Perez Investigations Blog

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October - Breast Cancer Awareness Month

As most people already know, October is breast cancer awareness month!  Almost everyone has been personally affected by breast cancer, whether directly or indirectly; we’ve watched mothers, daughters, sisters, wives, and girlfriend fighting for their lives.  However, most people aren’t aware that it’s not just women who are affected.  Although much rarer, men are susceptible to breast cancer as well.  The American Cancer Society estimates that around 2,350 new cases of breast cancer will be diagnosed in men in 2017, compared to 231,840 in women.  An estimated 440 men will die of breast cancer this year.  This is an awful cancer that affects everyone. Perez Investigations Inc. is proud to help those that have gone through, or are going through, breast cancer by donating a portion of our October 2016 profits to Nationbreastcancer.org.  If you would like to make your own donation, please take the time to visit nationalbreastcancer.org (or any other breast cancer donation site!), where you can contribute as well.

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Workers' Compensation "Red Flags"

Workers' Compensation Premium Fraud is very real. Over the years, patters have developed that can help claims handlers discover the "red flags" that are common in workers' compensation premium fraud. Here is a list of 10 "red flags" that should raise suspicions and trigger an investigation.

  1. Monday morning report of injury The alleged injury occurs first thing on Monday morning, or the injury occurs late on Friday afternoon but is not reported until Monday.
  2. Employment change The reported accident occurs immediately before or after a strike, job termination, layoff, end of a big project, or the conclusion of seasonal work.
  3. Suspicious providers An employee's medical providers or legal consultants have a history of handling suspicious claims, or the same doctors and lawyers are used by groups of claimants.
  4. No witnesses There are no witnesses to the accident and the employee's own description does not logically support the cause of the injury.
  5. Conflicting descriptions The employee's description of the accident conflicts with the medical history or injury report.
  6. History of claims The claimant has a history of a number of suspicious of litigated claims.
  7. Treatment is refused The claimant refuses a diagnostic procedure to confirm the nature or extent of an injury.
  8. Late reporting The employee delays reporting the claim without a reasonable explanation.
  9. Claimant is hard to reach The allegedly disabled claimant is hard to reach at home.
  10. Changes The claimant has a history of frequently changing physicians, addresses or jobs.

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Florida office to open in 6-10 weeks

Our company is currently in the beginning stages of expanding our investigative services to other parts of the country. Before the idea to expand our services to other markets, we were asked several times if we offered our services nationwide. Although there was client interest in expansion, we said no each time. Why? Before a business can expand its services to outside markets, it needs to become stable and mature in the home market first. Years of success and solid growth have resulted in a strong financial position. As a direct result, this allows us to make the most of our current situation by creating potential for continued expansion with focus on continuing to produce quality work for our clients. Before we expand into a new state, an assessment is made of the markets potential. Factors such as demographic structure, purchasing power, economic growth, infrastructure, political risk, human rights and environmental sustainability are analyzed. After doing our own diligence we have decided to start with Florida. With the rapid development of technology, our company's philosophy will remain the same. Our companies Head of Surveillance Operations Al Jr. just took and passed the Florida Private Investigators exam last week. Our agency application is currently in the Florida system pending review. We are estimating 6-10 weeks before we are up and running. If you have any questions please feel free to contact us.

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Could Fitbit & Other Technology Expose Claimants?

New technology is increasingly providing evidence that can reveal your lies, according to a newspaper essay that provides examples. In Pennsylvania, police examined a woman’s Fitbit activity tracker and used the results to charge her with filing a false police report. Insurance investigators track social media in an effort to refute workers’ compensation claims. Your smartphone tracks your location, and smart thermostats and security systems know when you are home. Your browsing history reveals your interests to advertisers. The Washington Post considers the ramifications. “Lies are a fact of life,” the newspaper says. “But technology may soon make them obsolete.” The story refers to Dave Eggers’ 2013 novel The Circle, about a dystopia where people reveal so much about their lives that lies and secrets are nearly impossible to hide. The Pennsylvania prosecution involved a woman who said she was asleep when she awoke to find a rapist who assaulted her. The woman’s Fitbit, however, showed the woman was awake and walking around at the time she claimed to be asleep, Lancaster Online reported. Related article: ABA Journal: “Data from wearable devices is being eyed as evidence in the courtroom”

