Dreams and Reality in the Wonderland of Investigations. Every Adventure Requires A First Step -Cheshire Cat

Transcription

1 Dreams and Reality in the Wonderland of Investigations Every Adventure Requires A First Step -Cheshire Cat

2 ABOUT OUR COMPANY Winston Services opened its doors on March 21 st, What began as a one-man operation has quickly grown into a current staff of 18 fulltime and part-time associates. Winston Services is a full-line investigative company specializing in Workers Compensation investigations. The company serves all major insurance companies and third-party administrators in the state of Oklahoma, Texas, Kansas, and Arkansas.

3 MISSION STATEMENT We at Winston Services believe that success is based on these four principles: Honesty Integrity Excellence Determination Our company has been built on an unbending intent to serve our customers better than anyone else.

4 WHAT TO LOOK FOR IN A P.I. COMPANY Character & Competence Professional Video - Hourly Time Shots Quality & Detailed Reports Flexibility & Availability (24/7) - Rush Assignments Well Trained & Experienced Investigators Timely Case Updates Honest Feedback Going the extra mile to get the job done.

5 INSURANCE FRAUD Workers Comp fraud is a large crime in America today. Tens of billions of dollars in false claims and unpaid premiums are stolen every year, the Coalition Against Insurance Fraud estimates. According to the National Insurance Crime Bureau, workers compensation fraud amounts to 7.2 billion per year across the United States, and it is the fastest growing segment of insurance fraud. More than one in ten small-business owners are concerned an employee will fake an injury or illness to steal workers - compensation benefits. (Coalition Against Insurance Fraud)

6 HOW FRAUDULENT CLAIMS WORK Hur t of f the job. Workers get injured of f the job, but say they're hur t at work so their workers comp policy covers the medical bills. A person might hur t his neck lifting a heavy box while cleaning the attic. Or maybe sprains an ankle during a sof tball game. Then he pretends the injur y happened at the loading dock at work. Inflated injuries. A worker has a fairly minor job injur y - maybe a slight twinge in her lower back but insists her back is seriously sprained. This lets the worker collect more workers comp money and stay of f the job longer. Fake injuries. Some workers simply invent injuries. Sof t -tissue injuries such as muscle problems with the back and neck are popular scams. They're hard to disprove, and thus are easier to get away with. Old injur y. Sometimes a worker with an old injur y that never quite healed will claim he just got hur t on the job. A damaged knee or shoulder, for instance. Malingering. Basically, this is goldbricking. Staying at home longer by pretending you're still disabled, even though you've healed enough to return to work.

7 INVESTIGATIVE SERVICES TO CONSIDER Activities Check Surveillance Reports Total Disability Reports Accident Reports Location Reports Asset/Financial Checks Background Investigations Social Media Reports

8 ACTIVITIES CHECK Complete an Activities Check at any time during a claim when you need detailed information on a claimant s activities. The information provided is obtained from knowledgeable outside sources. If uncertain of the feasibility of surveillance, complete an activities check.

9 SURVEILLANCE REPORTS When available information has indicated claimant activity is inconsistent with a diagnosis, the use of claimant surveillance is necessary. Claimant activity is documented via stationary and/or mobile surveillance with a digital video recorder. Covert video inside locations is also obtainable.

10 PERMANENT TOTAL DISABILITY REPORTS When a claimant is not likely to have a high probability of inconsistent activities, a Permanent Total Disability Report is compiled. Included in the report are direct interviews with the claimant, if not represented, as well as contact with two outside sources knowledgeable of the claimant s activity.

11 ACCIDENT REPORTS This report is provided when full details of an accident are required. These details may include recorded statements from the claimant, witnesses, and, if necessary, police officials. High quality photos and scene diagrams are also available upon request.

12 LOCATION REPORTS This report is utilized to locate any person or group of individuals. A report detailing their known whereabouts is then presented to the client.

13 ASSET/FINANCIAL REPORTS This report includes an extensive background check in search of property records, motor vehicle registrations, liens, bankruptcies, judgments, UCC filings, and criminal records.

14 BACKGROUND CHECKS This report includes a comprehensive investigation through court records, investigative databases, motor vehicle reports, workers comp records, financial records, and interviews, if requested. A background report is the best available service when full and timely details on an individual are needed.

15 SOCIAL MEDIA REPORTS Fraudulent activity can often be confirmed quickly and easily by searching for it online. Using advanced collection techniques, our investigators will compile information from a variety of online sources. This information is placed into a comprehensive report that only outlines pertinent/claim related online activity. TIP: REQUEST A SOCIAL MEDIA REPORT PRIOR TO SURVEILLANCE TO PROVIDE KEY INSIGHT INTO THE CLAIMANT S LEVEL OF ACTIVIT Y.

16 RED FLAGS O N E I N F I V E O W N E R S F E E L U N S U R E H O W T O I D E N T I F Y W O R K E R S C O M P E N S AT I O N S C A M S. Unwitnessed Accidents Delay in notification of injury Injury near a strike, layoff, termination, or right after hiring Claimant immediately gets an attorney Hostility, reluctance to provide information, address (PO Box), phone, medical records History of time off during the same time of year Being put on probation for poor job performance Recent conflicts with supervisor or coworkers Claimant known to have significant hobbies outside work and there is an upcoming event Recent family changes, especially a recent divorce

17 RED FLAGS Any recent criminal or civil charges filed against the claimant Suggestion from medical sources that a closer look at the claimant is needed Anonymous call from outside source Family member or known friend recently receiving a compensation settlement Others in the claimant s department involved in compensation claims Claimant being denied time off from work and then reporting a claim Adjuster intuition

18 WHAT DOES A P.I. NEED FOR SUCCESS? 1) Full Name / Social Security Number / DOB 2) Address 3) Telephone Numbers 4) Employer / Employer Address / Work Schedule 5) Position 6) Adjuster Name / Number / 7) Claim Number 8) Injury 9) Date of Injury 10) Restrictions 11) Description / Photo of the Claimant 12) Vehicle Information 13) Upcoming Appointments 14) Leisure Activities / Interests / Marital Status / Children 15) Clear Objective / Budget

19 ACHIEVING SUCCESS ON YOUR CLAIMS The more information you provide, the better. Initiating surveillance immediately after questionable claim is filed. Watching a clamant over a period of several days at varying times. Showing the doctor surveillance footage before the claim gets to court. Obtaining personal information from inside sources supervisors / employer contacts Trusting your intuition.

20 PATIENCE IS A VIRTUE

21 VIDEO OF WORKERS COMP FRAUD CONVICTION

22 2016 HIGHLIGHT VIDEOS

23 WINSTON SERVICES, INC WEST MAIN STREET, STE 201 NORMAN, OK PHONE (405) FAX (405)