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2008 - Phantom Investigators

In the world of insurance fraud investigation, everything may not always be as it appears. 

There are numerous investigative agencies that claim to be “national”, saying they have local, full-time people in areas across the country. Although claiming to have such resources may be an easy way to get business, just because an agency is licensed in a state does not mean they have any real employees there. In many cases, it wouldn’t even be possible for these companies to operate with full-time employees because factors like population density, claiming behaviors and state laws are such that there is simply not enough work to keep even one investigator consistently busy. 

These firms claiming to be national actually provide their coverage using three techniques: They send investigators traveling long distances to cover large multi-state territories, use part-time people, and/ or subcontract the work to a “general” detective agency that can cover the area. None are very good solutions.  

Traveling freelance investigators constantly approach us for employment, desperate for a job that actually allows them to go home most of the time. Some of the obvious drawbacks of sending someone like that out on investigations are that they are not familiar with the area and often may not even have the required individual licensing for the location.  Some may believe that as long as the “company” has a license in that state, the investigator can work under that license without having an individual license. Not true. They have no personal relationships with the local entities within the area and may not be familiar with local laws.  A dead giveaway of such “travelers” appears when the agency balks at rush assignments, does not identify the investigator or withholds the investigators’ contact information.  

Part-timers are another poor choice. Their skills do not stay sharp because they are not working consistently and they have no serious career stake in their job. Because you are paying for the investigator’s word, and one that will hold up in court, it is crucial to have an investigator with highly honed skills and considers his employment an essential profession and not a hobby.     

Subcontractors have other drawbacks. If they seldom work on a file for you, you will not have someone who knows how your company works and the specific rules that must be followed. With essentially no control over whom is doing the work or how they choose to do it, you may be exposed to significant risks.   Subcontractors normally are not told whom the work is being done for, and thus, may not be focused on the type of claim. 

The only agencies you should be using are those that are familiar with the unique ethical requirements of insurance investigations. They should be required to submit current lists of the names and qualifications of all their investigators, and that list should be audited by you to confirm residency of the investigators as it relates to where they will be working.  That is the only way you can be sure of the identity, location, credentials, individual licensing, local knowledge and true availability of the people assigned to your company’s files.  

You work hard to have a successful program. The people you have working for you, including those who are doing so through a vendor, should share your values.  If they are not the kind of people you would hire for your own staff, then it makes no sense to hire them through some vendor. 

2008 - Why GPS Devices Work Against You

In the industry of insurance fraud investigation, the credibility of the investigator and his testimony are critical to winning a case.  Many observations are made during a surveillance that are not on the videotape, so it is essential that the investigator is believed as he testifies as to all such observations he testifies that he made.

Because of this, a few companies claim that they have started putting GPS and other tracking devices on their investigators’ cars to ensure that they are where they are supposed to be, doing what they are supposed to be doing.

This is one of those ideas that sounds good at first. But when you think about it.  It could actually be an invitation to disaster.  Any smart plaintiff attorney could use it as evidence that even the investigators employer and the insurance company do not feel comfortable believing the investigator or what is in his reports. If they did, why would they need to track him to the point that they have to see if he was even where he said he was in the first place?

There are many proven internal techniques that responsible vendors use to ensure the veracity of their investigators reports. For openers, it is important to ensure your vendors are using only full time, highly trained, trustworthy investigators whose practices and credibility can hold up in court.  They also should use various performance benchmarks, cross checks and other precision management techniques to make sure any irregularities are immediately detected and addressed. Done properly, these methods are extremely effective at protecting the integrity of every report that goes out the door.

Not only does the use of tracking devices create openings for doubt in court testimony, but a GPS does not make a liar honest. It does not take a lot of imagination to evade a GPS tracking system.  For example, a dishonest investigator could simply drive his car to a claimant’s location and then leave in someone else’s car. Another factor to consider is that the GPS only informs the employer of where the investigator’s vehicle is, not what that investigator is doing while he is or isn’t in that vehicle. They may be taking a nap!

In many states it is illegal for GPS devices to be placed on the personal vehicles of investigators and can be construed as an invasion of privacy if the device is monitored at times when the investigator is not required to be working.

All of these factors lead us to the conclusion that the best way to control the credibility of your case is by only hiring investigators whose word is gold and who have proven their honesty in very respectable careers. For example, we use intense training programs to ensure their level of skill and commitment. We put in place checkpoints guaranteeing that by the time the case is in court the evidence that has been gathered is backed by research, documentation and credible testimony.

Communication and trust are attributes CVI, and all responsible vendors demand. Claims Handlers should have access to the investigator at all times, including the investigators cellular phone numbers, biographies and even scheduling face-to-face meetings if desired.

The vendor should have credible investigators and solid documentation. GPS devices are not the answer. Serious hiring and training practices produce superior results.  Avoid handing the other side a weapon to sabotage an otherwise solid defense by raising questions about the investigator and his or her report with quick fixes like GPS, which are poor substitute for responsible vendor management practices.