Services

SERVICES–INVESTIGATIONS

image1

FRAUD is a cancer

, and malingering is ever growing at a pace that is uncontrollable and difficult to measure.

We started off conducting surveillance, research and investigations for workers’ compensation and liability injury claims. Our knowledge base grew, and we now also conduct cargo theft, commercial transportation, fatality and large loss scene investigations, and theft investigations all around the country and parts of the Caribbean.

Our team of experts in this field aggressively combats this problem. We take a tactical, methodical and unyielding persistent approach to this enormous problem. Starting by establishing a trust and bond with our customers, developing a clear understanding of each individual situation and establishing an action plan to determine an accurate, actual account of the circumstances.

We utilize advanced technology, advanced methods, and advanced training to create strength in this area. Advanced training and recruitment allows us to meet our customers’ needs, wherever they may be. We maintain a focused approach and rely on accurate sources of information.

The sequence of events is critical – bring the investigative team in at the start of a claim to maximize your investment: investigation, surveillance, deposition, IME.

An effective investigative team is a critical part of the anatomy of a well-handled file. We will take a claimant’s recorded statement and offer recommendations based on the details of the statement. While you are collecting and evaluating prior medical records, we will conduct surveillance during the first part of the claim and continue throughout the duration of a claim.

As this problem grows, we will grow with you!

Types of investigations we conduct:

  • Surveillance
  • Workers’ Comp, Liability and Disability Claims Investigations
  • SIU Investigations
  • Large Loss Investigations (high-risk, high-exposure claims)
  • Scene Investigations
  • Fatality Investigations
  • Commercial Transportation Investigations
  • Cargo Theft Investigations
  • Clinic Investigations
  • Background Investigations
  • Internet Profiling
  • Activity Checks
  • Alive and Well Checks
  • Electronic Surveillance – unmanned surveillance operations
  • Witness Location
  • Interviews/Statements
  • Commercial Transportation Fleet Analysis Reports
  • Loss Control Reports
  • Agent and Agency Inspections
  • Underwriting Audits

The following are descriptions of each type of investigation, corresponding with the above bulleted list.

Surveillance

image3

Traditional one-man surveillance.

image2

Special Operations Group mission.

image5

Special Operations Group – all camera feeds displaying in mobile command post.

image4

Covert video streaming to mobile command post 
(see left).

Strong, clear video evidence of a subject engaging in activities that contradict his or her alleged physical restrictions can save the insurer thousands of dollars when defending an insurance claim. Direct Insight utilizes various methods and advanced technology to obtain legally admissible, unbiased evidence. We customize objectives for each case, and then tailoring what technology should use devise a plan by tailoring what technology to meet and exceed those objectives.

In order to justify your time and expense, several things should be present before you assign surveillance – primary and secondary sources of information, a reasonable belief of malingering, and a strong investigative team to obtain demonstrative evidence. Early detection drastically increases your chance of obtaining dispositive evidence. Being more selective about cases that justify surveillance will allow you to increase your success ratio and avoiding wasting surveillance budgets.

Prior to sending an investigator out on surveillance, we conduct a thorough background and social media and internet profile investigation so that our field investigators are armed with all of the information available. We research driver’s license records, vehicle registrations, address history, civil and criminal records – and any other relevant information that will prepare the investigator before any of the budget is even used.

Not only is the field investigator equipped with relevant details regarding the subject, Direct Insight investigators are also equipped with advanced technology to meet the case objectives. We determine what methods and what technology should be used to meet the objectives and then tailor a plan with what technology should be utilized in each situation. Our goal is to provide our clients with usable, admissible evidence and documentation.

Along with traditional surveillance, we have developed our Special Operations Group – an advanced division within the company. By utilizing a team of investigators with state-of-the-art mobile surveillance technology, Direct Insight has the capability to provide real-time video to you from the field.

Workers’ Comp, Liability and Disability Claims

Workers’ compensation and liability claims investigations are also our area of expertise. We thoroughly conduct these types of investigations methodically and on an individual file basis. Each subject and circumstances are different; however, all require methodical preparation, detailed objectives, and an action plan to meet those objectives.

