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Do Insurance Companies Investigate Injury Claims?

By Keith Stachowiak on December 1, 2016 // Leave a Comment

do-insurance-companies-investigate-injury-claimsHave you filed a personal injury claim against your place of employment, a business or an individual? Whether your injury came from a car accident, slip and fall, or any other negligent act, it is important to understand that an insurance investigation will occur. So what does an insurance company do after a claim is submitted?

For many, the thought of an investigation causes frustration and worry. While the specific nature of the investigation will depend on the claim, insurance claims investigators tend to follow a common series of steps.

There are a few key search tools and investigative approaches that you should be aware of and precautionary steps you should take to protect your privacy and the integrity of your personal injury claim.

A few key points for your personal injury investigation:

  • Insurance claims investigations are a common and necessary part of business for insurance companies
  • Insurance claim investigations are part of the risk management process to prevent fraudulent or invalid claim payments.
  • Try not to take it personally and participate as advised by your attorney
  • Work in complete cooperation with your personal injury lawyer towards the desired outcome
  • There are some recommended steps to take to protect your claim

The information below provides a full explanation of what an insurance claim investigation may entail and how you can protect your privacy and the integrity of your personal injury claim during the investigation process.

Be sure to review our key takeaways at the bottom of this article to make sure you are prepared for an insurance investigation. You can also download our privacy checklist at any time! Download our privacy checklist now.

The Insurance Claim Investigation Process - Approaches to Gather Evidence

As soon as you file an insurance claim, the cited insurance company has many tools for gathering evidence at their disposal. Some may seem like an invasion of privacy, while others are based on general public data. Explore these evidence-gathering techniques in detail, below.

Insurance Injury Claim Investigation Tactic :: ISO Claim Search

ISO-searchISO is an acronym for Insurance Services Office, which is a resource for property and casualty insurers. These search reports are only available to individuals in the insurance industry or self-insurers, particularly, claim adjusters working on claims for insurance companies.

What data is used in an ISO Search report?

An ISO search report uses the following data points: name, address, social security number, phone number, driver’s license number, vehicle identification and license plate number.

What information is included in an ISO Search Report?

  • Summary page - indicates the number of matches in the ISO system for claims that have the same data.
  • Past claims – the report will list the number of past claims on record.
  • Special designations – the report has a special designation if the date of loss occurs on a Monday or Friday, or the day after a holiday.
  • Claim analysis – the report will include detailed information for each claim on record. This includes the identification of the insurance company involved, the date and time of the loss, the location of the loss, the loss description, the insured party, the claimed injury, the status of the claim (open or closed) and the name and phone number of the adjuster.

red-flag-personal-injury-investigationWhat does this mean for you?

If you are involved in a car accident or are filling any type of injury claim, one of the first things the insurance adjuster will do is investigate information on the claimant. This includes: name, address, social security number, phone number, drivers’ license number, etc. The adjuster is likely running a search to see your claim history.

How to protect your privacy and your insurance claim:

  • Be smart with insurance claims. The more claims you file, whether they are workers’ compensation claims or otherwise, the more red flags that may be raised about the legitimacy of your claim. While some people seem to be unlucky and are the victim of multiple accidents that are entirely not their fault, there are some people who file multiple unmeritorious claims and that will draw the attention of the claims adjuster, even if that claim is legitimate.
  • Never give out your social security number. In most instances, there is no reason to provide anyone with your social security number. There are two major exceptions: the first exception involves worker’s compensation cases, because Wisconsin still uses social security numbers to track claimants; the other exception is if a person is on Medicare, because Medicare still uses social security numbers to track its beneficiaries. Otherwise, there is no legitimate purpose for an insurance company to need a social security number.  

Insurance Injury Claim Investigation Tactic :: Accurint Search

One tool used regularly to investigate individuals filing personal injury and car injury claims is Accurint search.

What information is included in an Accurint report?

MP_House_Blog.jpgAccurint search provides an in-depth look at any individual’s history. Some of the information insurance companies can review is alarming and can have a negative affect on your claim – take a look below.

