Posts

100+ Things a Private Investigator Can Do For You

When you get asked what you do for a living, do you answer with an elevator pitch?

Ahhh, the old elevator pitch. You know, that quick spiel describing what you do, for whom you do it, and how it is valuable to others. We’ve all got one, right?

But, when I tell someone what I do, it had better be a long elevator ride. Because, with only 30 seconds, it is nearly impossible to list everything I can do for my clients. Every private investigator has this same problem.

That’s why I put together a list of 100+ things that a private investigator can do for you. Each one is valuable. For now, it’s the best elevator pitch we have. Read more

Why I Started a Private Investigations Company

In 2015, I opened the doors to Gravitas Investigations, a Cincinnati-based private investigations firm.

But why did I start this company?

Sure, I’ve been a “private eye” for over 10 years and have solved some incredible cases, but that’s not why I do it.

The truth is that this company was started many years ago, based on the influence of two important people. Here’s that story: Read more

Workers’ Compensation Claims Fraud – The Ultimate List of Red Flags

A new workers’ compensation claim hits your inbox. But your spidey- sense kicks in. Why?

Well, several warning signs pop up; the claimant was injured on a Friday before a holiday weekend, they’ve already booked appointments with a chiropractor, and nobody witnessed the injury.

You ask yourself, “Is it fraud?!?”

Though not every claim you see is fraudulent, this one appears to be. But, what now?

You know that catching a fraudulent claim could save your client tons of money in insurance premiums.

What if you had a comprehensive list of red flags to check against your suspicions? A list that was compiled by a fraud investigator with the help of claims’ professionals like you?…

..well, we did just that.

We asked a dozen claims adjusters, examiners, insurance professionals, attorneys, and others for their workers’ compensation claim advice and compiled the results into a comprehensive list.

Here is the list of red flags (67 total) they provided:

The Timeliness of the Injury Report

  1. The injury occurred immediately before a holiday or a long weekend (many “injuries” occur on Fridays). – The most common red flag is the injury without a timely report of injury – Lisa Fike, Staff Attorney
  2. The claimant was injured after a holiday or a long weekend (this repeatedly occurs if the claimant is ineligible for holiday or paid-time-off).
  3. The claim was filed prior to a planned vacation allowing the claimant to collect disability during their trips.
  4. The claimant reports the accident days, weeks, months, or years after it occurred.
  5. The claim is filed after the claimant becomes aware of their imminent termination.
  6. The claimant is injured shortly after initial hiring (this is especially true after the initial probationary period for full-time hires).
  7. The claimant recently purchased personal disability insurance (a.k.a. gap coverage).
  8. The claimant hires an attorney immediately after filing a claim.
  9. The claimant instantly asks for a settlement. – Amy Rodallega, Claims Representative, Nationwide Insurance

The Accident

  1. There were no witnesses to the accident.
  2. The accident occurred on the employer’s premises but out of view of security cameras.
  3. The claimant was helping another employee despite being asked not to do so (not their department or job duties) by management.
  4. The claimant’s version of the accident is inconsistent – there are multiple variations of the story.

The Injury

  1. The claimant experiences a psychological injury, which is hard to substantiate.
  2. The claimant experiences a back injury, which is hard to substantiate.
  3. The claimant engages in physical activities inconsistent with the limitations they claim to have due to their injury.
  4. The claimant has a pre-existing injury.
  5. A hospital canvass determines that the claimant has been treated elsewhere for the same condition and/or an Insurance Service Office (ISO) check reveals that the claimant had prior injuries to the same body part. – Lori Terry, Claims Examiner, Careworks Consultants Inc.
  6. The claimant has a history of subjective injuries, psychological, mental pain, undisclosed pain or general pain.
  7. The claimant seeks to open or start a new claim based on a flow through injury (an injury developing in a body part not originally alleged) or from the result of an old injury. – Jean McEntarfer, Human Resources Manager, Teleperformance USA

Communication

  1. The claimant is never available to answer calls.
  2. The claimant has limited availability for exams and/or appointments.
  3. The claimant has a preference of receiving emails from claim representatives rather than phone calls.
  4. The claimant’s voicemail box is always full.
  5. The claimant screens or avoids calls.
  6. The claimant frequently changes appointments or does not show for appointments to avoid field case manager or nurse case manager. – Debbie Lantman, Manager – Workers’ Compensation , Formica Corporation

Circumstances Around the Job

  1. The claimant files a claim for job security – the claimant knows the employer will not terminate the claimant while on disability.
  2. The claimant performs seasonal work that will end soon.
  3. The claimant is approaching retirement and files a claim.
  4. The claimant has absenteeism problems.– “They ‘earn and burn’ their time by attempting to get off work when they’re out of PTO or off-days.” – Brenda Scalf, Client Services Manager, Sheakley
  5. The claimant has frequently used the Family Medical Leave Act (FMLA).
  6. The injury occurred as a result of the claimant’s side job.
  7. The claimant has a personal vendetta against management or fellow employees.
  8. The claim occurred just prior to or after a strike.
  9. The claimant shows up in pictures or in person with indications of having worked another job:
    • they have calluses on their hands, or
    • grease under their fingers.

