Once you suspect an insurance claim is fishy or fraudulent, things get complicated. Of course, you will need strong evidence to back up your suspicion. Only then can you deny it or refer it for further prosecution. To begin with, any insurance-related fraud investigation relies entirely on documented, verifiable proof. If a policyholder’s story doesn’t feel right, it doesn’t mean you should follow your gut instinct.
Well, you have other options available to find out the truth. This is where insurance companies, employers, and attorneys across Oklahoma bring in licensed private investigators. This move makes sense because private investigators know how to gather evidence legally and present it in court. They also have the training, resources, and tools to support your investigation.
In this blog, we will discuss what a private investigator can collect and how each type of evidence can hold up in a claims dispute. We will also focus on the merits of working with a licensed professional investigator and how this move can save your company from costly payouts.
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Why Does Insurance Fraud Require Professional Investigation?
Every time a fraudulent claim is paid, your agency incurs a huge loss. In fact, the Coalition Against Insurance Fraud estimates that fraudulent claims alone cost the industry over $300 billion each year. Now, this is a huge number, and it is unlikely that the issue of fraudulent claims is going to end anytime soon. On top of that, you are nowhere in a position to deny a claim to a person just because you don’t feel right about the claim. What if your insurance agency is slapped with a bad faith lawsuit if you deny claims without any proper proof or documentation? As such, you will need evidence that can support and back up your decision if the denial is challenged.
Herein, you are left with no other option but to rely on the private investigator you hired. They will know how to source and present the evidence through legal means. For the benefit of the case, they will also ensure the evidence is preserved and presented in a format accepted in court. This way, you protect your company and the many policyholders who rely on your agency.
Types of Insurance Fraud Investigators Help You to Uncover
In your line of work, you will come across different forms of insurance fraud. Each type of insurance fraud investigator calls for a different investigative approach, and this is necessary.
- Fraudulent workers’ compensation claims: often occur when the individual exaggerates or fabricates a workplace-related injury to collect benefits while remaining active or employed elsewhere.
- Auto insurance fraud: involves staging accidents, inflating repair costs, and claiming damage that existed before the actual reported incident.
- Disability insurance fraud: involves claimants who report an inability to work while engaging in activities that contradict their physical limitations.
- Property-related insurance frauds: involve exaggerated claims related to damage, arson, and false theft reports.
Considering the nature of the fraudulent claims, you will have to bring in an investigator who has a good understanding of the different fraud types. This way, it will become easy for you to focus on other aspects.
What Evidence Can an Investigator Collect?
When it comes to collecting evidence, you must leave it to the professionals. Of course, given the fraudulent claims, you’ll need strong evidence. The investigator will conduct legal, documented surveillance of a claimant to determine whether their physical activity matches their reported injury or disability.
If a workers’ compensation claimant reports that a back injury prevents them from lifting more than ten pounds, and surveillance footage shows them carrying heavy loads, this footage becomes powerful evidence.
But in the interest of the case, you must ensure the investigator conducts the surveillance legally. As such, the investigator must operate from public property, avoid trespassing, and comply with how and where they record. Remember, any evidence gathered illegally will eventually be thrown out and may expose your company to liability. For that reason, Keefe Private Investigations offers licensed private investigation services in Oklahoma City. We have built our evidence-collection methods to withstand legal scrutiny.
Surveillance evidence in a fraudulent claim case may include video footage, photographs, and a detailed written log documenting the claimant’s activities. The log will also include the dates and times of observation, along with a footnote of the investigator’s own observations. Do ask your investigator to present the evidence with proper time-stamped documentation. The surveillance details must be ready to submit as part of the formal filing.
How Investigators Verify a Claimant’s Medical Claims?
The issue is how you will confirm if a claimant’s reported injury or condition indeed matches their actual condition. Well, you will have to rely on your private investigator here. But the investigator is in no position to access private medical records without proper authorization. However, they can collect independent evidence that in a way supports or contradicts a claimant’s stated limitations.
This may include observing whether a claimant performs physical activities inconsistent with their reported injury. The evidence will also include documenting their workout regimes at gyms or sporting events. The investigator will also look for potential witnesses who can speak to the claimant’s actual activity level. All of this will help you build a clear picture of the claimant’s actual activity level.
What is the Primary Role of Social Media in Insurance Fraud Investigations?
You may be surprised by how claimants end up revealing their own fraud through social media posts. Social media is now an integral part of our lifestyle. Most people stay glued to it by regularly posting about what they’re doing. So, the Investigators you hire make it a point to review social media activity to check and verify photos, videos, check-ins, and posts that contradict the claimant’s actual reported condition. What if the same individual posts photos from a hiking trip but reports being unable to work? This is strong evidence that can directly challenge the claim.
Being professionals, the investigators will know how to properly present the document as evidence. They will also gather and preserve the evidence using professional methods that will further withstand the rigors of the case.
Is it Possible for the Investigators to Verify Employment and Income Claims?
Of course, you can hire a private investigator. This is because you will have to find ways to confirm whether a claimant’s reported income and employment status match or not. This is crucial in the context of disability and workers’ compensation cases. If the individual is reporting an inability to work and may actually hold a second job, this is a clear case of fraud.