Real estate information:

  • A list of all current and previous addresses
  • For each address, it lists the owner, the market value of the house, the assessed value, the year built, and a profile of the neighborhood, including average age and average income. It also takes a guess at who else was living with you at that address

Financial holdings and information:

  • Past or current bankruptcy proceedings
  • Any liens or judgments taken against the person in question
  • Driver’s license information, including restrictions on driving, any endorsements, and the full social security number associated with each license
  • Past or current real estate holdings
  • Past or current registered vehicles

Legal and professional information:

  • Your criminal record and sexual offenses
  • Professional licenses

Very personal information:

  • Voter registration
  • Whether you have a hunting or fishing permit
  • Whether you have a concealed carry permit
  • Possible associates, which lists the name and date of birth of people that you have lived with or worked with, and family members by blood or marriage. It will try to list what the association is by listing common addresses or common family members.
  • The report can often list current neighbors, including their name, address and phone number
  • Online and social media connections and data

What does this mean for you?

Insurance companies exist to protect individuals from unpredictable circumstances – to be a safety net in times of trouble. But like any business, the ultimate goal is to keep costs and expenses as low as possible. If an insurance company can find any red flag or point of vulnerability in the Accurint search, they can save considerably in the amount of money they have to pay out to each claimant.

  • If they think you are desperate for money, they can present a low settlement offer in the hopes you’ll take it
  • If your associates have similar insurance claims, it may raise a red flag about a fraudulent claim
  • If you have a history of filing insurance claims, or committing fraud, it may rouse suspicion

How to protect your privacy and your insurance claim:

Understand that privacy is difficult. There are certain pieces of seemingly personal information you cannot control. While it may seem like an invasion of privacy, it is possible for third party entities to access personal pieces of information.

Control privacy when you can. Control aspects of your personal information when possible. This means enacting privacy restrictions when it comes to your finances, real estate and personal life. Simple things like enabling privacy controls on social media and using secure databases and tools for your financial transactions.  

Be smart with social media. Make sure your privacy settings are turned on and as restrictive as they can be on all social media sites. Most importantly -- refrain from posting anything about your finances. If you post something about being broke or needing money, for example, an insurance company can assume you’re desperate for money and need a quick settlement.  

Be transparent. Knowing that insurance companies can access your financial and personal information, be transparent and fully disclose any past or current problems to your personal injury attorney. They can help you understand what information may affect the outcome of your claim, and more importantly, they can provide advice about how to proceed with your case.

Take the first step to protect your privacy, download our privacy checklist.

Insurance Injury Claim Investigation Tactic :: Social Media

social-media-insurance-claim-investigationIt seems everyone these days can be found online. Whether used for personal or professional connections, social media has made it significantly easier for insurance companies to gather information. In fact, some insurance companies have a dedicated team of social media investigators whose sole responsibility is to dig up information on claimants.

What information is included in a social media report?

A social media report will include a thorough vetting of all social and online accounts including: Facebook, Twitter, LinkedIn, Instagram, Google Plus, Bing, and regular Google search.

A social media investigator will be looking for information, like:

  • Do postings reflect the injury listed in the claim?
  • Do posts suggest that a claimant can do more physically than they reported?
  • Do the postings show that the claimant is struggling financially?
  • Do the posts show questionable judgment or criminal activity?
  • Are there any red flags that may reveal fraud?

Real Case Example:

protect-your-privacy-during-insurance-claim-investigationAbout a year ago our team was working on a third party case against a property owner. Our client was injured while she was working, meaning that she was covered by workers’ compensation and she was receiving workers’ compensation benefits through her employer. Since her injury was caused by the negligence of a property owner, a lawsuit was brought against the property owner, and that is a third party claim. If we are successful in this third party claim, then our client and the workers’ compensation carrier share in the recovery. Meaning, we were working together with the workers’ compensation carrier to reach a positive result.

In this case, the client had a head injury that caused frequent dizziness. Since the case was in suit, we needed access to the workers’ compensation file, as we would be making a claim for the injuries that they paid. We were not surprised to see that workers’ compensation carrier had done a very thorough social media check of our client. They had a four-star rating system where the researcher determined whether the information on social media would reveal relevant case information.

  • 1-star indicated “No significant information” was likely to be found.
  • 2-star determined that a presence was found but did not appear to show information relevant to the claim.
  • 3-star indicated that the presence likely showed information relevant to the claim.
  • 4-star showed that the online posts exhibited information expressly contradicting the claim.

