How To Get The Most Out Of Your Private Investigator The Intellectual Approach to Investigations

Virginia Chapter of RIMS and PRIMA Educational Conference

Tuesday, October 5, 2010

Presented by:Anthony Crofton, Owner/Principal

8775 Centre Park Drive, #454Columbia, Maryland 21045

(410) 964-0930 (Phone)(410) 964-0932 (Fax)

www.TitanPI.com

Insurance Fraud Facts

(Per the Coalition Against Insurance Fraud & NICB)

One of America’s largest criminal industries Costs Americans $80 billion a year Premium increases up to $900 per household Criminal convictions have increased 31% 2nd largest economic crime in America -

exceeded only by tax evasion

Insurance Fraud Facts

If insurance fraud were a business it would rank among the Fortune 500 companies

Approximately 10% of claim dollars paid out are attributed to fraud which translates into about 8% of all premium dollars paid by policyholders

National Insurance Crime Bureau estimated the workers’ compensation fraud is the fastest growing insurance scam in the nation

Insurance Fraud Facts

Is it taken seriously?

Myths and Challenges

Post 9-11 Restriction of Information Privacy Concerns The TV Detective

• Fact versus Fiction• Unrealistic Expectations

Bad Experiences Clouding Future Judgments

Common Types of Fraud Padding Misrepresenting Facts Submitting False Claims/Injuries Staged Accidents Backdating Coverage Premium Avoidance

Fraud in insurance might be defined as the abuse of the insurance mechanism for financial gain

Red Flags – A Tool

Fraud indicators are only an aid in the fight against fraud

The presence of any one flag by itself is not indicative of fraud

Red flags are a reason to further investigate for potential fraud

The vast majority of claims are legitimate Most injured workers’ are honest, decent, hard

working individuals

Red Flags of Fraud

Injured worker is new on the job No witnesses to the injury Injured worker is disgruntled, soon to retire, or

facing firing or layoff Seasonal work that is about to end Injured worker has history of short term

employment Injured worker is facing financial difficulties Details of the accident are vague

Red Flags of Fraud

Accident is not promptly reported Delay in reporting or filing of the claim Premature or excessive demands for

compensation Receive “tip” injured worker is self-employed

or working elsewhere Injured worker will not divulge home address Injured worker can never be reached at home or

abruptly relocates

Video #1

Back Brace or No Back Brace?

When An Investigation Can Help

♦ Compensability Stage

• Is the claim compensable?

• What is the exposure?

• How much lost time?♦ Accepted Stage

• Is injured worker treating too long?

• Is injured worker out of work too long?

Choosing and Using Your P.I.

Service selection Choose a qualified agency

• Licensing issues

• Established relationships

• Regional concerns Communication with Adjusters and Counsel

Types of Services a P.I. Can Provide

Surveillance (Video Evidence/Photographs) Activity or Alive-and-Well Checks Medical Canvasses Background Checks Witness Interviews Locate Services Business License and DMV Verifications Internet Investigations

Video #2

Have You Seen My Flip Flop?

Internet Investigations♦ Focus on social networking and social media sites

♦ Conducted pre-surveillance or stand-alone

♦ Used to identify and document an individual’s exposure on the internet known as an “electronic or digital fingerprint”

♦ Increasingly being used for pre-employment screening and to aid in employee theft investigations

♦ Searches are also conducted on the “deep web” or “invisible web” for information not always found on the “surface web”

What an Internet Investigation Can Provide

Videos or Pictures of the Claimant engaging in activities that may be contrary to reported activity levels

Evidence of income through e-commerce (i.e. eBay, Craigslist, etc.) as well as additional assets

Identifying information (self, family, home, neighborhood)

Civil and criminal court records

Schedules of upcoming or documentation of past events

More effective surveillance results

Most Popular Social Media Sites

Demographic Booms in Births Baby Boomers (Born 1946 to 1964)

Fastest growing segment on Facebook is 55-65 year-old females

Generation X or Baby Bust (Born 1965 to 1981)

Statistically hold the highest education levels

Generation Y or Millennial (Born 1982 to 1995)

Increased use and familiarity with communications, media, and digital technologies

Generation Z or Internet Generation (Born 1996 to 2009)

Often nicknamed the “digital natives”

Social Media on the Rise According to the U.S. Census Bureau, 52% of the world’s

population is under 30 years-old

In the U.S., 96% of Generation Y indicated they have used social media tool

Social media has outnumbered porn as the #1 activity on the web

More than 1.5 million pieces of content (news stories, blog posts, photos, etc.) are shared on Facebook…...DAILY

More people are using social networking sites from mobile devices

Social Network Statistics Facebook – 400 million registered users (as of 2/5/10)

MySpace – 253 million registered users

Friendster – 115 million registered users

Twitter – 105 million registered users

Tagged – 100 million registered users

Orkut – 67 million registered users

LinkedIn – 60 million registered users

Video #3

Would You Like Your Bike Washed?

Surveillance Is An Effective Tool

Can be the most effective tool in your arsenal Tests injured worker’s truthfulness versus daily

activities Timely and judicious use required Coordination with other events

• Independent medical examinations

• Doctor or rehabilitation appointments

• Depositions

• Off-work Days

Applying the Surveillance

Doctor’s conferences Mediation WCC hearings Civil trial (appeals) Criminal trials Disclosure laws (vary state to state)

What to Expect From Your P.I.

Timeliness in communication (status reports) Clearly written, timely, and accurate reports Positive ID of the injured worker Reporting of both “the good” and “the bad” Clear video that is time and date stamped Properly handled evidence Legal, lawful and ethical investigations

What Your P.I. Expects From You

Specific requests for service A set budget with clear guidelines Basic identifying information (photo if possible) As much background information as possible Restrictions and limitations Specific dates requested Copies of consent forms Evaluation mechanism

END RESULTS?

Video #4

When It All Comes Together!

QUESTIONS?

THANK YOU!