Insurance Claim Investigations

Were it not for the fact that insurance fraud occurs, insurance companies wouldn’t need insurance claims investigators. Unfortunately, there are many different types of insurance scams and false claims, and insurance companies may lose lots of money if they merely pay out on claims they think may be dubious. To avoid this loss, many insurance companies have on their staff or contract with at least one insurance claims investigator so they can attempt to only pay legitimate claims.

Usually, our help as insurance claims investigator is solicited when a company suspects fraud or to rule out fraud in all its claims. Suspicion may occur during the first examination of a claim, which may be conducted by insurance examiners or insurance adjusters. Our investigator will review the case, going over all information provided by the company and claimants. He or she also may investigate the claimants to a certain degree to find out or  suggest fraudulent behavior in the past or present. Searches for criminal records might be conducted, our investigator could look for collusion between claimants and witnesses, and he might also re-interview anyone involved in the claim.

In some instances our insurance claims investigator doesn’t just sift through witness/claimant details, but might be out in the field. He might need to perform surveillance or examine the scene of an accident. The job may vary between active and passive searching for evidence for insurance fraud.

There are quite few traits needed to become an insurance claims investigator. Some people have moved in from law enforcement work into our company. Others have studied criminal justice at the college level, most often earning a bachelor’s degree prior to entering our firm. Their familiarity with state insurance laws is phenomenal and they are quite aware of all identified and possible means by which people attempt to commit insurance fraud.

In addition to their experience and knowledge, our insurance claims investigators have a finely trained mind: one that can spot deception easily, see patterns in gathered information, and look for ways to prove suspicions. They are people who enjoy this field like logic, reasoning and puzzles, and aren’t afraid to do active detection work when required. They have high degree of organization for sifting through all paperwork and gathered evidence corroborating the evidences for a missing clue.

One of the cornerstones of SIB is our long standing tradition of providing investigative excellence to insurance carriers. Our investigative services, which include casualty surveillance, background checks and activities checks, have helped thousands of adjusters and defense attorneys from coast to coast to gather the information they need to make educated, responsible claims decisions.

We realize that too many insurance investigative agencies make far too many irresponsible promises about they can do which almost always leave you looking bad to your supervisors, claims team and the claimant. We understand that you have many choices when selecting an investigator and that most insurance investigators sound the same when pitching their services to you.

What we will promise you, which the giant national P.I. agencies cannot, is that we will not embarrass you or your company. We do not accept assignments that we cannot actually do and do well. We do not use investigators who are untrained, inexperienced and make for poor witnesses on the stand. In short, everything we do, we do with your best interests in mind. We follow an ethics policy and treat the subject of the investigation like a real person and respect their rights and dignity.

Many insurance investigative agencies can’t deliver the same level of service or product that we can because they try and be everything to everyone and everywhere, at the lowest price possible. In our business, labor costs are the main expense that a P.I. will incur. By keeping that cost as low as possible, they try and maximize their profit. (For those of you who may doubt that these national agencies pay only slightly better than the minimum wage, call and ask to apply for a job at one and ask the starting salary) Keeping labor cost low sounds like a sound business decision particularly when they rationalize this by relying on case management software, an initial training class and even some experienced supervisors to try and make up for a lack of experience or skill in the field. Oh, don’t forget, they claim to be able to do everything anywhere in the country. The problems arise when you realize that their investigators are not professionals, they are kids with little or no real world experience, supervision by telephone only and a true lack of concern for their low paying dead end jobs. No agency can provide you with true investigative excellence when the work is actually being conducted by inexperienced investigators who make ten dollars an hour, and that’s what they do. Even more insulting than providing these people as their field investigators, these same firms send out sales people to convince your manager that they should be hired to manage your claims files and special investigative unit. You need investigative expertise, not fairytale stories from someone who sees your case and number ten thousand.

Why would any carrier want to work these giant agencies? Because they sell the idea of “cost savings” to executives very high up in the company who get wined-and-dined by sales professionals with graphs and slick promises. In some cases, these investigative agencies also give their clients “refunds” or “rebates” a.k.a. kickbacks.

We have a different approach. We only take cases in areas we cover regularly and reliably, we have a strict code of ethics we follow, all of our investigators are experienced and make for strong credible witnesses in court and all of our investigators are well paid professionals.

Why disclose all our traits and secrets just for marketing our skills and success stories, unless you want one for yourself?

  • Cheating Spouses
  • Child Custody/ Divorce
  • Photo/Video Surveillance
  • Criminal Investigation
  • Background Checks
  • Missing Persons
  • Insurance Fraud
  • Traffic  Accident Investigations
  • Se Habla Español
  • Available 24/7

Private detectives and investigators assist individuals, businesses, and attorneys by finding and analyzing information. They connect clues to uncover facts about legal, financial, or personal matters. Private detectives and investigators offer many services, including executive, corporate, and celebrity protection; preemployment verification; and individual background profiles. Some investigate computer crimes, such as identity theft, harassing e-mails, and illegal downloading of copyrighted material. They also provide assistance in criminal and civil liability cases, insurance claims and fraud cases, child custody and protection cases, missing-persons cases, and premarital screening. They are sometimes hired to investigate individuals to prove or disprove infidelity.

Private detectives and investigators may use many methods to determine the facts in a case. Much of their work is done with a computer. For example, they often recover deleted e-mails and documents. They also may perform computer database searches or work with someone who does. Computers allow investigators to quickly obtain huge amounts of information, such as records of a subject's prior arrests, convictions, and civil legal judgments; telephone numbers; information about motor vehicle registrations; records of association and club memberships; social networking site details; and even photographs.

Detectives and investigators also perform various other types of surveillance or searches. To verify facts, such as an individual's income or place of employment, they may make phone calls or visit a subject's workplace. In other cases, especially those involving missing persons and background checks, investigators interview people to gather as much information as possible about an individual. Sometimes investigators go undercover, pretending to be someone else in order to get information or to observe a subject inconspicuously. They even arrange to be hired in businesses to observe workers for wrongdoing.

Photo/Video Surveillance
Photo/Video Surveillance
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