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Venue
of Experience:
For the most part, our
insurance claim investigation activities have been restricted to
Michigan, although in a few cases we have handled out of state or
Mexican claims work on unusual matters.
Type of Experience:
During his career in this
business, the president of L.P.C., Ltd. has handled insurance claims
investigations for most major insurance companies operating in
Michigan; and for many large Michigan manufacturers with self funded
risks. Conservatively, he has handled well in excess of 20,000
insurance-related cases over the past 33 years. Additionally,
another L.P.C., Ltd. investigator, who has over 25 years
investigative experience, also has 3 years experience working as a
claims adjuster for a major carrier.
The Changing
Investigative Field:
Many years ago, police
officers grumbled about the Miranda warning, claiming this would
prevent them from obtaining any prosecutions. They found,
however, that they quickly adapted to the restrictions and ran into
few real problems working within the new rules. Investigators'
rules have also changed from the days when P.I.s began every case by
obtaining a credit report. Most investigators have had little
problem adjusting to new legal restrictions and changes brought
about by insurance companies' internal policies. Some,
however, apparently have been unable to cope and continue to conduct
their operations in the same manner as they did in the sixties--but
without the knowledge of their clients. In the old days, all
workers compensation cases were handled on a sub rosa basis and
claimants were regularly interviewed under pretext. Today,
while pretext work is usually perfectly legal, many insurance
companies and self funded risks have dictated that all inquiries be
made in an open and direct manner. And for a variety of good
reasons, subject contact of any type is prohibited by most all
claims management professionals.
Our Investigative
Ethics:
While we believe there are
many occasions where pretext inquiries make good sense, we never
take it upon ourselves to violate clients' restrictions. In
one case, in fact, we actually lost a client because we refused to
conduct a pretext operation demanded by a local adjuster subsequent
to our confirming to the home office of that carrier that we
understood and would adhere to their open and direct policy on all
their investigations. (That adjusted had asked that we perform
the work under pretext, but write the report as if it had been
handled openly.) There are some investigative agencies
specializing in insurance claims, which routinely violate client's
restrictions. For instance, on workers' comp cases it is
standard operating procedure for some unethical P.I.s to telephone
or visit the claimant under pretext. . . but not show this contact
in the report. Instead, they will show the information they
get from the claimant as coming from a "confidential
source" or an informant--or just discreetly include the
information into the neighborhood portion of the report. In
many cases, serious problems can arise from this activity,
particularly in cases where a claimant is represented by counsel and
such contact constitutes a breach of legal ethics. When basic
activity checks contain information from undisclosed sources or
informants; or appears vague, the client should view the
investigating agency with some suspicion.
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