Our client’s Facebook page contained a photo of her sitting on the side of a mountain, making it appear like she had been hiking up a mountain with her head injury. While it looked bad for her at first, other photos from that event, which were not on Facebook, showed she had been driven up there by a friend, and had only walked several feet from the car to sit on a ledge for the photo. What seemed to be bad at first had a completely valid explanation. But the insurance company would not have known that from the one photo.

On the Facebook page, they were only able to find her profile photo and where she worked. They were able to find an Instagram account that again only contained her profile information. They were not able to find information on her from other accounts.

What does this mean for you?

Our real case example demonstrates that insurance companies and carriers alike have investigators looking at social media. The goal with an online investigation is to find information or photos that conflict with a personal injury claim. If conflicting information or photos are found, an insurance company can reduce a settlement offer or have a claim thrown out entirely.

How to protect your privacy and your insurance claim:

  • If you are injured, do not post photos on social media. It is in your best interest to avoid any social media posts at all. As our real case example demonstrated, a photo of you could incorrectly seem to indicate that you are in better health than you claim.
  • Do not reveal any information about your claim. Do not use social media to talk about your claim or your injury. Do not talk badly about your employer or engage in any exchanges with others about how to proceed in your case.
  • Trust the advice of your personal injury lawyer. Rely on the expertise of your lawyer before you post anything online, personally or professionally. This includes posts on your blog, website, social media or even professional groups or forums.

Insurance Injury Claim Investigation Tactic :: Surveillance

video-surveillance-insurance-claim-investigationVideo surveillance used to be an important part of an insurance company investigation, but it seems to have fallen from favor in recent years. However, for cases that involve serious injuries, we have seen video surveillance take place.

What information is included in video surveillance?

Video surveillance occurs when a claimant is recorded participating in regular activities. The footage is used to assess whether the claimant’s injuries match those in the claim report and to determine if the report is accurate or fraudulent. Video surveillance typically occurs after a recorded statement or deposition because the claimant states facts about what they can and cannot do and the injuries sustained in the accident. If video surveillance documents the claimant participating in an activity that goes against their recorded statement or deposition, it hurts the claimant’s case considerably.

What does video surveillance entail?

  • Video footage of daily activities – going grocery shopping, going to work, physical activity, etc.
  • Photos of daily activities

Real Case Examples:

  • We have received calls from clients indicating they are being followed while driving, or that there is a strange vehicle parked outside their home.
  • We had a client who sustained a left shoulder injury, but he was right handed. His after his surgery, his doctor okayed him to return to bowling, but apparently, the insurance company did not know this. They sent an investigator to follow him going bowling. It was obvious that the investigator was way out of place in this small town bowling alley, where everyone knew each other. Our client suspected it was some investigator, and approached the bowling alley owner about this, who promptly escorted the investigator to the door.

What does this mean for you?

If you feel like you are being followed or there is a car parked outside your home or place of employment, do not assume it is merely an investigator. Call the police to report a suspicious vehicle with a person in it. The police officer’s stop is usually enough to make the so-called investigation stopped.

How to protect your privacy and your accident insurance claim:

Video surveillance should be taken seriously and you should contact the authorities and your lawyer immediately if you feel like you are being recorded.

Take a simple step to protect your privacy, download our privacy checklist.

Insurance Injury Claim Investigation Tactic :: Recorded Statement

recorded-statement-for-insurance-claim-investigationFollowing a car accident or injury claim, an insurance investigator may contact you directly to provide a statement about the occurrence of events and any injuries you may have sustained. This statement will be recorded and used in legal proceedings.

The questions asked during the interview typically follow a pattern. As such, it is important that you work with your lawyer to ensure the statements you provide accurately portray the accident, with no embellishment, and cannot be used against you.

What questions will be asked during a recorded statement?

Here is a line of questioning you might expect following a car crash, motorcycle accident, or any multi-vehicle accident involving a driver who sustained some injuries.

All recorded statements start with: “Do you understand I am recording this statement? You understand this statement may be used in any court proceeding? Do I have your permission to record this statement?”

The next series of questions are fairly straightforward:

  • Your name, address, date of birth?
  • Marital status, if married, name of spouse?
  • Where do you work? What do you do there?

