Private Investigator’s Impact on Insurance Fraud Cases

When most people think of private investigators, they picture the heroes of film noir – hardscrabble detectives like Sam Spade, who smoked, drank, and wound up with the beautiful, mysterious femme fatale in the end, but the reality is very different for Houston private investigators, who spend most of their time collecting and analyzing information. Most have a background in military service, police work, or security. Most are licensed not only as private investigators like J.J. Gradoni of Gradoni & Associates, but to carry guns, for self-defense.

Their job duties may vary from tailing the subject of the investigation, to surveillance, to capturing subjects in photos or recordings, which are then turned over either to the insurance company, law enforcement, or the courts. They may also be called upon at times to testify concerning evidence that they collect in a court of law as expert witnesses in criminal or civil trials.

Types of Insurance Fraud

Uncovering Fraud in Houston, TX

Insurance fraud comes in as many forms as there are forms of insurance – life insurance, property insurance, vehicle insurance, health insurance, and worker’s compensation. Of these, worker’s compensation is one of the most common. This may be as simple as a worker faking injuries greater than actually exist, being caught doing anything that violates the limits of the injured person’s claimed injury, or working and being paid from other sources while out of a regular job and collecting benefits resulting in business owners losing millions of dollars annually to this type of insurance fraud.

Sometimes, Insurance Fraud Is Obvious

Looking Back at A Case in Houston, TX

In February, 2013, Martin describes a case in which a worker suffered hand injuries on his manufacturing job that he attributed to his employer’s product. The company’s management were horrified; their premiums would now go through the roof, and the employee might well have grounds for a lawsuit, potentially running into a million dollars.

Martin and his associates were called in to document the employee’s behavior post-accident, to determine whether his activities were consistent with the physical damage he claimed. He had opened his own moving company. Martin’s investigators were able to catch the employee on camera on several occasions, lifting what should have been furniture and other items impossible for him to carry, given the injuries that his worker’s compensation claim outlined. Based on the evidence supplied by Martin’s firm, the claim was rejected. Suddenly, the subject of the investigation might be facing jail time for his fraud.

Dogged Persistence Pays Off

On another occasion, again in 2013, Martin and his colleagues were hired to investigate a top figure at a multi-billion dollar company in Houston, TX. At the time, this company was ranked one of the top twenty in the United States. The executive claimed that his back was bad. Martin and company tailed him for several days. All was well, until they caught him lifting and loading a few suitcases into his car. He proceeded to Bush Intercontinental, where he caught a flight to Dallas. One of Martin’s men, seeing this, made the decision to follow the executive. Without a stitch of luggage, he boarded the same flight. The executive was later caught on tape playing golf and tennis, either of which would have been too strenuous for someone with a bad back, let alone both in the same day. The executive was denied disability payments, and his company took him to court for fraud. He was arrested and avoided jail time, but spent a small fortune in the process.

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