Building the Best Special Investigations Unit In Insurance Investigations
Special investigation units are a cornerstone of the insurance investigations process. When you’re dealing with potential fraudulent property and casualty claims, SIUs are responsible for providing the evidence the insurance companies need to deny the claim. They are often expected to act autonomously and are put in positions of high responsibility. When it comes time to take that denied case to court, you better believe they’re going to be required to testify. If you hire the wrong SIU investigator, this is where it all falls apart.
Your proof in the claims process is only as good as the people that gather it for you. These individuals have to be highly skilled, ethical and competent to stand up under scrutiny. Building the best special investigations unit isn’t just about finding people with active PI licenses. It’s also about finding people who know how to ethically gather evidence that stands up in a court of law.
Finding the Right Skillset for a SIU Team
Anyone in the P&C insurance industry knows those “caught on camera” insurance fraud cases are few and far between. When doing surveillance on a potentially fraudulent case, it’s rare to get a smoking gun. It’s especially rare if you hire an incompetent or unethical investigator.
I remember one story I heard from an insurance company adjuster that showed how bad a bad investigator could be. She was handling a bodily injury case for an individual who claimed he was unable to work due to a car accident. She received a tip and decided to refer it to an investigator. After a few weeks, the investigator came back, reporting he’d spent every day doing surveillance and hadn’t caught him working in any capacity.
The adjuster then pulled up the individual’s website, which advertised his construction business, complete with time-stamped pictures of him re-shingling a roof. The pictures were from the two-week period where the investigator claimed he hadn’t been able to find anything. As it turns out, the investigator never even did an investigation. He just assumed that no one would be dumb enough to run and advertise their own construction business while claiming they couldn’t work because of an injury.
This represents a significant problem with SIU investigations. They very rarely yield results, which might drive some to cut corners and then miss the big details that could help them. Building a special investigations unit with the right people isn’t just about finding someone with an active PI license, it’s also about creating a group of individuals with a wide range of skillsets so you can gain better results. Here are some things to remember:
- Their background must be above reproach – If that investigator must testify, the defense is going to try to undermine their credibility. If they have any issues in their background that show them in less than a positive light, that could kill your case.
- They must be ethical – Investigators may have to pretend to be someone they’re not to gain the evidence needed. This is a grey area that borders on entrapment. An ethical adjuster will know which lies are ok to tell to gain further information and which cross the line. For example, pretending to be a customer to prove someone is working when they say they can’t is ok. Pretending to be a police officer to bully someone into confessing is not.
- They must know the law – Knowing when and where it’s ok to videotape someone is tricky and fraught with legal loopholes. If the investigator tapes someone where they shouldn’t, it’s not the person committing fraud that’s going to wind up at the defendant’s table. It’s the investigator. There’s a fine line between an acceptable investigation and invasion of privacy. A good SIU investigator knows this.
- They must be persistent – Finding the smoking gun in an insurance investigation is an equal measure of persistence and luck. They may follow someone for weeks before finally catching something worthwhile. Investigators must be prepared to dedicate a lot of time, even when they know it’s incredibly unlikely they’ll find anything, because they also know that in the small instances, they will.
- Don’t assume your field people can do technical work – Too many people only focus on hiring field workers in SIU, and a lot of times, those field workers lack the technical skills needed to make those investigations better. The adjuster in the above story found the fraud by reverse searching the person’s email address. The field investigator never even thought to do that. You can find a lot of information online, which is why a good insurance investigations team will include a support staff that will root that info out.
Finding the Best Investigators
Personally, I’ve found that it’s better to hire someone with the right attitude and then sponsor the PI license, rather than making that license a deal breaker. It also allows you to train them on your company’s own policies, allowing you to custom make the perfect SIU team for your organization. Here are some places to consider hiring from:
- Former law enforcement – Law enforcement experience will qualify someone for a PI license in every state. Usually, all they have to do is pass a short exam. These individuals are already familiar with laws regarding surveillance and evidence collection. Law enforcement retirees are probably the best pool of candidates you’re going to find for an SIU team.
- Colleges that offer criminal justice degrees – Non-law enforcement experience of at least two years is generally required in any state where someone wants to gain a PI license. A great way to find SIU team members is to go to job fairs at universities that offer criminal justice degrees. This can also be a great opportunity for offering internships, as the person can work with one of your experienced investigators, gaining necessary skills. These individuals also make perfect support staff for field workers, because they’re well versed in new investigative technology.
- In-house personnel – Claims adjusters frequently act as lower level investigators, meaning they have experience in the particular field. Promoting those who are good at rooting out fraud cases will give you an experienced investigator, specific to the insurance industry, and will also offer opportunities for advancement that will improve morale.
The thing to remember is not to be blinded by the PI license alone. Sometimes, it’s better to sponsor someone for a license so they can get the specific investigative experience your company needs. If they’re supervised by a licensed individual, this is a perfectly acceptable practice.
Regardless of where you hire, remember that thorough vetting is essential in hiring the appropriate SIU team members. AC Global Risk offers remote Risk Assessment (RRA) technology that can help improve your hiring process by assessing for risk using an automated, phone-based process. For more information, contact us.
Image Source | Flickr user unreal estates