Insurance
Fraud
Fraud is an ever-present problem across all lines of insurance.
Vigilance and the use of skilled investigators are necessary to
reduce payment of fraudulent claims and deter others inclined
to criminal gain. Successful investigation most often results
from old-fashioned virtues. The first of these virtues is an
experienced investigator with a strong desire to understand the
truth. With the right investigator in place all becomes
possible.
From
the earliest days of DMA Claims Services, we have recognized the
need for a separate investigations division,
manned by professionals with a history of success in the field.
And as our field offices grew in number, each created its own
investigation unit supervised as its own separate activity. All
our investigators are full time employees; we do not sub-contract
work in our service areas.
We conduct investigations and provide investigative
expertise in the following areas:
- Workers
Compensation
- Life
and Disability
- Casualty
and Property
- Litigation support, all lines
- SIU
We specialize in the following services:
Surveillance:
We
use the best equipment in the hands of experienced investigators
to produce videotape of claimants doing what they say
they cannot do. Claim denied. Our reports are prompt
and to the point. Our investigators are trained in the regulations
and rules regarding expectations of privacy and permissible activity.
Compensability
(AOE/COE) Investigations: Is it an injury
arising out of employment? Did it occur in the course of employment?
Our investigators conduct the interviews with witnesses, supervisors,
fellow employees and the applicant to determine whether the claim
has merit. Increasingly claims departments are using such investigations
early in the life of the claim to reduce fraud.
Background
Checks: Each of our offices has access to a multitude
of data sources and investigators experienced at ferreting out
the facts. We can provide you with asset data, criminal and civil
legal records, and much more.
Special
Investigations Unit (SIU): DMA Investigations
is the designated SIU for several national carriers,
assisting in identifying fraud indicators, establishing procedures
for dealing with suspected fraud and providing continuing education
requirements. Our SIU director is in regular communication with
law enforcement and assists in preparing cases for referral for
prosecution. Our SIU conducts medical clinic inspections and other
investigations specific to insurance fraud. Click here
for more on DMA's SIU.
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