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Comparing Summonses and Subpoenas

Summonses and subpoenas are both legal documents that call a person or business into a United States court, but the difference has to do with why. A summons is generally used to inform someone that they are actually a party to a lawsuit, usually as a defendant. In most cases this means that the person is being sued, and the document will both inform them of the action and put them on notice that they need to prepare a defense. A subpoena, on the other hand, is typically used to call witnesses to court. Lawyers for each side of a legal dispute are permitted to choose witnesses who will offer testimony in support of their version of events, and witnesses are usually required to attend. Subpoenas inform prospective witnesses that they have been called, and also usually set out details of when the trial is and what the penalties are for failing to appear. Both types of documents usually compel mandatory appearance, and ignoring them can have serious consequences.

Documents for Calling Parties

When someone is being sued in the U.S., the law says that he or she needs to receive notice both of who has brought the action and where. This information is generally conveyed in a summons, which is an official order to appear in court. The exact information contained can very somewhat by jurisdiction and type of case, but most of the time it identifies who filed the action, names the lawyer representing that party, and states when the trial will be happening if a date has been set. Sending summonses is one of the first things that people do when they start a legal action. Almost anyone can sue anyone else for basically any reason, but a summons is a way to make sure that both parties have the same advantage when it comes to information about the legal proceeding and time to prepare, at least formally. These sorts of documents are used in both civil and criminal matters.

Legal Obligations Attached

The primary consequence of ignoring a summons is a default loss of the case, which is generally unfavorable. Judges don’t often look well on parties who fail to appear, and default judgments tend to be decided overwhelmingly in favor of the person or business who filed the case. People sometimes think that simply not appearing can make the case “go away,” but this isn’t how it usually ends up. Default judgments tend to be monetary, and the courts typically have the power to seize the losing party’s assets or garnish his or her wages to settle the debt. People who don’t appear in criminal actions often risk receiving heightened penalties and maximum sentences. Failing to answer a witness request, on the other hand, can land a person in jail. Witnesses are considered essential to the proper functioning of most trials, as they allow each side to build the best case possible. When someone who has been called fails to appear or ignores the order, he or she is generally considered “in contempt of court,” which is serious. People can sometimes get out of witness service if they have a hardship or other problem, but this usually has to be with the permission of the judge or lawyers involved. Simply ignoring the request is not usually an acceptable way forward.

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Claimant complains of wrist pain, but is seen not wearing brace

August’s Pictures of the Month dates back to January of this year.  As Investigators, we are trained to obtain as much VIDEO as possible when claimants are in public view.  Experienced investigators make sure to also zero in on the particular body part(s) that are identified as being injured. This particular case involved a claimant complaining of right wrist pain, which she alleged to be industrially related.  The key point to these photos are the time and date stamps.  On January 28, 2015 the claimant had a 5:00 p.m., medical appointment to check up on the status of her right wrist.

Perez Blog August 2015In the first photo at 4:59 p.m., you can see the claimant wearing a right wrist brace, while walking into the doctor’s office.

 

 

 

 

 

Perez Blog August 2015The second still shot is of the claimant as she is walking into a grocery store at 3:53 p.m., not wearing a wrist brace. These photos bring into question this claimant’s need/reliance of the use of a brace, as well as the issue of secondary gain.

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Claimant fixes flat tire & swims laps while allegedly having lower back pain

July's Pictures of the Month are taken from a case completed in February 2014. The claimant in the aforementioned pictures was alleging lower back pain, as well as a psyche overlay, which he alleged to be industrially related. The claimant was pushing for 100% total disability with the main goal being to retire early on a Workers’ Compensation claim. Our investigator was able to obtain COVERT VIDEO of this individual while fixing a flat tire and swimming laps at a local pool. With this video, our client was able to lower the disability rating helping them save money in the long run. 

Perez Blog July 2015

 

 

 

 

 

Claimant fixing a flat tire. 

Perez Blog July 2015

 

 

 

 

 

Claimant swimming laps at a local pool.

