Beau Dietl & Associates Insurance Investigations and Loss Services

At Beau Dietl & Associates, we are intent on providing services that protect the assets of the customer. We will employ the necessary techniques to obtain the results you need while always adhering to the laws governing our industry. We are proud to say that our experience with insurance investigations have provided us with the knowledge to get information and facts that will assist in claim decisions.

We know what you need to defend your company and its assets. We also know that there is no need to spend money obtaining information that does not assist in a defense. We are not limited to investigations pertaining to fraudulent claims; rather, we are a field resource for you to use to obtain any and all of the facts and circumstances of each claim. Beau Dietl & Associates wants to become an invaluable resource and will strive to be your most reliable service partner.

Each of the accounts established at BDA will be created with full customer focus in mind. Experience in the insurance industry has shown us that each client has different needs. We at BDA strive to meet and exceed those stated needs by establishing personalized customer profiles that guide us in our daily business dealings. We are very mindful that our success depends on customer satisfaction and to that end our clients’ needs will always be our first consideration.

Insurance Fraud Services

The strength behind any successful business is the experienced team of individuals who drive the company. BDA is second to none in this extremely important aspect. We employ the most industry-respected professionals known for their aggressive position on claim investigations. Our core management group provides hands-on supervision of each investigation and acts as a liaison to the client.

Comprehensive Discovery

Every assignment gets a private investigator with the specialized skills and necessary experience needed to handle any insurance investigation.

Ongoing Communication

We update you on a regular basis so you know what we’ve accomplished to date and where the investigation is heading.

Beau Dietl & Associate’s multi-disciplinary team of insurance investigators, researchers and experts collaborate to get the facts you need to make informed decisions related to:

  • Workers compensation
  • Vehicular accidents
  • Arson
  • Personal injury
  • Theft of Property

We tailor our services to meet the needs of every investigation. These services include:

  • Activity checks
  • Direct surveillance
  • Recorded and written statements
  • Background checks
  • Criminal checks
  • Witness location
  • Subpoena services
  • AOE/COE
  • Alive-and-well checks
  • Claim Investigations
  • Specialized social media investigations

Insurance Fraud Investigations

Claim Investigations

BDA is capable of working closely with claim professionals and can assist in suggesting the proper investigative approach to many claim issues. The investigative direction will be agreed upon jointly. Our action plans are designed to obtain favorable claim results through meticulous investigation.

Surveillance

BDA offers surveillance on a nationwide basis; however, we are not merely a surveillance company. Experience has shown us that surveillance is a tool that must be used at the right time. All too often surveillance is viewed as the “cure all” for each and every claim. We respect the use of surveillance, but we know that the proper deployment of investigative resources is crucial to the success of the investigation. The success of surveillance depends largely on being armed with accurate facts. We strive to learn the facts without incurring unnecessary expense.

Activity Checks

We perform activity checks in ways designed to obtain results and minimize cost. At times, results can be obtained through diligent telephone work, while at other times, field activity checks are necessary. BDA utilizes the most effective way to meet your objectives. Experience has taught us that claimant information is sometimes inaccurate. Inaccurate information can be costly, both to the success of the investigation and also to the bottom line.

Background Investigations

When necessary and pertinent, BDA can probe into a subject’s past employment records (time/lost wages), civil litigation records, property holdings, hospital records, prior reported injuries and financial records (with executed releases).

Additional Services

      • Witness Locates
      • Accident Scene Investigations
      • Photographs/Diagrams
      • Subrogation
      • Compliance Reporting
      • Subpoena Service

Fraud Indicators

Be able to recognize suspicious claims, and when to hire a fraud investigator.

Worker’s Compensation

SUSPICION THAT EMPLOYEE MAY BE WORKING ELSEWHERE WHILE RECEIVING BENEFITS

          • The adjuster has difficulty reaching claimant at home during the day
          • Claimant offers no permanent address or has frequent relocations while receiving benefits
          • Claimant frequently cancels or misses doctor or therapist appointments
          • A potential new employer for claimant calls to verify previous employment

SUSPICIOUS MEDICAL TREATMENT

          • The physician has a reputation for handling suspicious claims
          • Prolonged or excessive treatment received for a minor injury
          • Discrepancies exist between treatment or medication for the claimed injury
          • Sketchy details listed on medical bills
          • Medical bills are photocopies, not originals
          • Claimant received unnecessary hospitalization
          • Claimant visits several doctors (possibly in search of a medical opinion that favors the claim)
          • The physician directs treatment to occur at a facility where he has a financial interest
          • Bill lists a treatment date that is a holiday
          • Bill is inflated due to “unbundling” – billing for each step of medical procedures
          • Medical reports appear exactly the same as other reports from the same physician
          • Insurers for both workers’ compensation and group health are billed simultaneously and payment is accepted for both