The Physician

  1. The physician of record (POR) does not mention checking the state pharmacy website for the claimant’s narcotic prescriptions.
  2. In states where it’s permissible to do so, the claimant refuses to seek medical treatment or physical therapy.
  3. Multiple workers’ compensation claimants seek out the same physician. -“It’s suspicious when employees of the same organization magically go to the same doctor when they are injured.” – Kelly Flynn Reimer, Claims Manager
  4. The claimant refuses to go to vocational rehabilitation.
  5. The claimant refuses to go to an independent medical exam (IME).
  6. The subject explores “doctor shopping,” where they seek out physicians who substantiate their injury claims.
  7. The claimant seeks narcotics and once their prescription runs out, they shop for another doctor who will fill that prescription.
  8. After a doctor’s appointment, the claimant cannot describe the types of medical services that were performed on him or her.
  9. The claimant has a doctor that is a great distance from their residence for no reason at all.
  10. The claimant tells the doctor what kind of treatment they need.
  11. The claimant tells the doctor their employer has no light duty work.
  12. The claimant immediately seeks treatment with a doctor or chiropractor that is known to automatically take patients off work. “Some doctors are on the suspicious provider list if claimants go to them for initial treatment. Suspicions increase when employees of the same organization frequent the same physicians” – Anonymous Claims Professional
  13. The claimant sells their prescriptions to others or seeks out various medical providers to obtain multiple prescriptions. -“I would say that anyone who gets released from the physician, or is told they can’t have any more narcotics/meds, who then immediately starts ‘doctor shopping’ is a big red flag.” – Jill Thomas, Director of Claims, V&A Risk Services, LLC
  14. The injured worker immediately schedules a meeting with a chiropractor. -“Even if I’m not familiar with that chiropractor, that’s always a red flag to me because it means the injured worker (IW) is familiar with chiropractors” – Jackie Spring, Self-Insured Manager, Alternative Risk Management

Character-Related Suspicions

  1. Social media pictures and profile information indicate that the claimant is active and moving normally against their restrictions. – Lisa Ball, SIU, AllState Insurance
  2. The claimant has a history of filing Worker’s Compensation claims in the past.– “I have seen people do this because most employers will not get rid of someone that has filed a workers comp claim.” – Debra Goetz, Spooner Inc.
  3. Employees that are friends or associates with the claimant observe the claimant conducting activities that are in contradiction to their limitations.
  4. The injury occurred during a side sporting activity.
  5. The claimant is a nomad; they live in multiple places, and/or drive around from job to job.
  6. The claimant uses a PO Box as their mailing address, rather than an actual address, and/or refuses to provide a physical address.
  7. The claimant lives in an economically depressed area.
  8. The claimant has a history of bad credit, monetary problems, or is always in debt.
  9. Several of the claimant’s relatives and friends have similar Worker’s Compensation claims. This is what some investigators call ‘fraud school,’ where fraud/abuse methods are passed from relative to relative. 
  10. When taking a claimant’s statement, the claimant feels inclined to provide information on their personal character. For example, “I’m a good person, and I am not looking to scam the system or get something I don’t deserve.’ I can tell you that 9 times out of 10 when someone makes a comment like that to me they end up trying to scam the system!” – Adriane R. Thompson, SCLA, Senior Resolution Manager, Gallagher Bassett
  11. Claims representatives suspect the claimant’s character or personality traits determine the claimant is engaged in workers’ compensation fraud or abuse (The claimant’s demeanor is very calm or savvy).

Others

  1. The claimant does not have medical insurance.
  2. The claimant opts out of employer-provided health insurance and soon after files a workers’ compensation claim.
  3. The claimant has a high-deductible insurance meaning they’ll pay a lot in out of pocket expenses.
  4. The employee will file a claim before going out for a non-industrial health reason (i.e. major surgery) & their PTO time won’t cover the entire period of time they’re off.
  5. Employees who plan to visit their out-of-the-country/town family members for extended periods of time will file a temporary total disability (TTD) claim, allowing them to collect a Workers’ Compensation check if their doctor writes them off on a Physician’s Report of Work Ability. “For example, someone from a foreign country who is planning to visit their family for 1-2 months will file a claim the week just before they leave thinking they will be paid TTD the entire time they are gone.” – Holly Miller, The Ohio Manufacturer’s Association
  6. The claimant has shown an overall pattern of behavior that indicates fraud.
  7. The claimant had a recent auto accident or has had multiple auto accidents where they were injured.

What now?