SIU Investigations

image6

image7

image8

Direct Insight investigators aggressively investigate claims to help confirm the validity of a claim, assist in determining the compensability of the claim, document the circumstances surrounding the claim, and identify subrogation opportunities. Upon receipt of an investigation request, we develop a comprehensive list of objectives and identify and follow leads as they develop throughout the investigation.

Our investigators conduct thorough and comprehensive recorded interviews and collect relevant evidence and documentation throughout each investigation. Constant communication is maintained with our clients to determine where the investigation should go next and/or add more objectives based on the findings.

Defendants/employers have a greater chance of winning case when they have a complete, thorough, and accurate understanding of the facts of a case. That is what Direct Insight will provide.

Direct Insight specializes in large loss investigations by tailoring a customized plan for each investigation. After a thorough review of a case and developing specific objectives, we determine what methods and technology will be used to meet those objectives.

We understand what is at stake to the insurer, to the attorneys, and to all parties involved – we specialize in these types of investigations. We are confident and competent in gathering the necessary information before and during the investigation ends. We adapt, create new objectives, and gather the information any way necessary to meet the objectives. When you hire Direct Insight, we get the information to you that is essential and vital to the settlement process.

Theft investigations are very prominent in this country. We conduct theft investigations in attempt to recover stolen property (boats, vehicles, content, cargo, etc.). Below are two photos of a stolen tugboat that Direct Insight recovered in 2012.

image10

image9

Large Loss Investigations (high-risk, high-exposure, and theft claims) –
Recovered tugboat, 2012, Central Florida

Scene Investigations

image12

image11

Outboard motor theft

Direct Insight’s scene investigations begin with a customized list of objectives that are developed after a comprehensive conference with the client and an in-depth review of the initial provided information. An experienced and knowledgeable investigator will visit the scene, search for witnesses and surveillance cameras, obtain recorded statements from knowledgeable parties, gather relevant documentation, take photographs, and document the facts in the case wherever the investigation leads us. We believe in doing an After Action Review when the initial objectives are met, so we can determine where the investigation needs to go next.

Fatality Investigations

image16

image15

image14

image13

Similar to scene investigations, Direct Insight’s fatality investigations are also customized with a specific list of objectives that are developed after a comprehensive conference with the client and in-depth review of the initial provided information.

An experienced and knowledgeable investigator will visit the scene; inquire with the coroner’s office, obtain autopsy report, if applicable; interview police; visit the insured’s location; search for witnesses and surveillance video; obtain recorded statements from knowledgeable parties’ gather relevant documentation, take photographs, and document the facts in the case wherever the investigation leads us. We also identify subrogation opportunities and report our findings in a detailed reporting format. It is common to find that multiple parties have exposure in these cases, and we determine who those parties are and what coverage they hold.

Commercial Transportation Investigations

image18

image17

image19

The Direct Insight team has vast knowledge in the area of commercial transportation, trucking and fleets of all sizes. Every truck on the road has between $750,000-$1,000,000 liability policy, along with their cargo and physical damage policies. When accidents occur in this sector, they are sometime catastrophic.

We understand the complexity of these types of investigations and coverage issues that arise. Usually, in each and every case, there are coverage issues. We are able to determine if the drivers were qualified and listed on the policies and what equipment the companies own. We understand coverage issues, driver qualifications, DOT requirements, and equipment. This industry is a target for litigation.

Cargo Theft Investigations

image21

image22

image20

image23

Cargo theft investigations also tend to be quite complex, with multiple parties having exposure. With Direct Insight’s expansive knowledge in the commercial transportation and insurance industries, along with our aggressive and customized investigative methods, we conduct thorough and effective investigations in this area.

These investigations begin with reviewing the available information and then customizing a specific list of objectives to meet during the investigative process. We will make onsite visits to any and all locations involved, search for witnesses and surveillance video in the area of the incident, obtain detailed and comprehensive recorded statements from all knowledgeable parties, interview law enforcement, take photographs, and follow up on all leads as they arise throughout the investigation.