Investigators, on their part, conduct discreet inquiries and verify the employment records by using legal channels. In some cases, they will also identify undisclosed income sources. When you suspect a claimant is working while collecting disability benefits, you will need documented proof of that employment. This is where a detailed investigation gives you exactly what you are looking for.
What Do Investigators Do to Handle Staged Accident Investigations?
You are going to face a complex situation, especially when investigating suspected staged auto accidents. Well, these schemes often involve coordinating with multiple parties. The investigators you bring in will review the accident scene, compare the damage to the reported collision, and interview potential witnesses. They will also check if the vehicles involved have any prior accident or fraud history.
The PI will also look for red flags common to staged accidents. For instance, claimants who show up together at the same medical provider, prior relationships between the drivers involved, or damage patterns inconsistent with the reported speed and impact.
When you hire an experienced and licensed private investigator, you end up strengthening your case. The investigator helps by identifying these repeated patterns early, before your company pays out a fraudulent claim.
The Documents Investigators Compile for Property and Theft-Related Claims
In fraudulent claims related to property or theft, you will need a thorough investigation. Here, investigators can verify if the reported stolen items actually existed in the first place. They will also cross-check purchase records and receipts and confirm whether the reported damage matches the claimed cause. In a suspected arson-related case, investigators work closely with fire investigators and forensic specialists. This allows them to determine whether the fire origin and pattern match the policyholder’s account.
You also stand to benefit from an investigator’s ability to interview contractors, neighbors, or other witnesses who may have some form of information related to the circumstances or property related to the claim. This sort of fieldwork often helps uncover inconsistencies you may miss while reviewing the paperwork.
Can Skip Tracing Support You in an Insurance Fraud Case?
There will be occasions when you are forced to locate a claimant, witness, or additional party to a suspected fraud case. If you’re having trouble reaching them, you can rely on skip tracing services. It comes in handy when a particular claimant senses that an active investigation is underway and becomes less responsive.
With skip tracing services, you will be able to locate individuals who are somewhat connected to a claim. This is crucial when you need to serve legal documents, conduct a follow-up interview, or confirm someone’s current address and location. You cannot move forward with a fraud case if you cannot find the people involved. This is one reason why skip tracing services are often considered crucial in investigations that are somewhat complex in nature.
Why Does Documenting Proper Evidence Matter So Much?
What if you lose the case after collecting all the relevant details? This usually happens if the evidence you presented is not documented and preserved correctly. Courts in Oklahoma expect a clear chain of custody, precise timestamps, and evidence that is collected within legal boundaries. If your investigator fails to demonstrate how and when the evidence was gathered, the opposing counsel will eventually find a loophole, potentially losing your strongest proof.
With licensed investigators, you will have the advantage of working with a professional who understands these legal requirements. They comply with all the regulations to build their reports accordingly. They provide a final report that can hold up under cross-examination. As such, this gives your legal team everything they need to build a strategy with total confidence.
What You Must Look for When Hiring a Licensed Investigator for Insurance Fraud?
So, you are looking for a licensed investigator in Oklahoma? Well, you need to look for someone who has experience in handling insurance fraud cases. For fraud-related investigations, investigators need a specific skill set, including knowledge of insurance industry standards. They must also have extensive experience preparing evidence for claim disputes and be familiar with the legal requirements around surveillance and privacy.
Make sure to ask for a realistic turnaround time and the reporting format. An investigator who has handled dozens of similar cases can spot red flags faster, which really benefits your case. With the help of the investigator, you will be able to build stronger evidence that will help you in the long run.
How Will You Know If It Is the Right Time to Bring in an Investigator?
When you suspect something is wrong with the claimants, there is only one way to verify it. All you have to do is bring in a private investigator to deal with a case that seems like a potential red flag. Warning signs include inconsistent statements between the claimant and the witness, injuries that don’t match, claimants who don’t agree to a medical evaluation, and more. Make sure to act without any delay once you suspect something is wrong. Remember, surveillance and evidence gathering work best only when the claimant becomes aware they are being investigated.
If you wait too long, the fraudulent claimant may have time to adjust their behavior. In short, acting early gives your private investigator the best opportunity to gather the evidence that matters.
In What Way Does Keefe Private Investigations Support You in Insurance Fraud Cases?
At Keefe Private Investigation, we have worked closely with major insurance companies, employers, and attorneys. We also have years of experience building evidence that holds up in claim disputes and courtrooms. Our investigators combine surveillance, skip tracing, social media investigation, and expert witness support to build a strong case.
IN us, you’ll find experienced professionals who understand the legal standards and practical realities of building a case that will protect your company. Moreover, each investigation is handled discreetly and documented thoroughly. We then deliver the same evidence professionally so it stands up when it matters most.
Do you suspect any recent insurance claim is fraudulent? If so, don’t wait until it’s too late. The best you can do is contact Keefe Private Investigations or call us at 405-435-8355. We will then discuss how our licensed investigators can help you build a strong, evidence-based case.
