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Why Most Adjusters Feel All Insurance Claims Investigators Are The Same

Posts Tagged ‘ private investigator ’

Why Most Adjusters Feel All Insurance Claims Investigators Are The Same

Friday, February 12th, 2016

The reason why most adjusters feel all insurance claims investigators are the same is because, well, they are.

Although within the PI world this is not a politically correct thing to say, the truth (albeit painful) must be told. Please understand that this is a generalization, but it holds true for most private investigative agencies. The average PI agency serving the insurance claims community is a very small business. They usually only have a handful of investigators, the majority of whom do nothing but local surveillance. They do whatever you ask. If you give them three days of authority, they do three days. They underpay their employees and often, particularly if they get busy, will subcontract someone else to do the work. They have limited resources, no intelligent processes to planning or risk management and you hope that the investigator never has to testify. In short, if you are an average adjuster, you are more likely to work with one of these types of agencies than with one who is consistently better. They almost always underwhelm, thus, the reason why most adjusters feel all insurance claims investigators are the same.

If you work in claims and are sick and tired of “the same” underwhelming work product from PIs, call Sherlock Investigations today.

Michigan Surveillance Investigators Wanted

Thursday, July 17th, 2014

We are hiring! We are looking to add multiple surveillance investigator positions in SE Michigan. We encourage everyone to forward on our latest job posting to friends and associates who may know a qualified applicant. If you know someone already working in the industry who may be looking for an opportunity to be part of a high performance investigative team and improve their work environment, please have them apply too.

Surveillance remains the best option when investigating fraudulent casualty claims in Michigan

Wednesday, July 9th, 2014

Technology may change. The way we live will change too. One thing that does not change is the fact that a claimant demonstrating his or her true abilities and capabilities is still the best option when investigating fraudulent casualty claims in Michigan. Yes, privacy is the number one concern when it come to surveillance, but the reality is that true professional private investigators know the limits and they always stay within the confines of the law. Period. No matter how much it might benefit an insurance carrier to have footage of some activity that demonstrates that a claimant is healthy, they would never want it. The reason is simple, it would get kicked out of court and they would come under tremendous public scrutiny and end up paying far more than they could have ever saved. So what is risk that a casualty claims surveillance will end up violating someones rights? It resides with the private investigator. When an insurance carrier selects a PI to conduct surveillance, the integrity, education, training and oversight of the PI is the key. The vast majority of private investigators know the law and follow it. Unfortunately some investigators have erred in judgement and crossed the line. At Sherlock Investigations, we aim to set the standard in professionalism and to serve as an example to the industry on producing great work product and protecting the rights of those we are charged to investigate.

Costly fraud necessitates need for increase Michigan attendant care claims surveillance

Tuesday, June 17th, 2014

Last month the Louisiana Attorney General’s office charged 20 personal care attendants with insurance fraud as part of Medicare fraud scheme. As more law enforcement attention is being focused on attendant care fraud within the scope of Medicare abuse, in PIP states like Michigan, attendant care fraud and abuse is an ever present part of first party no-fault claims. What is truly troublesome about attendant care fraud and abuse in Michigan is how quickly the attendant care bills can get into the six figures, thus costing auto insurance carriers a significant amount of money which is passed on to everyone who purchases auto insurance.

One of the most effective tools that a first party PIP carrier has in fighting this type of fraud is through the effective use of Michigan attendant care claims surveillance. In these cases, the carrier needs to hire a private investigator who is able to watch either the PIP claimant or the attendant care provider. Often times, these care providers and claimants will over state the amount of care being provided in an effort to defraud the insurance company in small amounts, over and over again. Effective, well planned surveillance performed by expert private investigators will clearly demonstrate exactly what the claimant and the care giver are up to. In Michigan, Sherlock Investigations is the intelligent choice for professional Michigan attendant care claims surveillance.

