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
Stories
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
Staged auto accident by two women proven fraudulent
An ACM claim adjuster handled a bodily injury claim at the California/Mexico border, on a National Unity policy. The insured admitted fault, stating that she accidently struck a pedestrian that was standing behind her car. The claimant said she was walking in the parking lot. She was looking at her cell phone when the insured… Read More
Home “intruder” was actually a boyfriend
A homeowner reported waking in the middle of the night to an intruder. A fight ensued and the intruder fled with over $6,000 in personal property, breaking two windows. The insured acknowledged recognizing the suspect as a prior renter. The suspicious incident was referred to IS as a possible case of homeowner policy fraud. Investigators… Read More
Stolen good weren’t stolen. Claim closed.
An ACM adjuster was assigned a GL claim for a claimant who said her car and personal property were stolen when she dropped her BMW off at our insured dealership. Her investigation verified that someone stole the vehicle, which was recovered the next day. Another customer was arrested for the theft. The claimant was paid… Read More