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Claimant works-out while allegedly having lower back & shoulder injuries

June's Picture of the Month dates back to February 2011 as one of our investigators obtained video of this claimant working-out while allegedly having lower back and shoulder injuries. This particular case was one of the most difficult cases handled by Perez Investigations.  Following claimants who are being coached by attorneys makes an investigators job very difficult.  With our experienced investigator and state of the art video technology, our investigator was able to obtain a significant amount of video of this claimant during unguarded moments. 

Perez Blog June 2015

 

 

 

 

 

 

Claimant doing 185 pound shoulder press 

Perez Blog June 2015

 

 

 

 

 

 

Claimant using his upper extremities with 25 pound weights

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RESULTS!!! Seven Tips for Insurance Adjusters and Investigators

In recent years, we have experienced a number of potential clients complaining about past surveillance results.  Many people in the claims industry have experienced frustration due to the lack of video investigators have secured.  In today’s world with the internet, video games, smart phones, social media, high gas prices and inflation, peoples every day outside activities have been diminishing.  With that being said, experienced investigators can take advantage of the little things that can lead them to big results. Investigators are not going to obtain numerous amounts of video on a daily bases.  There are a lot of things that are involved when being out in the field that are completely out of the investigators control such as traffic, noisy neighbors and weather.   Any investigator that claims he or she has never lost a claimant is lying.  I will be the first person to tell you that there is a lot of luck involved in this job.  With that being said, there are a lot of things that investigators and adjusters can do to increase their chances of finding success during the course of an investigation.

Here are seven tips that can help Investigators and adjusters with their investigations.
  1. Surveillance is a great tool for adjusters.  If a case cannot be settled and surveillance is needed, make sure you start off by choosing an investigation company that has a proven track record.  Using investigators with a lack of experience can and will frustrate you and cost you money.  Once you have done your homework and selected a company, your next step is to determine your budget.
  2. If you do pick up the phone and call an investigator to conduct surveillance on an injury claim, the first step is to trust what the investigator has to say.  Perez Investigation Inc.  always recommends starting off with two full days of surveillance starting at 6:30 a.m.  Often times it can take a half to a full day to get a case assessed.  Based on the results after two days, further time may be warranted.
  3. Try to avoid doing a 4 hour activity check.  More often than not, Claimants who are currently off work sleep in and take advantage of being paid without having to work.  If the investigator starts at 6:30 a.m. and leaves by 10:30 a.m., you are only covering a small part of the day where an individual can be active.  In the summer months when the days are longer, investigators have a large window in which they can obtain video.  Investigators chances for success depend on how long he or she is out in the field.  If you are on a tight budget and cannot afford to assign at least two full days of surveillance, then consider at least one full day.  Four hour activity checks are good only if you’re trying to establish whether someone has returned to work.
  4. Make sure to conduct a Social Security trace, ANI trace and social media check before starting an investigation.  If you are able to gather information from Facebook, Instagram, LinkedIn or other sites, your investigation can often times revolve around that.  Often times, people post information about upcoming events or activities that they will be taking part in.  This kind of information is gold for investigators working in the field.
  5. Always conduct surveillance on days when the claimant has a medical appointment. Often times a claimant will exaggerate an injury on the day of a medical or legal appointment.  The best way to gage where the claimant is at with their injury and if he or she is being truthful is to conduct surveillance the day before, the day of and the day after a medical or legal appointment.  This will paint you a good picture of how ligament the claim may be.  On multiple occasions, I have witnessed claimants moving around without showing any signs of discomfort the day before and the day after a medical appointment.  On the day of the medical appointment they are exhibiting visible restrictions.
  6. Different locations call for different measures; Often time’s claimants live in remote settings.  Conducting surveillance in a rural setting can be very difficult.  For experienced investigative firms, surveillance in rural setting is difficult but doable.  To start off, you are going to need two investigators assigned to a case in a rural area.  Having two investigators will increase your chances for success greatly however it is more costly.  The saying “you get what you pay for” could not be truer when directly linking it to surveillance.
  7. Communication is key.  It is very important for the adjuster and investigator to communicate before, during and after the case is completed.  The more information the adjuster is able to provide the investigator the better.  Some of the top investigation companies have case management systems which ultimately makes communication easier and more efficient.  With a case management system, the adjuster is able to send pictures, notes, comments and other information to the investigator on a timelier basis.

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