Page 8 - November Issue 10 24 14_Neat
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INSURANCE FRAUD INVESTIGATION FLOWCHART
1. Corporate apprehension
a. Of illegal activity = Suspicion fraud, misappropriation of funds
2. Reported to Insurance Management
3. SPECIAL INVESTIGATION UNIT (S.I.U)
b. Undercover surveillance, Activity checks, covert interviews and forensic
accounting
4. Claims Litigation Procedures
a. Documentation of video evidence and Presentation of findings
5. At that point the fraud investigation can end up either going to civil action or criminal
proceedings (municipal / federal courts)
Courtesy of Robert Robinson
She got into the vehicle of record and departed On the third day of the surveillance detail, I
the area. I gave pursuit, but I lost her in heavy covertly approached the claimant and asked to
trafic. The next day I had another agent with speak to the boss. “I told her I needed a job.”
me and he spotted her on the opposite side of She (Claimant) said, “I am the boss and I’m
the house. sorry this is a family business we aren’t hir-
My partner and I were using two-way radios ing.” I said, “When you are going to open up
for business.” The claimant replied, “tomor-
and as I saw her coming out of the front door, row morning.”
it was realized, “They are twins”. My partner
stayed with the one in the backyard and I fol- On the fourth day of surveillance; I was able
lowed the other sister to a restaurant approxi- to shoot video tape of her working at the cash
mately four and a half miles away from their register though a large street side window.
home. She was collecting and counting money via
consumer transactions. That investigation lead
Upon arrival, I noticed that the business was to the closing of the business and she was
under construction and I ilmed the claimant charged with insurance fraud.
entering the business through the rear of the
building. I immediately updated my handler As you can see, one must pay detailed atten-
and reposted myself where I can see the rear tion to everything that is going on around you;
and front of the business. you must be a self-starter, self-accountable
The claimant was ilmed moving heavy restau- and develop the habits of a sniper.
rant equipment for example, oven hood, wood- Robert Robinson is a Former Private Inves-
en tables etc. from a truck shipment that was tigator in the state of Pennsylvania.
delivered in the rear of that business.
8
1. Corporate apprehension
a. Of illegal activity = Suspicion fraud, misappropriation of funds
2. Reported to Insurance Management
3. SPECIAL INVESTIGATION UNIT (S.I.U)
b. Undercover surveillance, Activity checks, covert interviews and forensic
accounting
4. Claims Litigation Procedures
a. Documentation of video evidence and Presentation of findings
5. At that point the fraud investigation can end up either going to civil action or criminal
proceedings (municipal / federal courts)
Courtesy of Robert Robinson
She got into the vehicle of record and departed On the third day of the surveillance detail, I
the area. I gave pursuit, but I lost her in heavy covertly approached the claimant and asked to
trafic. The next day I had another agent with speak to the boss. “I told her I needed a job.”
me and he spotted her on the opposite side of She (Claimant) said, “I am the boss and I’m
the house. sorry this is a family business we aren’t hir-
My partner and I were using two-way radios ing.” I said, “When you are going to open up
for business.” The claimant replied, “tomor-
and as I saw her coming out of the front door, row morning.”
it was realized, “They are twins”. My partner
stayed with the one in the backyard and I fol- On the fourth day of surveillance; I was able
lowed the other sister to a restaurant approxi- to shoot video tape of her working at the cash
mately four and a half miles away from their register though a large street side window.
home. She was collecting and counting money via
consumer transactions. That investigation lead
Upon arrival, I noticed that the business was to the closing of the business and she was
under construction and I ilmed the claimant charged with insurance fraud.
entering the business through the rear of the
building. I immediately updated my handler As you can see, one must pay detailed atten-
and reposted myself where I can see the rear tion to everything that is going on around you;
and front of the business. you must be a self-starter, self-accountable
The claimant was ilmed moving heavy restau- and develop the habits of a sniper.
rant equipment for example, oven hood, wood- Robert Robinson is a Former Private Inves-
en tables etc. from a truck shipment that was tigator in the state of Pennsylvania.
delivered in the rear of that business.
8
