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The Insurance Claim Investigation Form is a investigation form designed to facilitate the investigation of insurance claims related to workers’ compensation, subrosa surveillance, subrogation, and other insurance matters. This form is intended for use by insurance adjusters, Third-Party Service (TPS) providers, businesses, and law firms that are seeking to investigate or gather information on claims. It helps streamline the process of documenting key details, identifying potential fraud, and collecting relevant evidence for a variety of insurance-related inquiries.

We conduct Insurance Fraud investigations, Health Insurance Fraud, Auto Insurance Fraud, Medical Care Provider Fraud, and claims investigations on behalf of insurance carriers and other entities. These services include Workers’ Compensation insurance fraud, Subrosa surveillance and 4-hour activity checks, home care, hospice caregiver integrity investigations, employer-level accident investigation AOE/COE statements from the Claimant and witnesses, and third-party subrogation and identify property owners, individuals, responsible parties, or entities involved and fraud investigation focused on suspicious claims, surveillance; as well as, other insurance-related investigation requests.

INSURANCE CLAIM INVESTIGATION FORM:

Workplace Accident. Questions Call Our Office (800) 733-1950

 


SUBJECT INFORMATION & TYPE OF INVESTIGATION

Gender

AOE-COE / SUBROGATION / STATEMENTS /ACCIDENTS SCENE

CLAIMANT MEDICAL AUTHORIZATION
WCAB CASE HISTORY SEARCH
EDEX RECORDS
Checkboxes

EMPLOYER CONTACT INFORMATION

SPECIAL INSTRUCTIONS FOR AGENCY - SPECIFIC INFORMATION FOR INVESTIGATION

Upload Documents

Maximum file size: 516MB

BY SUBMITTING THIS FORM TO THE AGENCY YOU AFFIRMATIVELY AGREE TO THE FOLLOWING: 1. LIMITATIONS OF USE AND LIABILITY 2. ALL INFORMATION IS CORRECT. Limitations of Liability. While the information contained in the report(s) provided has been obtained from records data sources deemed reliable, its accuracy cannot be guaranteed due to potential human error in the actual recording of the records. Since this information is not owned by Stryker Investigation Services Inc., and since records data on any one individual, group of individuals, company, or companies can be contained in more than one repository, Stryker Investigation Services Inc., can only rely on its accuracy from the records data sources presently available at the time of the search. This information is furnished for your exclusive use and accepted by you without any liability whatsoever on the part of Stryker Investigation Services Inc., its sources, officers, agents or employees. Furthermore, you agree to indemnify Stryker Investigation Services Inc., its sources, agents, and employees of any liability for the use of this information.

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