You will then be asked some general questions about the car accident:

  • Did you sustain any injuries in the accident?
  • Date, time, location of accident?
  • Weather at the time of accident?
  • Road conditions at the time of accident?
  • Traffic conditions at the time of accident?
  • Are you familiar with the roads where the accident took place?
  • How many vehicles were involved?

Next, the insurance company will ask very specific questions:

  • What type of vehicle struck you?
  • What color of vehicles were involved in the accident?
  • What direction was each car going?
  • How many lanes of travel were there, what lane was each vehicle in?
  • Description of how the crash occurred?
  • Did you see any brake lights on?
  • Any vehicles have blinkers on?
  • Did you hear any horns sounded before the accident?
  • Did any vehicles swerve to avoid the accident?

Next, you’ll be asked to recall what happened after the accident:

  • Did the police come?
  • Were tickets issued?
  • Where is your vehicle now?
  • Describe vehicle damage?
  • Did any airbags go off?
  • Were seat belts used?
  • Were any witness statements taken?

If you were injured in the car accident, you can expect these types of questions:

  • Did you go to the emergency room?
  • What tests did they do?
  • What diagnoses did they make?
  • How would you rate your pain at that time?
  • Did you return to work?
  • What other treatment have you had?
  • What injuries were diagnosed?
  • Have you had any prior injuries to the body part injured in this accident?
  • Who is your health insurance with?

As the interview concludes, you can expect the following closing questions:

  • Anything else that you can tell me that might give me a better idea of what happened or how it happened?
  • Do you realize this conversation was recorded?
  • Did I have your permission to do so?

recorded statement for personal injury claimWhat does this mean for you?

First and foremost, you may not be required to give a recorded statement. Before you participate in any recorded conversation, be sure to consult with your lawyer. If you are required to provide a recorded statement it can seem overwhelming, but rest assured, if you are honest about the events of the accident, you have nothing to worry about. A recorded statement is crucial part of an investigation and the answers you provide can have a major influence on your claim.

How to protect your privacy and your injury insurance claim

It is important that you prepare for your recorded statement appropriately and trust in any advice your lawyer may provide. Here are some key pointers to help you prepare.

  • Be honest about the events of the accident
  • If a question is unclear, ask for clarification before you answer
  • Use plain language and avoid exaggerating statements like ‘the car came out of nowhere!’ and ‘the car was going 100 miles an hour!’ These types of statements raise questions about your awareness during the accident and you ability to accurately describe the accident
  • Answer only the question you are asked and do so succinctly. This is the point that is the biggest problem. Listen closely to the question and answer only that question.
  • Do no embellish on any points, including on the seriousness of your injuries
  • Be polite
  • Do not agree to any settlement offers

4 Key Takeaways to Protect Your Privacy and Your Personal Injury Insurance Claim

MP_1.pngManage your online privacy .
Whether it is your social media accounts, financial accounts or professional groups, you need to make sure what you broadcast is only seen by the individuals or entities of your choosing.

Manage your privacy and security settings on all social media accounts and any online forms, apps or databases. Ensure that websites you use for finances or personal information have secure certificates and HTTPS domains.

MP_2.pngBe transparent and honest.
Knowing that insurance companies can access your financial and personal information, be transparent and fully disclose any past or current problems to your personal injury attorney. They can help you understand what information may affect the outcome of your claim, and more importantly, they can provide advice about how to proceed with your case.

MP_3.pngBe cautious with social media use.
If you are involved in an ongoing investigation it is in your best interest to avoid posting photos or updates on social media sites. Consider anything you post as fair game to insurance companies and be aware that what you post could negatively affect your claim. If you do post, make sure your privacy settings are enabled and make sure you are aware of your online connections.

MP_4.pngConsult regularly with your lawyer.
If you have any questions about the insurance investigation process, be sure to talk with your lawyer. Your lawyer should have regular communication with you as your case progresses. If you are unsure about any step in the investigation or something doesn’t seem right, call your lawyer.

Download our privacy checklist now!
 

At Murphy & Prachthauser we practice law the way it should be practiced – motivated and equipped to do our best for you. We take pride in being good lawyers who help people.

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