In the United States, approximately $30 billion is lost each year through insurance fraud, and although most companies have systems in place to mitigate these types of losses, certain methods are simply not effective. Texas Investigative Network’s (TIN) investigators are often engaged to step in when fraud is suspected, as one claim can potentially cost a company millions of dollars. TIN’s licensed investigators are experienced fraud specialists and often implement a variety of investigative techniques to our insurance clients who have been defrauded. These services include, but are not limited to:
- Surveillance: When a fraudulent disability claim is suspected, TIN recommends short term or long term, covert surveillance of the claimant. During the course of surveillance, TIN fraud investigators discretely monitor a claimant’s activities and provide video evidence of the claimant’s current and true physical capabilities. In 2012, TIN was hired to conduct surveillance on a plaintiff involved in a civil lawsuit that was filed as a result of a motor accident which had previously occurred. The plaintiff claimed that injuries caused by the accident restricted her from working or exerting herself in any way physically. TIN’s investigators initiated stationary and mobile vehicle surveillance, and over a period of three days, obtained covert video evidence of this plaintiff walking long distances, running, jumping and performing some routine gardening activities at her residence. Our video evidence was produced to our insurance law firm client and as a result of this investigation, the plaintiff received $229,000 in damages, a fraction of the $3.2 million dollar demand she was originally seeking to recover.
- Witness Locate and Interviews: Witness testimony can be a critical component in many insurance fraud cases. TIN Investigators routinely locate and interview fact witnesses, memorialize their statements into a court admissible format, and retain them for official use in the event this information and/or evidence is ever ordered to be produced by court order or by opposing counsel in the discovery process. For example, if a person involved in a vehicle accident reports a particular sequence of events to the investigating officer suggesting liability upon the other driver, any witness who actually observed this same accident may provide critical testimony which may be contrary to the plaintiff’s claim.
- Persons of Interest in Property Loss Claims: A claimant may file a false claim in connection with services that were never actually rendered. In November 2013, TIN was hired by an insurance company to research and obtain contact information on several people whose vehicles were supposedly damaged as a result of a fire at a local business. The claimant, an owner of an auto repair shop located in proximity to the business, filed a claim with the insurance company in the amount of $ 220,000.00 for vehicle repairs that were allegedly provided. TIN located six of the individuals whose vehicles were identified in this claim and conducted extensive interviews with each of them. Each of the six individuals which TIN located and interviewed stated that they had NOT brought their vehicle to the auto repair shop due to fire damage, and several had never even had repairs done to their vehicles. As a result, TIN was able to demonstrate unequivocally that the documentation provided by the claimant was in fact fraudulently produced repair records, and thus assisted our insurance client in denying this claim.
- Provide evidence in medical insurance fraud cases: Providers and patients alike can be involved in false claims, and many of these situations include unnecessary and/or non-prescribed medical treatment, fraudulent service/equipment coding, fraudulent billing and/or greatly exaggerated claims of personal injury and/or disability. TIN fraud investigators are routinely engaged to conduct meticulous levels of due diligence including research of all appropriate background, claims history, government and public record sources relative to claimants and if necessary, practitioners, clinics and medical facilities as well.
In the field of insurance fraud, it is common yet also very gratifying when we are able to expose the many creative methodologies that a claimant may use for sole intent of defrauding an insurance company out of a large amount of money. Our job and privilege every day is to do everything possible within an investigative capacity to ensure that this does not happen to our insurance clients.