Insurance Services

State of Michigan

Full Day Surveillance

Surveillance Includes four (4) hours of travel time. Eight (8) hours of on-site surveillance, cellular calls, mileage, photographic/video documentation and detailed reports.

Half Day Surveillance

Surveillance Includes three (3) hours of travel time. Four (4) hours of on site surveillance, cellular calls, mileage, photographic/video documentation and detailed reports.

Additional Travel or Surveillance will be billed at standard rates

Insurance fraud by individuals and organizations has become commonplace. Fraudulent claims in every category have been rising every year, with no end in sight! There are indicators that tell you a claim is suspicious.

The challenge is in obtaining relevant and court admissible evidence for insurance companies, self-insured organizations and attorneys to refute these claims.

Insurance ServicesPFI investigators use comprehensive investigative methods to achieve cost-effective results. Through traditional investigative techniques, complimented by advanced technology and creative thinking, we have assisted adjusters and attorneys in making more informed, educated decisions when processing these claims.

We know what type of evidence to look for and where to find it, before we begin work on your case.  

Our evidence gathering techniques include:

  • Discreet field surveillance
  • State of the art electronic methods
  • Using the appropriate team of professionals  

InsuranceWe obtain the admissible evidence you need, quickly and efficiently. In performing our services for you, we respect the claimant’s rights. Our experience and knowledge of human behavior aids us in gathering relevant video graphic evidence, photographs and written statements. We specialize in documenting the actions and behaviors of those claimants who have filed for undeserved benefits.

Our investigators are fully trained in State of Michigan Personal Injury and Worker’ Compensation cases, Assigned Claims Investigations Guidelines, and statutory ownership issues.

Click Here for General Indicators of Fraud; Indicators of Workers Compensation; and Commercial Property Loss Fraud

General Indicators of Fraud Click Here click here to learn more

 

The following are some general indicators of fraud. They do not prove fraud exists, but they should raise suspicion and prompt a closer examination of the claim.

1. Difficulty in attempts to interview the claimant.
2. Claimant does not return messages.
3. Lack of witnesses to the occurrence.
4. Claims extensive injuries from a minor incident.
5. Excessive demands regarding compensation.
6. Claimant has multiple prior claims.
7. Claimant is overly familiar with insurance terms or procedures.
8. Claimant threatens to go to an attorney or doctor if claim isn’t settled quickly.
9. Claimant indicates willingness to settle for less if done quickly.


Indicators of Workers' Compensation Fraud Click Here click here to learn more
1. Claimant is disgruntled, soon-to-retire, or facing imminent firing or layoff.
2. Employee is involved in seasonal work that is about to end.
3. Employee took unexplained or excessive time off prior to injury.
4. Employee takes more time off than the claimed injury seems to warrant.
5. Employee is nomadic and has a history of short term employment.
6. Employee is new on the job.
7. Employee changes physician when a release for work has been issued.
8. Employee has a history of reporting subjective injuries.
9.

Review of a rehab report describes the employee as being muscular, well-tanned, with calloused hands and grease under the fingernails.
10.

First notification of injury or claim is made after employee is terminated or laid off.
11.

Has several other family members also receiving workers' compensation benefits.
12. Demands quick settlement decisions.
13. Demands quick payments for medical providers, etc.
14.

Is unusually familiar with workers' compensation claim handling procedures and laws.
15. Is consistently uncooperative.
16.

Employee refuses to allow visits or rehabilitation at home or specifies plenty of warning time prior to visit.
17. Employee, participates in contact sports or physically demanding hobbies.
18.


After injury, the employee is never home or the spouse/relative answering phone states the employee "just stepped out" or may have to contact him/her by pager.
19.

Return calls to residence have strange or unexpected background noises indicating that it may not be a residence.
20. Employee protests about returning to work and never seems to improve.
21.

Employee cancels or fails to keep appointment, or refuses a diagnostic procedure to confirm an injury.

 


—Provided by the National Insurance Crime Bureau

 

Commercial Property Loss Fraud Click Here click here to learn more

 

The following are some general indicators of fraud. They do not prove fraud exists, but they should raise suspicion and prompt a closer examination of the claim.

1. Individual is overly anxious for a quick settlement.
2. Contact with agent for coverage information shortly before loss event.
3. Loss occurs shortly after coverage is in effect or increased.
4. A large amount of cash is included in the loss.
5. Losses include a large amount of old inventory or obsolete equipment.
6. Insured is experiencing a business downturn or financial difficulties.
7. Extensive losses claimed but no security measures were in place.
8. Claimed losses are substantially different from the police report.
9. No police report was made.
10. Business/property was recently up for sale

 

Our Special Investigations Unit (SIU) can provide the following fraud investigation services:

  • Workers Compensation fraud
• Personal Injury Liability claims
• Auto Liability & Bodily Injury claims
• “Alive And Well” checks
• Missing Person Investigation
• Property claims
• Disability claims
• Witness Interviews and Statements
• Field Surveillance


If you want professional investigative results, call PFI Today!

Alive and Well Checks

When you need to verify your claimant’s status, Phase Four Investigations is a resource you can depend on.

Based on your needs and instructions, we will verify your claimant’s health and activity status. Our service can include a face-to-face personal interview with your claimant to verify the following;

  • Health and Activity Status
• Employment Status
• Home Environment
• Physical Status
• Hobbies and Activities
• Telephone Number Verifications
• Spouse and Dependent Information
• Photographs of the claimant and the residence.
• Interviews with neighbors


These services can be scheduled or unannounced, based on your needs, to determine that the client is alive, in good health and is receiving the benefit checks.