An adjuster had a disputed auto accident claim. The claimant said she and her daughter were injured when the insured pulled into her lane on a busy Los Angeles Street. The insured confirmed that she changed lanes from the far right to the far left lane to make a turn but blamed the claimant for… Read More
Stories
Vandalism claimed to get new appliances for free
Our client’s adjuster was assigned a $15,000 homeowner’s claim for vandalism, reportedly by a homeless person. The insured reported that someone broke into his home while he was out of the country on vacation, changing the lock on the front door so he could stay there. Because this was a new policy loss of just… Read More
$50,000 personal auto claim denied
The insured submitted a PIP claim on a personal auto policy. She claimed significant injuries, though the contact between the two vehicles was limited at best. She even claimed that she needed help bathing and getting dressed. An investigator met with the insured, who admitted that her daughter’s car was in her garage, though she… Read More
Surveillance revealed “injured” worker was employed elsewhere
A contractor was hurt on the job and filed a claim for back and leg injuries. When Investigation Solutions was asked to look further into the claim, the senior investigator first tried the injured contractor at home, but he wasn’t there. Our investigator went to the claimant’s doctor’s office and found a vehicle registered to… Read More
Medical clinic without a medical doctor equals fraud
On behalf of an insurer, American Claims Management was getting California workers’ compensation claims with treatment at a medical clinic outside their MPN (medical preferred network). ACM also received invoices for interpreters and suspected medical fraud. The “injured” workers reportedly saw multiple doctors at the clinic, but the reports were inconsistent: One patient was found… Read More
“Injured” worker found guilty of fraud and ordered to pay restitution of $84,304
A worker injured in 2012 committed workers’ compensation fraud when he said his arms, shoulder, back and knee were injured from driving a truck. However, he got better and forgot to tell his doctors, his adjuster or his attorney. IS caught him working while claiming to be disabled. Not only was he working – he… Read More