INVESTIGATIVE TIP #8
More on Evidence Documentation
In the last section we covered the use of video film in documenting the lack of injury of the applicant. Film can also be used to prove the fact that an applicant is working when he has alleged that he is unemployed.
The normal procedure to document current employment is by conducting an activities check to determine where the applicant is working, and then subpoenaing the relevant employment records.
This method works well as long as the applicant is not trying to hide his employment by means such as working for cash, or having his payroll checks made out to his wife or a relative, or using a false name and social security number. Unfortunately, this is not an uncommon situation.
When this is the case, an investigator must resort to documenting the applicant's work routine with the use of a still camera and/or video camera.
The best means of doing this is to obtain film of the applicant actually engaged in work at the job site, or traveling in and out of the workplace on a routine basis.
One of our cases called for documenting the fact that the applicant was working in a clothing factory under a false name and social security number. Subpoena of the records only gave us a personnel file on a fictitious person; there was no photograph in the file to prove it was our subject.
The investigator determined he would have to get inside the factory to obtain film evidence. He arranged a tour of the factory on a suitable pretext, and during this tour surreptitious photographs were taken of the applicant operating a weaving machine. This gave the insurance company the evidence required to stop payment on the claim.
INVESTIGATIVE TIP #9
Evidence - When Film is Not an Option
We have discussed in past sections the use of film and still photographs to document the employment activities of an applicant. But what does an Investigator do when the person is self-employed, working out of their residence, or working with no fixed schedule or routine? In situations like this the investigator must turn to other forms of evidence collection in order to document the applicant's wage-earning capacity.
The ways in which such evidence is obtained are almost as varied as the situations with which the investigator is presented. The investigator's own statement or testimony is often critical in documenting such a case. Other evidence collected can include items such as business cards, printed promotional pieces, written estimates, or even goods purchased directly from the applicant.
In one of our investigations we discovered that the subject was operating a business selling ammunition near an area in the mountains designated for target practice. The location was on a remote winding road, and could not be filmed without attracting notice. Instead, our investigators periodically dropped by and bought ammunition from the applicant, in order to document that he was operating the business on a routine basis. As a result, his claim that he was unable to earn a living was successfully challenged.
INVESTIGATIVE TIP #10
Fraudulent Claims - Identification Of
The first step in detecting a potentially fraudulent claim is to be able to recognize its indicators. DMA Investigations has two checklists of indicators we have compiled to assist claims professionals in identifying cases for further investigation (these are available upon request).