Investigation Solutions Saves Client $50,000 on Fraudulent Workers’ Compensation Claim

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San Diego, CA, 02/10/11 – Investigation Solutions, Inc., the subsidiary of American Claims Management, Inc. (ACM) that handles fraud and special investigations, announced its first fraud arrest for 2011. A suspicious workers’ compensation claim ultimately led to the arrest as well as saving the client $50,000.

The claimant had filed his original workers’ compensation claim for work-related back injuries in early 2008. After receiving treatment, the claimant returned to work for almost nine months at which time he was laid off. When he was notified of the layoff, the claimant alleged that his back injuries were worse and requested further treatment. ACM’s claim examiner was suspicious of the new claim of disability. The claims examiner called the claimant on his cell phone and was surprised to find a voice mail greeting identifying the name of claimant’s now defunct construction company. The examiner immediately referred the case to Investigation Solutions for investigation.

The surveillance team for Investigation Solutions observed claimant performing construction work on a home, with no indication of the disability he was claiming. Although the claimant continued to allege that he was unable to work, Investigation Solutions continued its investigation and verified that the claimant was paid for the work observed by the surveillance team. Finally, Investigation Solutions met with claimant’s physician, presented the surveillance video, and confirmed with the physician that claimants’ alleged injuries would not allow him to work in the manner observed on surveillance.

Investigation Solutions referred the case and evidence to the Marin County District Attorney’s Office and the Claimant has been charged with two felony counts of insurance fraud and grand theft. Investigation Solutions and ACM’s efforts on this claim will save the client close to $50,000.

Investigation Solutions, Inc. is a multi-line field adjusting and investigation company providing nationwide field investigation, surveillance, SIU services and CAT handling expertise to the insurance, legal and self-insured communities, and is a wholly owned subsidiary of American Claims Management. Since 1988, American Claims Management has been an independent national third party claims administrator specializing in both commercial and personal lines. By offering professional expertise in claims administration, ACM is committed to providing superior claims services and innovative solutions. For more information, please visit www.ACMclaims.com

CONTACT – Bill Randall, Director of Investigations
BRandall@investigation-solutions.com | 619-744-5055