• • • Subrogation Management: Subrogation Management takes the claim from the initial scene investigation, further develops the facts by creating an Investigative Plan. The plan is created in Consultation with the client or the law firm. Once approved, the plan is managed as it determines additional facts and focuses on potential responsible persons or products. Management also assists in securing evidence, selecting experts and testing to make the file ready for subsequent use by the law firm.
  • Investigative Management for Claim Defense: This involves working directly with the law firm to review known facts and determine strategic needs. Then overseeing the process of verifying facts, location and interviewing witnesses. Then, if needed, use the Medical Investigation and Audit protocol to examine the medical documents to validate or deny the claim.

OUR PEER REVIEW INCLUDES:

NFPA Standards, Codes, Guidelines and ASTM Standards

DIFFERENCE BETWEEN A PEER REVIEW AND A TECHNICAL REVIEW:

In a detailed PEER REVIEW we will discuss with you further items that will reinforce your opinions, any other suggested investigative activities and, indicate any mistakes in information or typos etc. In a less detailed TECHNICAL REVIEW  we would only review whether the proper methodology was utilized. We would of course, point out obvious mistakes and typos etc. We would not go into detail with suggestions for reinforcement of determinations or follow up activities. In either case, you would receive a paragraph from us to add to the bottom of your report indicating that the report was either Peer or Technically reviewed and that it met the minimum requirements.

SEND US YOUR REPORT FOR PEER OR TECHNICAL REVIEW

• Theft – Home Owner or Commercial: Beginning with a site visit, the investigation will determine the validity of the claim, conduct the needed interviews, contact law enforcement, conduct a neighborhood canvass, and obtain and verify the receipts or documents that support the claim.
• Workers Compensation, Auto Liability, and Injury Claims: Determine the facts that would support or deny the validity of the claim. Manage any needed surveillance or investigation to determine the activity level of the claimant. Interview any witness to the event or discover other witnesses. Utilize Medical Investigation and Audit protocols to establish prior existing physical conditions, other potential causes of injury, use the National Federal Registry to benchmark billing amounts, code correctness and evaluate medical standards of care questions.
• Fraud and other types of claims: Determine facts supporting claims in Mortgage Fraud, Credit Life and Disability, Inland Marine and Maritime, Fiduciary Trust and Identify Theft issues.
• Contracted Special Investigation Unit: Many states require Mandated Fraud Reporting if fraud is suspected in a claim. Many also require the presence either in-house or by out source contract a Special Investigations Unit to conduct investigations in suspect claims and regular training of adjusters in fraud issues.
• Training for Adjuster Staff in Fraud issues: Workshop and Seminar setting training is available in all types of insured claims matters. This training reviews with adjusters of fraud and overviews the common fraud schemes. The training also presents methods to resist the suspect claim.