Insurance Fraud, Worker's Comp
Southern Professional Investigation has over 14 years of experience working insurance fraud for major insurance companies and attorneys. Our expertise in surveillance has resulted in several prosecutions for fraud and saved our clients thousands of dollars over the years. We have conducted investigations all over the state. When an insurance company contacts us, they already suspect fraud and employ us to confirm their suspicions. Sometimes the injuries to the claimant are verified and the claimant is unable to work and the benefits paid to him are justified. Other times, we find the claimant working another job for cash so as not raise any red flags. These investigations require long hours of surveillance beginning early in the morning and continuing into the afternoon hours. The investigator has to blend into the community in order not to be detected. The investigator has to be alert at all times and quick thinking since conditions can change in an instant. Sometimes the current location of the claimant is unknown to the client and database searches or other investigative techniques are required to locate them. Surveillance requires stationary surveillance and mobile surveillance. The emphasis on these investigations is to obtain video documentation of the claimant’s activities which may in contrast to his/her reported injury. Most of these cases require a minimum of two days surveillance.
We have obtained video of the claimant jogging and exercising when he claims he can hardly walk. We have caught other claimants working other jobs or working for themselves while receiving paid benefits. This is in violation of the Workers Comp laws. These investigations are very difficult depending on where the claimant is residing. A claimant may only be seen for a few seconds and that may be the only chance to obtain video. Insurance fraud is one of the most unreported crimes. It is costing the insurance companies millions of dollars each year. Those costs are passed down to the business which is required to have workers compensation insurance on their employees. Georgia has one of the highest rates for workers comp insurance in the country.
A few examples of investigations we have conducted over the years are as follows:
A woman up in Northwest Georgia was a school bus driver. She filed a report of an on the job injury to her foot. She claimed she could not walk without crutches and had to wear an ankle brace at all times. We monitored her on two occasions in Dalton, GA where she had a scheduled medical appointment. On each occasion she parked in front of the doctor’s office and slowly exited the vehicle and stood on one leg, while retrieving her crutches from the back of the vehicle. She then slowly hobbled into the doctor’s office. Later she hobbled out of the office and returned to her vehicle. She slowly entered the vehicle, careful not to put any weight on her injured foot. She departed and traveled a short distance to a nearby fast food restaurant. She parked her vehicle, jumped out of her car and walked at a brisk pace into the restaurant. No crutches, no brace, no nothing. It was a miracle; she had been healed from the time she left the doctor’s office until she traveled a few blocks to the restaurant. Two weeks later she did the same thing. The insurance company was very pleased when they saw the video.
Another case took place in South Georgia. An employee of a major home improvement store claimed he hurt his back while working. He filed a $100,000 claim against the company. During the surveillance, the claimant was observed in his front yard carrying a dishwasher from the rear of his residence to the front yard. There he began to build a cabinet for the dishwasher. He spent several hours, bending over, hammering, sawing, and measuring. He then carried the cabinet up the front stairs into the mobile home. H returned and then picked up the dishwasher and carried it up the stairs and into his mobile home. Needless to say his $100,000 claim was denied and he was prosecuted criminally for insurance fraud.
If you are representing an insurance company as an adjuster or attorney and need surveillance conducted on a suspected fraud case, contact us for a consultation. Our investigators are experienced in covert surveillance and provide professional testimony if needed for court.