When that next claim hits your inbox, do your clients a favor – check it against the list above. If it saves them money, they’ll be happy you did.

Did we leave out any red flags? Let us know in the comments below or email Gravitas Investigations at adam@gravitasinv.com with your suggestion.

If you’d like to discuss a plan to combat fraud, Call Us Now to speak with directly with a fraud investigator.

Investigating in Italy — An Interview with Alberto Paoletti

You are transported back in time as you walk along Via dei Calzaiuoli, Florence, Italy’s main pedestrian street. It is a wide, cobblestoned walkway stretching several hundred yards from the historic, domed Florence Cathedral, or simply “Duomo,” to the famous Palazzo Vecchio. Historical figures like Michelangelo, Dante, and Leonardo da Vinci called this place home. And so does Alberto Paoletti, private investigator (PI).

In Florence for my wife’s work assignment, continuing to attend graduate school, and operating my own private investigations business remotely, I looked up local private investigators online in hopes of connecting with one. There, I found Alberto.

So I threw on my suit and tie, and after a 20-minute walk from my apartment, mustered up the courage to knock on his office door. The goal was to simply drop off my business card, but I got much more than I bargained for. Alberto invited me into his office, and we sat down and talked shop for almost an hour. He turned out to be an incredibly nice and accommodating man.

A few days later, Alberto graciously took time out of his busy day for an interview. Here is an excerpt from that interview (special thanks to Google Translate for helping Alberto and me bridge the gap from Italian to English):

Read more

Tax Fraud Is on the Rise, Take Extra Care to Avoid Phishing Scams

The Internal Revenue Service renewed a consumer alert for e-mail schemes (phishing scams) after seeing an approximate 400 percent surge in phishing and malware incidents so far this tax season.

In a press release, the IRS reported:

The Internal Revenue Service renewed a consumer alert for e-mail schemes after seeing an approximate 400 percent surge in phishing and malware incidents so far this tax season.

The emails are designed to trick taxpayers into thinking these are official communications from the IRS or others in the tax industry, including tax software companies…E-mails can seek information related to refunds, filing status, confirming personal information, ordering transcripts and verifying PIN information.

When you click on any of those email links, you’re taken to a site that looks just like an official IRS page but is actually a fraud site asking for your personal information. Those sites might also contain malware. There were over a thousand of these incidents reported to the IRS in January, compared with just 254 that same time last year.

The IRS says it typically doesn’t email taxpayers asking for any personal information, so that’s the biggest red flag right there: simply getting an email from an entity claiming to be the IRS. And here are a few recent email scam subject lines:
  • Numerous variations about people’s tax refund
  • Update your filing details, which can include references to W-2.
  • Confirm your personal information.
  • Get my IP Pin.
  • Get my E-file Pin.
  • Order a transcript.
  • Complete your tax return information.

The IRS says variations of this scam are sent via text, too. It also helps to know the common characteristics of a phone call scam, because scammers will often follow up their calls with an email. They might be able to recite the last four of your Social Security number or even spoof the IRS’s toll-free number on your caller ID. If you think you’ve been sent a scam, forward it to phishing@irs.govand, obviously, don’t click on anything in the email. You can also call the IRS directly at 1.800.829.1040 to see if they are indeed trying to reach you.

Source: Tax Fraud Is on the Rise, Take Extra Care to Avoid Phishing Scams

How Working Out Helped Me Bust a Fraudulent Workers’ Comp Powerlifter

“You wouldn’t mind if I… you know… videotaped us working out, would you?” I said to Lifter Guy. “Just to look at my form and stuff?”

“No problem. You gonna put it on YouTube or something?” Lifter Guy responded.

“Yeah,” I smirked, “something like that.”

Little did Lifter Guy know that I was a Private Investigator (P.I.) working undercover to videotape him powerlifting while defrauding the workers’ compensation system.

Read more

How To Beat A Surveillance Investigator At His (Or Her) Own Game

counter-surveillance

Apparently wearing leather gloves is the badge of a private eye

Let’s say you get hurt at your job and go on workers’ compensation. And let’s also say that—after you’re off work for a few days—you start to enjoy not having to get up and go to work every morning. You get paid about two-thirds of your weekly paycheck for sitting on your behind. Occasionally, your employer makes you go to medical checkups and visits, but that’s it. You like your new life.

What you don’t know is that your employer has hired a surveillance investigator to find out exactly what you are doing with this newfound free time.

There are tons of red flags that signal to an employer that a workers’ compensation claimant is fraudulent. To find out if an employee is abusing the system, employers hire private investigators to conduct surveillance to follow up on those suspicions. We stake out your house, dig through your public records, and scour your social media posts for clues. We want to catch you, but you don’t want to get caught. You’ve become accustomed to your lifestyle.

Here’s how to get away with a workers’ compensation fraud and not get caught by a PI like me.

Read more