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Workers Compensation Insurance Fraud

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Workers Compensation Insurance Fraud

  1. 1.
  2. 2.
  3. 3. As Employment Goes Down……..<br />
  4. 4. ..then Fraud Goes<br />
  5. 5.
  6. 6.
  7. 7. Jones Act Claims <br />
  8. 8.
  9. 9. More files than you can handle? <br />
  10. 10. More files than you can handle? <br />We Can Help!!!<br />
  11. 11. We can help You be more effective in<br />managing <br />your caseload!<br />
  12. 12. Pre-Dated Coverage Losses<br />
  13. 13. We know the “Dirty Doctors”<br />Subluxation!!!!<br />
  14. 14.
  15. 15. If Inflation Goes Up……..<br />
  16. 16. ..then Fraud Goes<br />
  17. 17. AOE/COE Investigations<br />
  18. 18.
  19. 19. Alias Identification<br /> If you’re not who you say you are, you don’t have a claim!<br />
  20. 20.
  21. 21. WA L&I Coordination<br />
  22. 22. If Interest Rates go up……..<br />
  23. 23. ..then Fraud Goes<br />
  24. 24. Fraud…… the “Iceberg “ Crime<br />87% of the <br />Iceberg is<br />Invisible<br />From the Surface<br />
  25. 25.
  26. 26.
  27. 27. Some folks think Worker’sCompensation Claims are the<br />
  28. 28. Scene Investigations & Photography<br />
  29. 29.
  30. 30. If Gas Prices go up……..<br />
  31. 31. ..then Fraud Goes<br />
  32. 32. Premises Liability<br />
  33. 33. Asset Investigations<br />
  34. 34.
  35. 35. Jones Act Claims <br />
  36. 36.
  37. 37.
  38. 38. Asset Investigations<br />
  39. 39. If the Dollar Goes Down……..<br />
  40. 40. ..then Fraud Goes<br />
  41. 41. Witness Locates<br />
  42. 42. Recognizing Fraud<br />One of the best indicators is your intuition.<br />“I just have a bad feeling about this claim…..” <br />“There’s probably nothing you can do , but can you take a look at this claim……”<br />“ I can’t put my finger on it, but there’s something that’s not right here…”<br />
  43. 43. Recognizing Fraud<br />You don’t have to be a fish expert to know you’ve got a dead mackerel in your drawer…<br />If it doesn’t pass the “smell test,” There’s probably something fishy going on…<br />
  44. 44. Litigation Histories<br />
  45. 45. How do fraudsters think?<br />They all want <br />easy money.<br />and<br />They’re limited<br />only by their <br />imagination. <br />
  46. 46. Public Records - Nationwide<br />
  47. 47. Witness Locates<br />We routinely find them when other investigators have given up! <br />
  48. 48.
  49. 49. Public Records Nationwide<br />
  50. 50. Background Checks<br />
  51. 51.
  52. 52. Fraudsters<br />talk to each<br />other!!<br />
  53. 53. Neighborhood Canvasses<br />
  54. 54. “Dirty” Doctors and Attorneys<br />Questionable claims tend to gravitate to questionable legal and medical professionals<br />
  55. 55. Recorded Interviews<br />
  56. 56. Witness Locates<br />
  57. 57. Online Background Checks<br />
  58. 58. Factual, In-Depth Reports<br />
  59. 59.
  60. 60. On Call 24/7<br />
  61. 61.
  62. 62.
  63. 63. Criminal Histories may reveal: <br />Additional aliases<br />Relevant moral turpitude issues<br />
  64. 64. Interviews of Represented Claimants<br />
  65. 65.
  66. 66. Pre-Existing Injuries? <br />
  67. 67. File Reviews<br />
  68. 68. Don’t Burn Money – Good Investigation is Cost Effective!<br />
  69. 69.
  70. 70. Questioned ProvidersHave Big Bills!<br />
  71. 71.
  72. 72.
  73. 73. Are you Overworked?<br />We can Help!!<br />
  74. 74.
  75. 75. Medical Histories<br />
  76. 76. Good Investigations Save Money!<br />
  77. 77.
  78. 78.
  79. 79.
  80. 80. Too many pending??<br />We can Help!!<br />
  81. 81. Premises Liability<br />
  82. 82. Partners in Fighting Fraud:<br />Seattle Insurance & Legal Investigations <br />Employers<br />
  83. 83.
  84. 84. Accident or Intentional??<br />
  85. 85.
  86. 86. As Housing Values Go Down……..<br />
  87. 87. ..then Fraud Goes<br />
  88. 88.
  89. 89.
  90. 90.
  91. 91.
  92. 92.
  93. 93. Employers <br /> need to look<br /> out for <br />Themselves!<br />
  94. 94. A company’s reputation for resisting fraud is built over time!<br />
  95. 95.
  96. 96.
  97. 97. Legitimate Claim or <br />Fraud?<br />When you need to know!<br />
  98. 98.
  99. 99.
  100. 100.
  101. 101. The most <br />effective <br />weapon in<br />recognizing <br />fraud is the <br />proactive Risk <br />Manager.<br />
  102. 102.
  103. 103.
  104. 104.
  105. 105.
  106. 106. Liars are Thieves andThieves are Liars! <br />
  107. 107.
  108. 108.
  109. 109. Financial Profiles<br />
  110. 110.
  111. 111. Insurance Claims = Easy Money!<br />
  112. 112.
  113. 113. When you get a reputation for<br />paying everyone that comes <br />to your door…….<br />
  114. 114. When you get a reputation for<br />paying everyone that comes <br />to your door…….<br />You soon have a lot of people<br />coming to your door!<br />

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