SUSPICIOUS ENGAGEMENT OF LEGAL ASSISTANCE

          • Your first notice of claim is by an attorney or you learn that the claimant has hired an attorney immediately after filing the claim
          • Attorney lien or representation letter is dated the day of
          • Attorney suggests a settlement or buy-out soon after the claim is filed
          • Claimant initially shows a willingness to settle with the insurer but later hires an attorney and files subjective complaints
          • Attorney threatens further legal action if a quick settlement is not made
          • The claim involves excessive demands for compensation of a permanent injury
          • The attorney has a reputation for handling suspicious claims
          • Your company experiences a high number of suits from a specific law firm
          • The same combination of attorneys and medical providers involved in previous claims recurs

SUSPICIOUS ACCOUNT OF ACCIDENT

          • No specific date, time and place for injury or claim
          • Details of injury reported on the claim are sketchy at best
          • The claimant does not promptly report the injury to a supervisor
          • Discrepancies between claimant’s account of injury and medical evaluation
          • Discrepancies between claimant’s account if injury and witnesses’ accounts
          • Injury is unwitnessed
          • Co-workers share rumors that accident is illegitimate
          • Reported accidents occur in an area where the claimant does not work
          • The claim may be part of a suspicious pattern of claims from the same area or location

SUSPICIOUS TIMING OF CLAIM

          • Injury is reported as occurring on a Monday or Friday (injury might have occurred away from workplace or claimant may use claim to extend weekend)
          • Claim occurs prior to anticipated layoff, termination, strike or retirement
          • Claim occurs after the claimant has been terminated
          • Claim occurs shortly after the employee was hired
          • Claim occurs after the injured worker took unexplained or excessive time off
          • Injury is “seasonal” before seasonal layoff or is recurrent (claimant has a pattern of reporting an injury before a vacation)
          • The claimant is having financial difficulties
          • The claimant has been complaining about his job, supervisor or the company
          • Claimant recently purchased a private disability policy

SUSPICIOUS NATURE & EXTENT OF INJURY

          • Type of injury is unusual in claimant’s line of work
          • Injury concerns soft tissues and cannot be objectively verified
          • Discrepancies exist between injury and facts of the accident
          • Claimant refuses diagnostic procedures to confirm the injury
          • Claimant refuses to cooperate with rehabilitation personnel
          • Claimant refuses to return to work despite doctor’s OK to return
          • Claimant files for compensation because of vague complaints of stress
          • The claimant has a history of reporting subjective injuries (such as headaches, nausea & sleeplessness)

Bodily Injury Claims

SUSPICIOUS BODILY INJURY CLAIMS

          • No police report or on-scene police report
          • Several claimants in the same vehicle, subjective injuries, similar reports, same doctors and/or same attorneys
          • Bodily injuries appear excessive compared to the amount of physical damage to the auto
          • The accident is a rear-end collision caused by a sudden, unjustified stop by the claimant’s car
          • The accident occurred shortly after one or more of the vehicles was purchased, registered or insured
          • Insurance feels “set up” by the claimant(s)
          • Claimant’s workplace phone number connected to answering machine or registers to an answering service or mail drop
          • Slight impact; subjective injuries (soft tissue); substantial treatment and excessive demands
          • Questionable dates of treatment, evidence of alteration of dates and/or charges
          • Slip and fall with no witness or the witness is unusually observant
          • A company name on a lost wage statement cannot be located, there is no record of said employee at that company and/or the company is owned by claimant’s relative
          • Claimed ailments persist far beyond the normal recuperative time period
          • Insured takes out a new policy even though the insured vehicle was purchased long before coverage was sought
          • Doctor’s mode of treatment, duration of treatment always the same even though injuries/ accidents differ
          • Designated doctors and lawyers have a known history of bodily injury claim involvement
          • Location of doctor/therapist inconvenient to the claimant
          • Doctor making house calls beyond a convenient distance
          • Wage documentation is lost, not on the letterhead of its handwritten or photocopied; includes questionable earnings; difficult to verify
          • Presence of damaged items (props) found (claimed) as damaged
          • Insured is eager to accept blame for the accident
          • The vehicle is a “beater” – an old car with basic coverage
          • Vehicle damage, although minor, “totals” the car

MOTOR VEHICLE

SUSPICIOUS MOTOR VEHICLE CLAIMS

          • Cash purchase of late model or new vehicle
          • Behind in payment to lien holder
          • Out-of-state purchase
          • Individual named as lien holder
          • Insured has no bill of sale or the bill of sale is out of line with the car’s value
          • The vehicle is totally burned
          • Vehicle Identification Number (VIN) of the damaged car does not match the VIN of the insured car or match the model shown in appraisal photographs
          • NICB cannot match VIN
          • VIN plate is different than VIN on the title
          • Vehicle was rebuilt
          • Prior loss or salvage on vehicle
          • The prior owner cannot be located
          • All vehicles in accident taken to the same body shop
          • Recently duplicated or assigned title
          • Counterfeit title documentation
          • Insured claims expensive equipment and items
          • The vehicle has a poor reputation (defects, recalls, performance, etc.)
          • Neighbors, friends, and relative have no knowledge of vehicle
          • The car has not been seen for some time prior to the theft
          • Insured is unemployed
          • Insured wants to retain title to salvage
          • Loss takes place between insurance of binder and state-mandated pre-inspection (where applicable)
          • Premium paid in cash
          • Comprehensive coverage only
          • Duplicate coverage
          • Repair shop estimates include repairs that body shop is not equipped to make (painting, straightening)
          • The body shop has a history of high damage claims
          • Appraiser/adjuster is threatened or offered a bribe for a quick settlement
          • There is heavy property damage to the vehicles indicating a major collision but no bodily injuries are reported
          • Salvage or repair shop takes an active interest in the claim
          • Repair or installation bills are numbered consecutively or dates show work done on Sundays or Holidays
          • Two vehicles are involved with heavy damage to the struck vehicle and relatively light damage to striking vehicle
          • The striking vehicle is a rented car
          • Accounts of the accident by drivers, passengers and witnesses appear rehearsed or are conversely inconsistent
          • Appraisal photography show only close-ups of the damage, but not enough of the car to identify make and model
          • The vehicle is recovered and…
            • No ignition or steering column damage
            • Carefully stripped lug bolts & washers put back
            • Extensive body damage and no towing charges; vehicle remains drivable
            • Car shows signs of previous damage
            • Damage does not match the type of accident claimed

