A focused approach to Insurance Fraud Investigations
A discrepancy in a claim deserves careful investigation rather than an assumption of fraud. ISI evaluates the assignment against the specific representations at issue and develops a plan to document relevant facts. The goal is a balanced record that can support a reasoned decision.
What the investigation can include
Authorized work may include surveillance, witness interviews, public-record checks, and comparison of timelines or business information. Observed activity is described with its context, duration, and limitations rather than characterized beyond what the evidence shows.
Clear, documented findings
Reports connect findings to the assignment and identify the records or observations supporting each point. Relevant media is accompanied by a narrative, while inconclusive results and inconsistent information remain visible.
What to prepare before we speak
Provide the claim type, precise issue being investigated, relevant dates, identifying information, and instructions from the responsible claims professional or attorney.
Scope and practical limits
Observation alone may not establish fraud, medical capacity, or coverage. ISI does not substitute investigative findings for medical evaluation or the insurer’s legal and contractual analysis.