We have many contacts in the cargo theft community around the country. This is a tight-knit investigative community, and inter-agency networking is imperative. We have these contacts to work hand-in-hand with insurers, officials, law enforcement, and freight forwarders nationwide to make recoveries. These can involve very sophisticated organized theft rings, and a team concept is necessary.

Clinic Investigations

image25

image24

image26

For insurers who are questioning bills for coverage, clinic surveillance is a powerful tool to determine if subjects are actually going to a provider’s location and, if so, how long they remain inside.

This evidence can be compared to what the provider/clinic is billing to ensure that you are not paying for treatment that was not provided. For example, if a subject is authorized to see a provider for weekly 30-minute psychotherapy sessions, clinic surveillance will ensure that the subject is showing up for the authorized appointments. Additionally, if the subject is showing up, that he/she is not leaving after 10 minutes.

Additionally, clinic surveillance will confirm if a provider or a specific physician is, in fact, at that location on that date.

Background Investigations

image27

A comprehensive background investigation is a great resource and foundation to beginning an investigation. There is no “one-stop-shop” for background searches – we believe in rigorous research in to numerous areas, specifically going to the source and not just relying on a summarized data report, to provide real and accurate information. We teach courses in this area specifically.

Some of the areas we research and analyze include:

  • Address History
  • Professional License Search
  • Business Search
  • Real Property / Asset Check
  • Civil and Criminal Records Research
  • Witness Locate
  • Death Records
  • Social Media
  • Social Security Verification
  • Litigation Search
  • State Driving Record
  • Marriage / Divorce Check
  • Bankruptcy Records
  • Incident / Police Reports
  • Vehicle Registrations
  • Workers’ Compensation Databases
  • Prior Medical Records
  • Internet Profiling

image28

This claimant was just awarded permanent-total status one
month before this Facebook post.

This type of research alone, or coupled with a comprehensive background investigation, is a good way to profile a subject’s online activities. Areas checked include social media (Facebook, Twitter, LinkedIn, etc.), craigslist postings, eBay and Amazon postings to name a few.

Activity Checks

image30

During an activity check, this claimant exited his garage with a five-gallon bucket of paint. We followed him and confirmed that he was working.

During an activity check, we found this
 claimant doing work on his house.

Activity Checks are a useful tool to determine whether extended surveillance is warranted on a claim. The activity check includes a claimant profile, brief surveillance on the residence with a full description of the property and residence (focusing on signs of work being done at the residence, who is coming and going, vehicle registrations), discreet neighborhood inquiries, and a detailed description of the environment. The investigator is fully equipped and prepared to obtain video if the subject is active while the activity check is being conducted.

Alive and Well Checks

image32

Headline: Woman stores dead father in freezer
while cashing his benefit checks.

Is your subject the person who’s cashing the benefit checks? When you need to confirm that a subject who is receiving benefits is still alive and well, Direct Insight’s alive and well checks are imperative. We begin our research with checking several death indexes, as well as running and analyzing an updated data report. If there are no indications of the subject being deceased, we proceed to the subject’s address to confirm in-person that the subject is alive. A photograph is taken, and a brief in-person interview is conducted to determine the subject’s overall situation.

In many cases, we find very useful information for our clients and permanent-total disability cases are often reviewed as a result.

Electronic Surveillance – unmanned operations

image35

image34

image33

When a specific subject requires long-term electronic surveillance, we have the knowledge, equipment, and resources to set up this type of surveillance. If you have specific questions regarding this, please feel free to contact our office.

Witness Locates

image37

image36

We can locate and interview any potential witnesses to you assist you in your matter. Locating individuals isn’t always an easy task, and there is no “instant locate” resource available. As with gathering information for a comprehensive background investigation, locating individuals must encompass numerous resources to put the puzzle together. We begin with running a data report, which gives us the areas to research deeper. We analyze the data, research available real-time data (vehicle registrations and driver license records), follow leads, and make onsite/in-person inquiries to provide accurate and current information.

