part. If any of the information provided by the client or the private investigator’s databases proves to be false or outdated, then they rack up a $ 2,000 bill for you with no actual chance of seeing the claimant. Do you really want the person who does the invoicing, answers the phone, orders office supplies and takes out the trash designing and managing your surveillance? This is not intentional, it is simply what this model produces, and ever vanilla, cookie cutter agency works the same way.

At Sherlock, we have a different model. One that consistently produces superior surveillance results. We have full time, professional investigators in the field, who are supported by actual full time skip tracers who understand the importance of verifying where a claimant lives before initiating surveillance.

If you are not a Sherlock client, we encourage you to contact our team and learn more about how we can make you look better.

6 Tips for More Successful Summer Casualty Surveillance in Michigan

Tuesday, June 28th, 2016

6 Tips for More Successful Summer Casualty Surveillance in Michigan

Use these six tips to get the most out of summer time casualty surveillance of claimants in Michigan.

  1. Use an investigative agency that creates a plan of action before they do anything else. A Surveillance plan of action is an essential part of conducting an effective casualty surveillance.
  2. Confirm IME time and location. In the summer, physicians like to compress their schedule and will often move an IME appointment time to help get the doc out of the office and out on the golf course. Always request that the IME clinic not move the scheduled appointment, and verify it again.
  3. Watch the weather. When Michigan weather gets sketchy, people change their behavior and that can impact the surveillance. Some investigators want to work no matter what the weather conditions. Don’t use those firms.
  4. Use summer holidays to your advantage and the days before them to get more activity.
  5. Monitor the social media of immediate family members to identify potential activity like vacations, sports and entertainment attendance and gatherings. These days and the dates prior to can be great opportunities.
  6. Know about road construction in the area before undertaking surveillance. Construction avoidance can make mobile surveillance difficult.

Sherlock Investigations is a leader in casualty surveillance for the insurance industry. If you are considering surveillance in Michigan this summer, please contact one of our team to discuss how we can get plan the right surveillance for your case.

Surveillance Plan Of Action

Tuesday, May 10th, 2016

Does your private investigator give you an actual plan of action BEFORE they spend your money? Chances are, unless your go-to investigation agency is Sherlock Investigations, the answer is no. At Sherlock we think a little differently and a lot more frequently than most agencies. Before we commit  any of our client’s money, we develop a detailed surveillance plan of action on each surveillance assignment. We not only calculate where to be, but when to be there and which assets we need to get you meaningful, actionable video more consistently. No guess work. No lost opportunities, No fishing expeditions.

At Sherlock, surveillance is intentional.

Surveillance plan of action

To learn more about how our free, customized plans of action can enhance our claims handling and decrease the amount of time a claim is open, call Ryan Cylkowski, Dan Klimek or Brian Coykendall today.

surveillance plan of action

3 Important Things to Know About Locating Hospital and Pharmacy Records

Tuesday, February 24th, 2015

In the case of many casualty insurance claims, locating hospital and pharmacy records is a vital part of the claims investigation process. The good news is, when done correctly (meaning legally and ethically) this is an excellent tool to either verify that all the medical records have already been provided or to locate additional records that have not been provided during the normal claims process. What is important is to understand three things about locating hospital and pharmacy records that will help you to expedite the process and to set reasonable expectations. Here is the list:

  1. Many times, a signed records release must be provided to the hospital or pharmacy or they simply will not cooperate. In some instances, a hospital may even require that the release be their release and no other. We recommend that you try and obtain a signed release as soon as possible and be prepared for additional foot dragging from some hospitals. It is just how they roll.
  2. If a release is mandated, it can often take time to get a hospital or pharmacy to respond and sometimes they simply don’t reply at all, requiring the request to be submitted multiple times. A bit of patience needed more often that it should be.
  3. Sometimes the canvass must be performed in multiple geographic areas. If a claimant has lived in more than one geographic area in the past few years, it is highly likely that records exist at facilities in their old neighborhood. In some cases, claimants have moved three and four times in a short amount of time, leaving you with the decision to have the search conducted in more than one location, which increases the cost.

Now for the bad news: if you are working with an investigator or search firm that is providing you with actual medical information (i.e. diagnosis, prescription information, etc.) from a provider or a pharmacy and they do not have a signed release from the claimant, they are NOT acting within HIPPA compliance and they are certainly exposing you to serious liability in the process.

For more information about our hospital and pharmacy records canvassing, please contact one of our team at 888-989-2800.

January in Michigan Brings Little Snow But Strong Surveillance Results

Saturday, January 31st, 2015

Normally Michigan and metro-Detroit receive snow on 10 of the 31 days in January with averages over a foot or accumulation. In 2014 that number was much higher, and accordingly we filmed a lot of casualty claimants out shoveling snow and cleaning off cars. Occasionally we even get those dedicated homeowners who are filmed shoveling snow off of their roof, but not so far in January of 2015. This Michigan January brings little snow, but life here has also been unusually normal, meaning lots more people are going about life as usual and surveillance activity has been fairly normal and consistently productive in documenting “normal” activities. Even the cold seems to be a little less prevalent this year, with our surveillance investigators filming far more people dressed for moderate weather than those bundled up like Eskimos. The one exception is in west Michigan along the lake where, as usual, the snow accumulation has been consistent and surveillance of clean up activities very productive.

