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Over the years, there has been an increasing trend in the rise of internet use in people’s daily lives.   Social networking internet sites are being formed daily.  People are signing on and divulging their lives and inner personal secrets to all that will listen.  These websites are an important tool for investigation when attempting to find out more information about a person in question.   In litigation, a person’s conduct and morale are always in question.   Many adjusters are unaware of the claimant’s extracurricular activities and possibly even there appearance.

In recent times, we have been successful in finding additional employment and sporting events that claimants were involved in through this resource.  ICU Investigations has developed the IPR (Internet Profile Report) as a tool to monitor claimants.   Through this report, we search websites such as Google, You Tube, Myspace and Facebook to develop a more intimate look into the person in question.  This ancillary report is being employed free of charge with any requests.   We would like to offer this type of service to you as an added value with insight.

Hospital and Radiology Canvass:

When reporting accidents it is common that people conveniently “forget” past injuries or ongoing pain that they have been experiencing over the years.  Many may not be conscious of past injuries or don’t believe that prior injuries will have an affect on the present condition of a specific injury.  Some have been awaiting their recent “slip/fall” so that they have an opportunity to have a recurring problem fixed.  It is important to know whether or not the claimant has ever been treated in medical facilities for any type of injuries.  This way, you may determine whether the injuries sustained from this most “recent” accident are the responsibility of your company.

In order to fight these types of claims, ICU Investigations has developed an investigation known as the Hospital or Radiology Canvass.   A hospital canvass will retain dates of service for undisclosed medical treatment, in patient, out patient or emergency room admissions for a 50 mile radius of the person’s home.  A radiology canvass will verify dates of service for any undisclosed X-rays, MRI or CT scans for facilities not affiliated with hospital visits.  After the dates of services are verified, the adjuster will then use that information to formulate their next step in the settlement process.  When dates of service are verified, the medical records can then be subpoenaed by an attorney.  After you receive the medical records for the claimant, you may find that the injury they are reporting may have occurred years ago for the first time.  This investigation could possibly save your company and/or client thousands of dollars.  These services can be ordered separately or be ordered together for a combination service.

It is important to remember that not all cases will merit these types of investigations.  There are some general warning signs that can help determine if this type of investigation is right for you.  Some of these signs may include:  accidents with no witnesses, changing of stories, sketchy details, missed medical appointments, financial hardships, and disgruntled employees.  Perhaps one of the most prominent signs of a fraudulent claim is a Monday morning claim, or first day of the week claim.   The Monday morning claim may have actually occurred over the weekend.   If you are suspicious of a claim, contact ICU Investigations and we will put forth our best effort to find you the answers that you need.

Many of us may not be surprised about the relationship between the desperate state of the economy and influx in fraudulent insurance claims.   Throughout the country there has been a sense of fear and uncertainty about the future of personal finance and job security.  This threat has been causing many to react indifferent and often resort to criminal activities to provide themselves with a false sense of financial stability.  With the insurance industry compiling thousands of different companies and having trillions of dollars infiltrating in premium payments, it makes the industry a prime candidate for crime.  (www.fbi.gov)

In 2008, there was a Pennsylvania couple charged with fraud after they submitted claims for more than 11 accidents.  They reported claims for damage and medical bills for allegedly crashing into various stationary items such as parked cars, trees and utility poles.  In addition, they submitted claims for medical appointments that they were not present for and both received several prescriptions for pain medications.  (www.post-gazette.com)

The issue of insurance fraud in this country should be of concern for everyone.  Statistics say that one in five US adults believe that it is acceptable to defraud insurance companies.  (Four Faces of Insurance Fraud, Coalition Against Insurance Fraud, 2008).  It is estimated that insurance fraud, not including health insurance, is approximately costing the American public over $40 billion a year.   This can translate into increased premium rates between $400 and $700 for the average household.  (www.about.com)  We all have a civic duty to be aware and fight against this problem.

It is estimated that three percent of slip and fall injuries are fraudulent. (National Floor Safety Institute)   False injury claims in conjunction with litigation costs can reach approximately $2 billion dollars a year.  (www.insurancefraud.org)

In 2003, a New Jersey man was charged with fraud in a slip in and fall scam.  The injuries had supposedly been sustained during a 1999 bus trip on an Elizabeth bus route.  He submitted over $6, 000 in false claims.  He was ordered to pay restitution to Sedgwick Claims Service and Aetna/ US Healthcare and was placed on three years probation.  (www.njinsurancefraud.org)  In 1999, another case was that of Ernest Woodson, a Vineland man, who used 7 aliases, making 21 phony claims in a period of a little over 1 year.  He attempted to obtain close to $32,000 in insurance claims from 19 different establishments.  He pled guilty to theft and fraud charges.  He was ordered to pay restitution for the $9,000 that he ended up finally collecting and faces up to a 1 year in prison.  (www.njgov/lps, New Jersey Department of Law and Public Safety)

There are many cases ongoing throughout the country involving organized fraud rings and repeat offenders.  According to a case in Pennsylvania, there were six involved in a long running slip and fall scam targeting several restaurants, grocery stores, convenience stores, bars and laundry mats.  They would all “witness” the accidents of one another and use fake names and addresses to have the insurance checks mailed to.  They are all facing various charges. (www.insurancejournal.com)  There was another slip and fall fraud ring developed in Florida.   Michael Evans of Hollywood had used several aliases while submitting claims for fake slip and fall occurrences all over the country.  There were four other members of his family involved in this crime ring.  He has been charged with many different charges including theft, racketeering and organized fraud.  (www.claimsjournal.com)

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