If you work for an insurance company, it is crucial for your business to determine whether or not the claims you receive are legitimate or illegitimate. One or more fraudulent claims could cost your business thousands of dollars, which would affect your bottom line. Insurance claims investigation services typically involve physical surveillance conducted by a trained professional that can uncover the intel needed without alerting the subject of the investigation. In this blog, we will cover how you can benefit from this specialized service.

Why are Insurance Claims Investigation Services Needed?

Unfortunately, employees and employers commit workers’ compensation fraud, particularly during economic recessions and in high-risk industries. According to the Coalition Against Insurance Fraud (CAIF), workers’ compensation insurance fraud costs insurers and employers approximately $6 billion a year. Health insurance and medical fraud also have a significant financial impact. According to the National Health Care Anti-Fraud Association (NHCAA), losses via health care fraud equate to tens of billions of dollars each year. These are only two types of insurance fraud that occur regularly. We are here to help you prevent financial losses.

An Insurance Claims Investigation Services Case Study

At CaptureINTEL, our field investigators have numerous years of experience conducting claims investigation services for various cases. Here is an example of a job that saved one of our client’s several thousands of dollars. We had a case with an employee claiming he had a permanent injury to his lower back, neck, and bilateral shoulders. He was off of work indefinitely at a weekly rate of $552.86. He was entitled to 130 weeks up to $71,871.80. He likely would have reached this amount because his attorney refused to allow him to go to an independent medical evaluation due to COVID-19. His attorney indicated that he was incapable of returning to work because he could barely walk and had a low immune system, so he could not be treated in a large clinical setting. His employer hired us to conduct surveillance, and we found him walking everywhere, including at a mall and a casino with no mask. As a result, his benefits ended, and the judge ruled in favor of maintaining the denial on those benefits. In the end, his employer only paid him $4,313.86 in benefits versus $71,871.80, equating to a total cost savings of $67,557.94.

Now that you know more about insurance claims investigation services, you can set yourself up for success if you are in a position where those services are beneficial. At CaptureINTEL, our seasoned field investigators have a deep understanding of proper procedures. We always comply with state and federal mandated laws so that we never violate restrictions put in place to ensure an individual’s privacy. Connect with us to explore how we can help you uncover valuable intel!