As we get ready for the annual super bowl Sunday celebration, we are on track to monitor a large number of claimants both Saturday, as they run errands and shop before the big game, and Detroit is reportedly going to receive over 6 inches of snow on Saturday night and throughout Sunday. With this new twist, we anticipate that many of our clients who long for the snow shoveling activity will see a payoff this weekend with overall strong surveillance results.

Colder Weather Not A Factor in Michigan Casualty Claims Surveillance So Far This Year

Saturday, January 17th, 2015

Michigan in January can be bad. Last year alone, the cold, ice and snow was so sever that everyone suffered, the economy came off the rails and life here was anything but usual for several weeks. The good news is, thus far 2015 has little to resemble 2014. With only a few days reaching below the fifteen degree mark, life has been normal and operating as usual. Please are still shopping, going to school, attending IMEs,  recreating outdoors and very visible in public domain. In short, the casualty claims surveillance business in Michigan is red hot right now!

Here at Sherlock, we have made good use of this weather and achieved some excellent surveillance results. For some, there is the idea that January is just too cold and snowy to produce good insurance claims surveillance, but this year, that crowd is missing some great opportunities and allowing for some bad claims to move further along than they should.

If you have questions or concerns about the viability of claims surveillance at this time of year, we encourage you to call us. We can give you a detailed understanding of the opportunities and a variety of ways for you to potentially take advantage of the weather, as opposed to being a victim of it.

Sherlock Investigations: Michigan Casualty Claims Surveillance Experts

Holiday Surveillance Produces Unique Opportunities

Friday, December 26th, 2014

One thing that the Holiday Season produces a lot of is diversity. For almost everyone the holiday season creates many activities and changes everyone’s schedules and patterns of activity. This can lead to some frustration for the investigator in the field, but also creates many unique opportunities to observe a claimant doing something that they normally would not, but that is certainly something they could skip if actually injured. One easy and frequent scenario is the marathon shopping trip in which a claimant and friends or family will walk, stand, shop and carry things for hours at a time. These trips are sometimes difficult to monitor as claimants travel from store to store, but they do clearly demonstrate someones true capabilities and limitations. Some other frequently encounter scenarios include hanging outdoor decorations, attending holiday parties, and engaging in charity work. These opportunities can be exceptional especially when dealing with a claimant who may require attendant care and replacement services as part of a Michigan first party auto no fault claim or PIP claim.

Michigan Supreme Court Changes Independent Contractor Criterion, Allows Worker to Sue For Auto No Fault Benefits for His Injury

Thursday, December 4th, 2014

A recent ruling by the Michigan Supreme Court has ruled that each criterion of the Michigan workers compensation statue must be met for a worker to be deemed an employee and that a failure to meet any one of them would indicates the worker is a sub contractor. This ruling came from a case in Macomb County in which an employee was using a a company vehicle while on the job and was injured by the vehicle. The employee preferred to sue for auto no fault benefits his injury rather than file for workers compensation benefits. Likely this is because the PIP benefits would offer him 5 additional percent in wage benefits than his workers compensation benefits.

Crain’s Detroit Business reports:

Injured workers in Michigan are employees of a company, rather than independent contractors, only if they meet three criteria under Michigan’s workers compensation law, the Michigan Supreme Court has ruled.

The ruling last week stemmed from a lawsuit brought by Joseph Derry, who was injured while vacuuming leaves for Sterling Heights-based All Star Lawn Specialists Plus Inc., court records show.

All Star had commercial general liability insurance, commercial no-fault automobile insurance and workers comp insurance

The full story can be found here.

Sherlock Investigations serves both workers compensation and Michigan auto no fault carriers providing a variety of investigative services, including Michigan PIP claims investigations, to assist claims professional in making informed claims decisions.

Insurance Claim Surveillance Footage That Is “Out of Context”

Monday, November 24th, 2014

The reality of insurance claim surveillance footage is that actual video of what someone is doing is very compelling and powerful evidence. In instances where a claimant is observed and documented, the insurance carrier, and very likely a supervisor within that claims department, will review the footage and use it to evaluate if the observed activities are consistent with what the claimant has reported they are physically able to do. It’s that simple; unless you are a plaintiff’s attorney.

Enter “out of context”. This is where one tries to explain that what you are seeing is not actually what you are seeing. When a claimant reports that they are unable to lift or stand for long periods of time, then video is taken of them hanging Christmas lights on their gutters for 2 hours, please understand that they are actually hurt and this is some odd but certainly explainable exception to reality. “Out of context” can be applied to almost anything observed on video. A person who has an attendant care claim ongoing because they cannot take care of themselves but who decides to go shopping and out to lunch with a girlfriend, carrying shopping bags and large purse is not demonstrating that they are much healthier than they allege. They were simply having a miracle day in which shopping and dining out pushed the limits of their pain tolerance and actually a true testimonial as to the capabilities of an injured person who wants to fight back and live like a normal person for one short afternoon. Did you know that as a result of that shopping day they were laid up at home for two straight weeks, crying and moaning? (Incidentally they were not under surveillance at that time) Remember, the evidence of 9-11, the moon landings and the holocaust never happened and were simply taken out of context.

Perhaps to avoid the “issues” involved with insurance claim surveillance footage, all claims should be reported via a polygraph based interview about the extent of injury and claimants should have their homes monitored with remote cameras and they should wear a tether throughout their recovery. This would help us to get things in better context.