Work Comp Fraud: Hell hath no fury…

A day laborer reported back and neck injuries after falling 10 feet off a water tank, landing on his back. Sometime later, the claimant’s ex-girlfriend called his then-employer, wanting to testify that he had not been injured and his claim … Continued

Auto Fraud: Who’s in the passenger seat?

An insured driver was allegedly rear-ended by another car. Both the insured driver and his passenger sought PIP benefits under the insured policy. An investigation revealed valid insurance in force for the at-fault vehicle, negating the PIP claim; plus no … Continued

Work Comp Fraud: Caught on tape

An “injured” worker on disability was found to be working again, this time as a janitor for an office building. Five hours of surveillance video showed him exceeding his modified duty restrictions while working for his new employer. In a … Continued

Auto Fraud: Uncovering a non-covered driver

A claimant attorney reported the loss, stating the claimant was driving the insured vehicle when it was involved in a hit-and-run, head-on collision. Injuries to head, back, neck and arm were reported. Our investigation discovered not only the identity of … Continued

Auto Fraud: Running through the medical mill

The insured reported that she was driving her insured vehicle when another vehicle ran a stop sign and collided with her. She complained of neck, back and side injuries; her two children and another passenger were also injured. The investigation … Continued

Auto Fraud: Nothing’s as it seems

The accident was reported by a friend, stating that the insured vehicle was driven by the insured’s brother when he rear-ended another farm tractor and trailer. The insured was in the vehicle and complained of a dislocated/fractured hip. Two more … Continued

Auto Fraud: Damage to a non-covered car

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, … Continued

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 … Continued

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 … Continued

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 … Continued

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 … Continued

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. … Continued