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. With all the advances of technology and the Internet, 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 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 staff and the claimant 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 Claims Services is the designated SIU for several national carriers, assisting in identifying fraud indicators, establishing procedures for dealing with suspected fraud and providing the 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 DM&A's SIU.
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