A claim has happened – you can’t change the unfortunate fact that you’re facing a loss, but conducting an aggressive and thorough investigation can be extremely important in the claims process. Tools that can often be used to ensure claim legitimacy and help protect your organization’s bottom line include:
1. Database Investigations
Utilizing a robust research and database investigation gives you access to the most current fraud information and the ability to sort through data quickly and accurately. Database investigations provide insight to:
• Authenticate the identity of people and their businesses
• Identify all assets
• Link and identify relationships between individuals, businesses, and assets
• Uncover financial stress
2. Social Media and Web Crawling
Social media and web activity offers some of the most consistent evidence against fraud. Both can be used to meticulously examine the claimant’s web footprint through a deep dive of online networking, social media, internet information and public record searches. Online activity often provides greater knowledge of the claimant’s interests and activities and can provide validation for surveillance expense and reduced reserves.
3. Medical Canvasing
Medical canvasing is a research and analysis process designed to help uncover pre-existing conditions and claims, helping the investigation to more accurately determine a claimant’s history of treatment and uncover incidents of attempted fraud. Often the search includes-- but is not limited to-- hospitals, pharmacies, dental, physician-all specialties, MRI and imaging, and physical therapy. Canvasing can help:
• Gather evidence necessary to confirm or deny the validity of a claim
• Uncover the dates a claimant visited a specialty doctor and/or facility
• Discover whether or not prior treatment was provided
4. Medical Canvasing
Surveillance can be performed any time throughout the duration of a claim and is often used to help determine whether a claimant’s representations are truthful. Evidence of a claimant performing activities contradictory to their claim and reported restrictions that can be captured using video surveillance often results in significantly reduced claim costs.
5. Field Investigations
Information is king when looking to quickly and accurately resolve a claim, especially those headed for litigation. Using a field investigator can help save you time and money by skillfully uncovering and reporting back key pieces of information regarding the claim. Benefits of field investigations include:
• Provides very detailed information
• Often uncovers facts that may not be immediately obvious
• Information can be used to help make more educated decisions about how to proceed with a claim