Interviews / Statements

image38

Direct Insight’s interviews and statements are thorough and calculated; a useful in our SIU, LLU, scene and fatality investigations. We develop a customized list of questions, but we don’t stop there. This is where the knowledge and experience of our field investigators is showcased. We do not just stick to a scripted list of questions. We follow-up with additional questions based on the subject’s answers to obtain the most detailed and comprehensive interviews and statements from all relevant parties. The recorded interview questions are methodically organized in a way that gathers facts. We turn them around quickly to provide a verbatim transcript of the recorded interview/statement.

Loss Control Reports

image40

Direct Insight’s loss control reports for fatality investigations are essential to be in compliance with some state workers’ compensation guidelines. Due to time restrictions on determining the compensability of a claim, we begin our investigation immediately, proceed to the loss location and conduct a thorough and in-depth investigation as to the circumstances surrounding a fatality.

For example, in the state of Texas, if the insurer believes that a claimant is not eligible to receive death benefits, the insurer has 15 days to dispute the eligibility. If the notice of dispute is not filed within 15 days, the insurer is liable for all benefits that had accrued and were payable.

Therefore, rapid response is imperative to meet the reporting guidelines in these types of claims.

Agent and Agency Inspections

The agent and agency inspections/audits that we provide are beneficial to both the insurer and the agency. An onsite visit to the agency, along with an in-depth review of various procedures and expectations, provides an informative evaluation as to the degree of compliance on issues such as timeliness and proper documentation.

From an E&O standpoint, the benefits can be tremendous. Since documentation is a key issue with the defense of agencies on E&O matters, evaluating the staff in terms of the quality and timeliness of their system documentation is extremely important. Proper documentation should detail the date and time of the conversation, who was spoken with, and what was resolved.

image41

image42

We work with each client’s specific underwriting guidelines to help the underwriter quickly evaluate a policyholder’s operations and make effective underwriting decisions. We provide onsite visits/inspections, as well as a virtual process to assist in the underwriting process. We confirm the location, confirm the nature of the business, classification codes, commodities (if applicable), etc. We find, based on past experience, that the information provided to underwriting to make underwriting decisions is often times less than accurate, leaving our insurer with unnecessary exposure.

Onsite visits or the virtual process can be conducted prior to policy issuance or policy renewal to determine and confirm things like: Is the insured using subcontractors? Is there an employee-employer relationship? How many employees are listed on the policy? What classification codes are reported? For commercial transportation, are the drivers eligible, MVRs current, equipment and VINs match the policy?

This allows a proactive approach prior to a catastrophic loss, or any loss. Often times, these details are not discovered until after the fact.

Our virtual process offers a more cost-effective alternative to onsite visits. This process combines a telephone interview and extensive internet research to confirm information about the insured’s operations, safety programs, and exposures.

Examples: We recently worked on an assignment where a 17-year-old boy was killed after being instructed to oversee/perform a security function, overnight, for millions of dollars worth of government/military equipment at a firing range. Subsequently, there was drinking involved, which resulted in a fatality. The problem was that the insured’s policy only listed “property management” and “clerical” as covered class codes. An onsite visit, internet research, and background investigations prior to any renewal of this policy would have uncovered the true nature of this insured’s business operations.

image43

image45

image44

Government vehicle, not listed on policy, and insured engaged in several businesses not reported.

Another example where a fatality occurred, was an insured/owner who had a workers’ comp policy for a welding operation with one clerical worker. We conducted online satellite imagery analysis and found excavating and heavy equipment parked at his reported business address. This prompted an onsite visit, and we found that the deceased/owner had not only a welding shop but also an excavating operation engaged in government contract work, a convenience store, and a beauty salon – all on the same property. His policy only covered the welding and convenience store operations. Unfortunately for the insured, he died while doing excavation work and had not been forthcoming with that business classification.

Similar to red flags in claims investigations, there are red flags in the underwriting process. Has the insured been compliant with premium audits? Have they reported accurate payroll amounts? Is the address listed on the policy a mail drop (The UPS Store, Mailbox Plus, etc.)?