Insurance Investigations

High cost claims are a risk of every insurance carrier. However, if there is suspicion that the claim could be fraudulent, it pays to thoroughly investigate the facts around these cases. Our investigators are highly trained to obtain and document the facts, interview witnesses and all other involved parties including the claimant as well as obtain relevant medical records. The accident scene will be captured in pictures and diagrams and, including engineering specialists, will be utilized to fully illustrate the facts surrounding the accident. A final report summarizing the validity of the claim will be produced. This report can be used to determine if payment should be made on the claim.

It is estimated that over $7 billion in workers’ compensation fraud is committed per year. Our investigators are highly experienced in uncovering fraud and providing the evidence to deny claims and even prosecute when desired.

Surveillance is a powerful tool in the investigative process. It provides both a visual and written record of the activities of the person being investigated and includes their habits, movements, activities and locations. Surveillance can provide critical evidence when cases go to court or can be pivotal in keeping cases out of court. All our investigators are professional and experienced when needed to testify in court or during mediation. Prior to starting any surveillance case, preliminary investigation using computer searches and interviews will be utilized to maximize effectiveness and minimize costliness of surveillance.

The State of Florida mandates that any insurance company with premiums above $10 million must have either an in-house SIU unit or contract for outsourced SIU services. BI group can either outsource your SIU function or work with your SIU unit to provide any of the following services:

• Full claims investigative services
• Annual reporting to State
• Development and submission of comprehensive anti-fraud plan
• Fraudulent claims identification and investigation
• Division of Insurance Fraud compliance reporting

An investigative canvass used to uncover prior conditions and / or injuries, undisclosed medical treatments or prior claims. Also, used to uncover prior pharmacy usage, pain mgmt. clinic visits, sleep testing and substance abuse counseling. Finally, canvassing can uncover gym, country club and athletic league participation. All this evidence can be used to uncover fraudulent complaints of health, mobility, injuries and other issues.

Whenever a worker’s compensation claim is made, it is important to determine if the injury was work related and if the claim arose out of employment or occur during the course of employment? Also if there is another party that should be responsible for the loss? In the early stage of a claim it is critical to undergo a thorough AOE/COE investigation in order to document the facts around an incident before details and potential witnesses get lost or forgotten. BI group’s investigators are highly skilled and experienced in this type of investigation.

Activity Checks are a key tool for providing a baseline for surveillance. The purpose of this type of investigation can be varied. It can be used to determine if the subject is working and if so, when and where. It can also be used to determine who they spend their time with and the pattern of their activities. Or it can be used to determine the activity level of an individual in cases where they may be claiming injury. In any or all of the scenarios, BI group brings the expertise and talent to quickly and affordably conduct this type of investigation.

It is estimated that 10% of all property claim payouts are fraudulent. Buchanan Investigation Group has experienced investigators who know how to discover the truth when it comes to property claims such as fire, water and other causes for structural damage. Our experts understand the tricks and trends behind the different types of property loss schemes and are able to get results.