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Services for Insurance Carriers and Self Insured PDF Print E-mail

  • Fire and Explosion Scene Examination:
    Examinations are conducted to examine the origin and cause of the loss so as to determine appropriate actions for the claim to include subrogation. If the event was the result of an intentional act, investigation to determine if the insured was involved will be undertaken. If the loss was of accidental cause, evaluation as to subrogation potential will be made.

  • Theft - Home Owner or Commercial:
    Beginning with a site visit, the investigation will determine the validity of the claim, conduct the needed interviews, contact law enforcement, conduct a neighborhood canvass, and obtain and verify the receipts or documents that support the claim.

  • Workers Compensation, Auto Liability, and Injury Claims:
    Determine the facts that would support or deny the validity of the claim. Manage any needed surveillance or investigation to determine the activity level of the claimant. Interview any witness to the event or discover other witnesses. Utilize Medical Investigation and Audit protocols to establish prior existing physical conditions, other potential causes of injury, use the National Federal Registry to benchmark billing amounts, code correctness and evaluate medical standards of care questions.

  • Fraud and other types of claims:
    Determine facts supporting claims in Mortgage Fraud, Credit Life and Disability, Inland Marine and Maritime, Fiduciary Trust and Identify Theft issues.

  • Contracted Special Investigation Unit:
    Many states require Mandated Fraud Reporting if fraud is suspected in a claim. Many also require the presence either in-house or by out source contract a Special Investigations Unit to conduct investigations in suspect claims and regular training of adjusters in fraud issues.

  • Training for Adjuster Staff in Fraud issues:
    Workshop and Seminar setting training is available in all types of insured claims matters. This training reviews with adjusters of fraud and overviews the common fraud schemes. The training also presents methods to resist the suspect claim.

 

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