Vandalism, including a keyed door and dented hood, was reported by the insured’s lien holder. However, the claim actually occurred just three days after the vehicle was removed from the auto policy. Also, the damaged vehicle was an older model, yet had full coverage (with no inception photos). Murkier still was the fact that no… Read More
Medical Provider Fraud: A little too interconnected
Working with a claims management client, ISI obtained evidence of a chiropractor who was part-owner in several medical clinics and a law firm. Further investigation found that a group of injured workers were all represented by the same law firm and consistently received the same treatment/referral patterns. The chiropractor had been indicted; however, the various… Read More
Auto Fraud: Physician, heal thyself
An alleged hit-and-run accident left the claimant with reported injuries to his neck and back. The claimant – a chiropractor whose license had been revoked for failure to pay child support – was treated by his own clinic plus two others. When the case was turned over to ISI’s Special Investigations Unit, they discovered he… Read More
Premium Fraud: Payroll Scandal
In June 2014, Investigation Solutions, Inc. received information that the claimant was receiving cash payments from the insured. After further investigation, it was discovered that the claimant was not documented to work in the United States and therefore the insured paid him cash for his work. The investigation department assisted with coordinating an audit which… Read More
Auto Fraud: Car Jacking
Within a two year period of insuring her vehicle, an insured had been involved in 17 different incidences. However, on April 8, 2014, at approximately 11:30 PM, the insured alleged she went to an intersection in Los Angeles driving her 2000 Buick Regal to pick up her boyfriend. Upon arriving at the intersection, her boyfriend… Read More
Work Comp Fraud: Painted into a corner
The claimant suffered a low back injury when he fell off a ladder while performing his job duties as a painter. The initial injury was found compensable. The claimant had minimal objective findings that did not support his subjective complaints. Surveillance was conducted on two days between March and May. The surveillance showed the claimant… Read More