STRYKER’S INVESTIGATION OFFICE: (800) 733-1950 INSURANCE REFERRAL FORM

INSURANCE DEFENSE & INVESTIGATIVE SERVICES | WORKERS’ COMP FRAUD | SURVEILLANCE

Do you Suspect Insurance Fraud? Do you need to Determine the Claimant’s Activity Level?  Stryker Investigations battle-tested insurance defense services encompass all aspects of Insurance Investigations, Workers’ Compensation, Activity Checks, Surveillance, Subrogation, AOE/COE Statements and Fraud Investigations. We provide insurance defense services to insurance carriers, third-party administrators, law firms, municipalities and employers from the private sector. Every investigation is unique, and there is no one-size-fits-all approach regarding Activity Checks, Surveillance, Subrogation, AOE/COE Statements and Fraud Investigations. We work directly with the examiners, attorneys, and management to conduct the services around specific client requests and service instructions, or significant claim activity. Each investigation is tailored towards the unique needs of a particular client and designed on a case-by-case basis to uncover the nature and extent of the deception and expose fraudulent and/or abusive claims.

Property, Casualty, Life and Health Multi-line Insurance Investigative Services

ALIVE & WELL CHECK | PHONE INTERVIEW & IN PERSON

SUBROGATION INVESTIGATIONS

Subrogation is your opportunity to conduct a causal investigation and identify property owners, individuals, responsible parties, or entities involved. Determine any contributing factors and establish if there is any contributory negligence, immediate cause, intervening cause, proximate cause or proximate consequence and establish any negligence. If any legal cause is identified and can be proven it is possible to recover the money you have paid for damages caused by a third party.

If you are liable for a Workers’ Compensation claim, but not responsible for the actual injury, subrogation investigations may help you recover the funds you have paid to an injured employee. If your company decides to pursue subrogation, Stryker will work to recover the damages from the responsible party. Damages may involve costs paid by you and the insurance company. Costs paid by you usually means your deductible, but could include amounts over your policy limits not paid by your insurance company. This would depend on the laws in your state and the specific circumstances surrounding the loss.

WARNING SIGNS OF CLAIMANT FRAUD

• Surveillance and Activity Checks
  

  

• Social Security Number Validation  E-Verify
• AOE/COE Interviews and Investigations
• Subrogation & Scene Investigations
• Workers’ Compensation, Liability, Auto, Property Loss
• Return to Work Investigations
• Disability Management
• Alive and Wellness Checks
• Litigation Support
• Skip Trace and Locates
• Background/Internet/Social Networking Investigation
• Medical Canvass/Pharmaceutical Canvass

Defending a lawsuit is vastly different from managing the litigation for an insurance company, or even managing the many cases for which an individual claims professional is responsible. The investigation agency and investigators are fighting an individual battle in each case; the claims professional is fighting a war consisting of many individual battles. The relationship between claims professionals and their outside investigation agency is a key part of providing a successful defense for policyholders. But that relationship will always fall short of the ideal when half the people do not fully understand what motivates the other half. Lastly, there is no place for opinions and judgments in a claim file.

Furthermore, the claim file must document everything which has been uncovered in the investigation of the claim and all of the steps taken in the investigation. One of the greatest danger comes from what is not done, rather than what is done. When an insured alleges a violation of the unfair claims practices act, the most common allegation is a failure to properly investigate the claim. The claim file must demonstrate a comprehensive and objective investigation of the claim in order to refute such allegations. Everything recorded in the claim file should be recorded in such a way that it will prove a proper investigation was conducted. It should be assumed the claim file will be read by a judge at trial. For this reason, the claim administrators, investigators, SIU, and attorneys must take care to make sure there is nothing in the file which could raise questions about the objectivity of the investigation.

DOCTOR OFFICE | HOSPITAL | MEDICAL CLINIC | URGENT CARE CANVASS

Stryker’s canvass program is effective tool investigators use to determining whether there has been any previously undisclosed medical treatment(s) obtained by the subject, which may reveal a pre-existing injury or treatment prior to the alleged date of loss. You can use this information to dispute the extent of injury issues and questionable dates of injury. Every investigation report has the same basic objective… even the canvass reports. Their objectives are to collect, assemble, and preserve evidence. Find facts known to be true and those that may be presumed from all the evidence. Gather the best available evidence with the least possible delay and make determinations and recommendations for administrative disposition. Stryker’s canvass reports include a detailed chart depicting the search findings and a map of the area canvassed. Also included are standard database search results with the subject’s social security number, date of birth, possible aliases and address history, when available. This can be useful in locating previous addresses where the subject may have prior medical treatment records.