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The Fraud Chronicles 4: Where Can You Hide in the Middle of a Field?
By Tom Reitze
When an insurance claim contains red flag indicators of potential fraud and an assertion of total disability, it is appropriate and sensible to discreetly document the claimant's activities on film to verify or discredit the claim. This is known as surveillance. If the person isn't really disabled, chances are the investigator will catch and film them doing something that a truly disabled person would not be able to do.
DMA Claims Services (http://www.dmaclaims.com/investigations.shtml) investigates suspicious cases, conducts surveillance, and if an insurance claim is found to be fraudulent, turns the information over to the insurance company.
This is a case from the DMA Investigations archives, Part 4 of the Fraud Chronicles, and involves a case where the investigator had to be inventive to get the film without tipping off the "disabled" person doing heavy farm work.
Where Can You Hide in the Middle of a Field?
Andy Schwarz, Investigations Manager Los Angeles, DMA Investigations
"A first rule of surveillance in rural areas is: When in Rome do as the Romans do. Or perhaps better stated: Look like what a Roman would expect a stranger to look like. For the last several years in many situations that has meant: look like you are interested in buying real estate.
"Our assignment involved a claimant alleging total disability, and he was located near a small (population 400) farming community in the middle of Missouri. I arrived just prior to Labor Day weekend and quickly realized this was not going to be a walk in the park.
"First, the Mapquest to the claimant's only known address led to the fifth row of a cornfield.
"Second, Labor Day was approaching rapidly and every store and public facility in town was closing. We knocked on the door of the tiny City Hall, the only known repository of records, but got no answer. It looked like it was shut down tight already. Main Street was deserted. But the experienced investigator knows where he can get information even when faced with such daunting absences - the nearest bar.
"Finding the bar was easy, but soon I was striking out once again. Asked about land I 'heard' our claimant had for sale, the bartender knew nothing. The few patrons in the place knew nothing. I stepped back into the dusty street with an uneasy feeling and not one good idea of where to go next.
"But I was rewarded for not staying in the bar to enjoy several cold ones and feel sorry for myself. A woman approached and asked if I had knocked on her door. Turns out she was City Hall staff, by herself in the office and on the phone, thus unable to answer the door. One thing led to another and pretty soon I was studying a map showing the location of every house in town.
"I soon arrived at the residence I found on the map, and confirmed it was the home of our claimant. But the test of investigator will was not over. There was no activity. I waited and still nothing, totally quiet.
"Some digging was in order and once again I resorted to an establishment purveying liquid refreshment. This time, closer to the residence, I came up with what I needed. The claimant was possibly building a house in a nearby town, and was known to be in Southern Missouri attending a wedding. Best of all he was expected to be home later that night.
"The next day I followed the claimant from his house out to a farm ten miles outside of town. That was easy, but it turned out this assignment, as a test of investigator will, was the proverbial Bar Exam or SAT. There was no place to park outside of obvious view. Farmhouse, fields and the road - that was all there was. No trees, no stone outcrops, not another parked car within five miles. No hills with vantage points from which to view the farm.
"Your tireless investigator proceeded to the last resort - staging a vehicle breakdown off the side of the highway just beyond the claimant's farm (and disconnecting the battery in case the claimant proved to be a helpful type, which he did not). The claimant ignored the vehicle with its hood up and just continued with his farm work. I was thankful for this attitude as I sat in the back with video rolling.
"As any professor of agriculture (or five year old child) will tell you, farm work is not an appropriate use of time for the totally disabled. Just looking at the video of our claimant cruising by on a tractor, bouncing around over rough ground, and manhandling bales of hay makes me want to lie down and take a nap.
"Our film was the end of that claim. And in my estimation, a pass with flying colors on this particular test of investigator will."
Another victory for truth, justice and lower insurance premiums.
About the Author
Tom Reitze is President of DMA Claims Services (http://www.dmaclaims.com), an independent claims adjusting and investigations company with 42 offices in 16 states.
Article Source: http://www.simplysearch4it.com/article/44033.html
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| Some other articles by Tom Reitze | |
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