Claims Investigations

Examples of referred investigations:

• Plaintiff Care Provider Fraud subject to civil / criminal RICO.
• Rate Evasion / Premium Avoidance.
• Fraud Ring Investigation
• Property / Auto Loss where reasonable suspicion exists that a clear fraudulent act has been committed.
• Medical / Disability / Bodily Injury Claims where reasonable suspicion exists that a clear fraudulent act or "professional claimant" profile is identified.
• Investigative findings where, after consultation with the carrier / self-insured, a claims denial will be exercised and an aggressive plaintiff - initiated response to the denial is anticipated.
• Claims moving to litigation

Fraud

Research studies have indicated that fraud and related crimes cost U.S. business more than $400 billion each year. Insurance claims fraud is a key contributor to these staggering losses. The persistent, pervasive, and costly problem of fraud in its many forms is one of the fundamental reasons for security programs. For example, the filing of false workers' compensation insurance claims on one of the most common economic crimes committed in the U.S.

Studies have shown the earlier an investigation is initiated, the greater the chances of detecting fraudulent and/or fictitious claims. A June 1990 Claims Magazine article by Charlie Rodgers, C.F.E., "Early Investigation Reduces Fraudulent Claims", is an excellent study of this.

Psychologists hold that anyone can be a potential thief and that it is impossible to recognize one. So whether your case involves workers' compensation, disability, property, casualty or product liability claims, Diogenes LLC has the state-of-the-art equipment, experience and proven techniques to unearth the facts of the claim and provide detailed, reliable reports, timely follow-up and admissible evidence. As an Diogenes LLC client, you'll have access to a pool of highly experienced investigative personnel to investigate your questionable insurance claims. Our investigators are aware of the sensitive legal requirements regarding surveillance and will ensure that your desire to use the information during litigation is not jeopardized.

Claims Investigations & Surveillance

Diogenes LLC's Claims Investigation & Surveillance services are designed to help insurance companies and self-insureds fight fraudulent insurance claims. Our proven techniques of gathering information of include:

• Activity Checks
• Claimant and witness interviews
• Surveillance that provides admissible evidence
• Disability management calls
• Medical and autopsy reports
• Public records searches including: court and administrative records, driving history, employment history, professional credentials and licenses, workers' compensation claim history, neighborhood checks, etc.

Property & Casualty Claims

We have the specialized experience and techniques to investigate effectively any type of claim. We begin with a thorough preliminary investigation, followed by surveillance documented with admissible videotape. Accurate and timely reports, and expert, credible testimony protect our clients against fraudulent claims of all types, including:

Workers' Compensation

Research studies have indicated that fraud and related crimes cost U.S. business more than $400 billion each year. Insurance claims fraud is a key contributor to these staggering losses. The filing of false workers' compensation insurance claims on one of the most common economic crimes committed in the U.S. These "Red Flags" can assist in identifying fraudulent claims.

Diogenes LLC investigators have the experience and proven techniques to unmask the facts of the claim by obtaining positive identification of claimant, investigating eligibility and restrictions compliance, conducting activity checks to determine post-accident activities, and doing surveillance. As an Diogenes LLC client, you'll have access to a pool of highly experienced investigative personnel to investigate your questionable insurance claims.

Malpractice

We conduct interviews with all individuals connected with the alleged malpractice including professionals and character witnesses.

Theft/Burglary

Psychologists recognize three factors which, often motivate individuals to become dishonest: 1) need or desire, 2) rationalization, and 3) opportunity. Whether a specific incident or an ongoing problem, these problems can be solved with an exposure and vulnerability assessment, asset tracking, development and application of procedural safeguards, tracking and recovery procedures.

Due Diligence Research

When making decisions regarding relationships, financing and acquisition of companies, principals, venture capitalists and underwriters turn to the experienced professionals at Diogenes LLC. Exhibiting the attention and care legally expected in examining information can be an important, but time-consuming, responsibility. Our sophisticated Electronic Search System (ESS) and immediate access to numerous information services enable us to perform the most comprehensive checks efficiently and in strict accordance with the law. Our investigators can verify deeds and tittles, prior or existing litigation, outstanding liens and personal or corporate reputations in order to minimize the risks involved in lending or underwriting. We can also utilize our resources to track, uncover and identify hidden or undisclosed assets on our client's behalf.

For fidelity bond cases involving forfeiture for theft or employee embezzlement, Diogenes LLC's investigators will collect information from public records on attachable assets while maintaining absolute discretion and secrecy.

Services are available for investigating burglary, robbery and theft under Fur & Jewelry Floater policies and Jewelers' block policies. We look for fraud in Mercantile, Cargo Theft, and Bankruptcy cases.

Life, Accident & Health Claims

Contestable Death Claims are investigated by checking health history prior to policy issue, personal habits, status of beneficiary and alleged dependents. Experts in the field investigate absentee cases where the presumption of death exists.

Accidental Death and Dismemberment Claims require Diogenes LLC's full documentation from all available sources-witnesses, police, public records-plus investigating contributory health factors or possibility of suicide.

Disability Claims require the development of information covering financial background, other policies in force, and current activities determining the circumstances and extent of injury or loss.