Central Montana Investigations - Private Investigations

Central Montana Investigations
Great Falls, Montana
info@montanaprivateinvestigator.com
Phone-(406)-899-6638

RED FLAGS THAT MAY IDENTIFY A CLAIM WHICH WARRANTS REVIEW:

Company receives an anonymous tip
Reported injury occurs on a Monday
Injury occurs immediately before the end of a temporary job or scheduled lay-off or termination
Claimant’s period of disability has exceeded all reasonable expected recovery time
There does not appear to be any objective basis for the claimed disability
Claimant receives all mail at a post office box and refuses to divulge residence address and current telephone number
Claimant uses someone else’s address/phone number
Employer’s statement is completed by the claimant, his spouse or someone with the same last name
Employer has same address as claimant, but a different telephone number
Motor vehicle accidents, where damage to vehicle is minor but injuries are severe
Motor vehicle accidents where injuries are minor, but period of disability is lengthy
Misspelled medical words or procedure names on claim forms completed by attending physician
Claim forms received are completed by a combination of printing, typing, writing, white out and crossed out items
Claim forms appear to be completed entirely by the claimant, including attending physician’s statement
Key questions are left blank
Claim forms are always copies
Attending physician refuses to complete form for continuing disability
Form for continuing disability is always the same
Attending physician signature changes monthly
Disability which began with a minor condition and quickly becomes a major chronic condition
Claim forms are inconsistent as to why disability continues
The claimant’s self employment should allow for continued work activity, or their work duties can’t be defined
Frequent changes of both diagnosis and attending physicians
Excessive prescription medications listed on the claim forms
Evidence of multiple insurance companies involvement or receipt of other company claim forms
Claimants calls to the company are frequent and special handling is always request
The claimant is overly helpful, but at the same time vague on specifics

Claim forms where the signatures appear to be photocopies
Claimant always returns phone calls late in the day or early in the morning
Claimant can’t be contacted at his residence by telephone, without leaving message

All claim forms received either initial or continuous should be carefully scrutinized as to how, when, where and who completed them. A combination of these listed red flags may be indicative of fraud or actual claim abuse that requires further in-depth review and additional documentation.