How to compare one private investigator to another

Tuesday, June 10th, 2014

As a professional private investigative agency, we work very hard to provide our clients with the maximum value on each case. Most would agree that every private investigator wants to do that, but the real question is, what do they actually do that produces a better result than the next PI?

The best way to answer that question is to pull back the curtain and see who is really doing the work. In Michigan and anywhere else in the country, the answer is usually hiring the cheapest possible labor to work on your case. Really? Yes, this is the business model of almost every large agency serving the insurance industry. Hire someone willing to work for peanuts, who usually has very little experience and is not necessarily employable in many other fields and, abracadabra, you have a surveillance investigator. Now this is only true when the private investigator actually employs the person they gave the case to. In many instances, perhaps even the majority of the time, the private investigator you hired subcontracted your work out to the cheapest PI she/he could find. (Notice the recurring theme of price being the only real factor?) So essentially you hired someone who then hired the guy you would not touch with a ten foot poll.

Cheapness also prevents things like training. On a side note, there is no formal education to become a field surveillance investigator, let alone a good background investigator, so the best agencies have to create internal training programs. This costs money, most PIs don’t spend money on training.

Surveillance execution is only a small part of adding real value. Much of the real value comes from pre-surveillance planning, which requires the private investigator to be good at profiling and data mining, and also cost money to do well. 9 out of 10 times, this goes by the way side and surveillance becomes a fishing expedition. Good luck required to add value.

Lastly, knowledge of how insurance claims work, how plaintiff’s present claims and how the finders of facts will review same. This is relatively high level thinking for the average PI and rarely is part of the offering.

When true investigative excellence is needed on an insurance claim, consider calling the experts at Sherlock Investigations. The consultation is free and the advice exceptional.

Locate Investigations separate real private investigators from databases

Thursday, June 5th, 2014

Although few will admit it, all private investigators are not the same. Yes, anyone can print off an interview questionnaire and ask someone the questions on it and yes anyone can pick up a video camera and film someone, but the mere act of doing these things does not make someone a good investigator any more than having that same person put on a jersey and pick up a basketball and perform like Lebron James. When it comes to insurance claims investigation, the locate investigation is one area where many claim to be good at it, but in reality they have no training and do nothing more than run a couple of databases and go with whatever those report. a professional skip tracer has far more techniques, avenues to explore and resources to tap into, yet each year well intended insurance carriers hire unskilled, generalist private investigators who waste near countless hours and dollars pretending to help by doing nothing more than running these databases.

Sherlock Investigations is a premier insurance claims investigative agency headquartered in metro-Detroit and staffed with a team of highly skilled locate investigation specialists who work nationwide finding claimants, witnesses and insureds. Please visit us at claimspi.com/services/locates/ or call for immediate service.

Private Investigator Job: Experienced Insurance Claims Surveillance Investigator Wanted for SE Michigan Region

Tuesday, March 25th, 2014

Private Investigator Job: Sherlock Investigations is looking for experienced surveillance investigators looking to join an investigative team that values excellence, pays well and supports it’s people. This position will require almost no travel outside the SE Michigan area. If you or someone you know is interested in joining, please direct them to our job posting here.

Is surveillance in personal injury claims legal?

Friday, November 8th, 2013

Although we are insurance investigators and not attorneys, and by the way, this is not legal advice and you should consult with an attorney before relying on the information presented below; it is based upon our understanding of the law and experience investigating personal injury claims in Michigan.

When a personal injury claim is presented to an insurance carrier, they have an obligation to investigator that claim to ensure that it is legitimate and that benefits should be paid to the injured party. Unfortunately criminals have not overlooked to profits that can be derived from defrauding insurance carriers. Personal injury claims in Michigan are often the target of fraudsters and even average citizens who feel that they can make some extra, easy money by faking an injury and trying to cash in on it.  One of the ways that an insurance company can fight fraud in personal injury claims is to conducted surveillance of the claimant (injured person).  Someone who is not familiar with casualty insurance claims in Michigan, like personal injury claims, may not be aware of the fact that it is legal for an insurance company to have an investigator conduct surveillance of the injured person to determine if they are actually injured. If you think about it, the insurance company really does not have many other ways to weed out the fraudulent insurance claims from the legitimate ones.