GENERAL INDICATORS OF SUSPICIOUS CLAIMS

          • History of claims activity
          • Familiar with insurance claim terms and procedures
          • Refrains from using the mail or fax; conducts business in person
          • No police report or on-scene report
          • Aggressive demands for a quick settlement, sometimes for less than the full value of the claim
          • Threatens to contact higher company authority to push demands
          • A temporary address used – post office box or motel
          • Recent policy or walk-in business
          • Photocopied support documentation or computer generated invoices
          • Insured’s employer address is a post office box
          • Unreasonable delay in reporting the loss
          • Refuses to give recorded or written statement
          • Self-employed in a vague occupation; reluctant to produce tax records
          • First notice of claim and/or immediate attorney representation
          • Recent changes in coverage/inquiries to agent
          • Loss occurs immediately before or after policy renewal/inception dates
          • Claimant experiencing financial problems
          • Discrepancies between official reports of incident and statements made by the insured/claimant
          • Lifestyle inconsistent with observation and facts
          • Insured/Claimant wants a friend or relative to pick up the check
          • Over documentation of loss
          • Insured/Claimant has no phone
          • The claimant is transient or an out-of-towner

These indicators can help identify fraud schemes. No indicator by itself is necessarily suspicious and the presence of any indicator does not firmly establish that a fraud has been committed.  However, closer scrutiny of the claim is necessary.

PROPERTY & FIRE

SUSPICIOUS PROPERTY & FIRE CLAIMS PROPERTY

          • Building and/or contents were for sale at the time of loss
          • Receipts allegedly are stolen or destroyed
          • Insured had a loss at the same site within the preceding year, but the prior loss, though small, may have failed to liquidate the contents
          • Insured is heavily in debt
          • Insured refuses replacement in items
          • Loss occurs at night or early morning hours
          • Risk is over-insured
          • Public officials indicate the loss is suspicious
          • Insured and/or family away from premises at the time of loss
          • Items claimed in loss recently scheduled or added to the policy
          • Changing neighborhood
          • Loss includes a large amount of cash
          • Alarm system failed to work at the time of loss
          • Loss inventory includes a high number of recently purchased “big ticket” items
          • Insured cannot recall the place and/or date
          • Insured(s) balk at signing releases
          • The commercial loss involved seasonal inventory
          • Business/home for sale/moving
          • Inventory obsolete

FIRE CLAIMS

          • Building in deteriorating condition and/or located in a deteriorating neighborhood
          • Fire scene reveals the absence of expensive items normally found in risk
          • Absence of family Bible, family photos or any other items of sentimental value
          • Absence of other items normally found in homes or business
          • Responding police/fire personnel report all doors, windows and means of entry/exit were secure
          • Clocks, candles or other timing devices found at the scene
          • Items that usually don’t burn (I.e. jewelry, firearms, coins, etc.) are missing from debris
          • Obsolete inventory substituted for modern general inventory prior to the loss
          • Incendiary fire identified
          • Lack of forcible entry to premises, yet all keys (including alarm) are accounted for
          • Accelerant identified is foreign to the premises and no container or other means of starting a fire are found at the scene
          • Multiple points of origin in a key location and/or throughout premises
          • Alarm/sprinkler system turned off or inoperable at the time of loss
          • Insured’s whereabouts at the time of loss is questionable or varies from normal routine
          • Fire occurs while the property is vacant or unoccupied
          • Family pet survives the fire of is unusually absent from Premises
          • Insured uses fire as means to break tenant/lease agreement

One of the cornerstones of Beau Dietl & Associates is our track record of providing investigative excellence when it comes to Insurance Investigations. Our investigative services have helped thousands of adjusters and defense attorneys to gather the information pertinent to make educated and responsible claims decisions. What differentiates our company from others in the investigative arena is in one word – experience. Our goal is to provide insurance professionals with the information they need to make qualified claim decisions. Prompt turnaround, quality investigations and continuing communication make Beau Dietl & Associate the benchmark for excellence in insurance investigations.

Call us today to speak with an investigator.

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