INSURANCE CLAIMS SERVICES
The best defense against fraud is effective investigation.  RSG provides its services to claims departments and special investigation units investigating potential fraudulent claims.  We have the experience and resources to assist insurance companies, third party administrators, the self-insured and insurance defense law firms.  In addition to surveillance, we perform other relevant services relating to claims investigations.  The following are some of the more common investigations we conduct for the insurance industry.
Surveillance
Statements
Witness Locates
Background Investigations
Due Diligence
Litigation Support
Service of Legal Process
and more...
AOE/COE Investigations
Covert Activity Check
Activity Checks & Alive and Well
Interviews and Statements
Our Covert Activity Check is basically a mini-surveillance conducted to watch a claimant for a short period of time (typically 3 or 4 hours) to see if there is any contradictory activity detected.  A covert check is effective, for example, in determining if a claimant leaves for work during the morning hours or goes out in the evenings.  This check may also involve canvassing neighbors for information concerning levels of activity.  A covert check can quickly turn into a full surveillance case depending on what is discovered.  These are used by clients with limited budgets to take a quick snap shot of someone's day, which may reveal activity warranting and justifying additional investigation.
AOE/COE (Arising Out of Employment / Course Of Employment) is a workers' compensation based investigation centered around determining the facts or alleged injury by a worker on the job. The AOE/COE investigation is crucial in the early stages of a workers' compensation claim to determine injury related accident facts before evidence gets lost or memories deteriorate. The purpose of the AOE/COE investigation is to establish if the employee’s alleged injury was work related or whether the injury was non-industrial or affected by third parties. AOE/COE investigation is an effective tool to control workers' compensation costs and return the claimant to work as soon as possible.
Our Activity and Alive & Well checks are straight up visits to a claimant's home.  We will conduct a short interview with a claimant using a standard questionaire updating their information such as work status, hobbies, medicals and prescriptions.  A photograph will be taken and their identification confirmed.
Recorded or written statements are an important part of the claims investigation.  We will conduct a thorough interview and obtain the preferred statement format whether written or recorded.  We also have a transcription service for client's who need a recording transcribed.
Accident Scene & Site Investigations
Subrogation Investigations
Investigations conducted in order to determine possible third party compensability.  This investigation examines the circumstances around an injury or damage claim to determine if a third party has any responsibility in the incident.  Possible third parties can be equipment manufacturers, contractors, municipalities, and other drivers.
Investigations include obtaining photos of an accident scene, scene diagram and measurements.  Canvassing for witnesses and obtaining statements may also be part of our investigation.  Other site investigations may involve photos of machinery and workplace locations.
©Copyright 2011 Copyright The Risk Solutions Group, Inc.
"...It is in the best interest of society that valid claims be asserted and fraudulent claims be exposed"
Forster v. Manchester, 189 A.2d 147 (Pa. 1963)
The Risk Solutions Group, Inc