What is involved in surveillance of a personal injury claim? It is just as simple as it would seem. A private investigator will attempt to locate the injured claimant and obtain some video of what he or she does when in public view. They do not care what you are actually doing, nor if you are injured or healthy. In short, they get paid no matter the claimant is actually doing.  If someone is truly injured, they still have to live life and do things, but those things are usually limited by the injury and the surveillance will reflect that. What the insurance claims investigators do not do are things like peep into windows, intentionally trespass or try and entrap someone with deceptive practices. They simply watch what happens and leave it up to the insurance carrier and/or a medical expert to decide if someone with that injury should be able to preform those activities. They can watch you at work, while running errands, doing yard work and the other daily activities that take place in public domain.

One thing that is very common is for an insurance claimant in a personal injury claim to think is that the insurance company has a private investigator watching them all the time.  This is absolutely not the case. Investigating a personal injury claim is not personal. They are not “after” anyone. They simply have a job to do and being defrauded is not part of that. Further, surveillance in personal injury claims is expensive and would not be done. The insurance company also know that they only need to watch someone long enough to identify if the claimant is injured. There is no point in saving money by not paying the claimant if instead they intend to give all the money away to a private investigator.

 

Insurance Claim Surveillance in Michigan for Auto Injury Claims, Liability Claims and Workers Compensation Claims

Medical Provider Fraud Investigations on the Rise

Monday, October 7th, 2013

It was only 10 years ago that most private investigators working for insurance carriers were confined to investigating the claimant’s true activities and abilities. Today, medical provider fraud investigations are one of the fast growing areas of insurance fraud being handled by private investigators like those at Sherlock Investigations. In these medical provider fraud investigations, the medical provider usually does one of the following: inflates the billings to the insurance company, knowingly submits bills with improper medical codes, misrepresents the facts of the care provided or simply fails to provide any care at all but still bills the insurer. One growing area of healthcare fraud investigations involves the use of private investigators to conduct clinic inspections of the medical providers facilities. Surveillance is another highly effective way to gather evidence of who is providing care and who is receiving same. This is a growing area on investigation in Michigan, particularly in metro-Detroit. in many cases the same fraudulent medical providers billing insurance companies are also defrauding the government medical systems.

Michigan PIP Claims Surveillance On The Rise This Summer

Wednesday, June 26th, 2013

With the improvement in Michigan’s weather and TV commercials for legal representation in first party auto claims at an all time high, smart carriers are increasing their use of Michigan PIP claims surveillance statewide with private investigators. In many instances, when a casualty PIP claim appears to be fraudulent or embellished in some way, carriers are taking advantage of the good weather to document exactly what claimants are actually capable of doing on an average day. When one claims not to be able to return to work or requires replacement services, it is expected that they would not be seen washing their car, going to the fair, planting flowers, playing catch with the kids or any of the other things that normally occur in our lives each summer.  With Michigan PIP Claims surveillance is conducted on the injured policy holder who files a claim for benefits after sustaining injuries in an auto accident. In May and June, Sherlock Investigations has seen a combined 18% increase in requests for Michigan PIP claims surveillance over last year and this increase is coming from a wide variety of carriers.

In the past five years, Michigan PIP claims, or first party claims, have grown substantially and the number of law suits in this space has grown almost exponentially as more attorneys have found this to be a lucrative area to make money in. PIP is also the fastest growing area for insurance fraud in Michigan. Smart carriers are fighting back be increasing their use of Michigan PIP claims surveillance with Sherlock Investigations (Michigan Private Investigators specializing in claims surveillance) on speculative PIP claims.