Case Study 1: Insurance Fraud

We have completed thousands of matters in relation to personal injury claims.

Our work covers both litigated and non-litigated matters with reserves ranging from a few thousand dollars to many millions of dollars.

The following case is typical.

BackgroundObjective: Test assertions made in claim using information obtained from social media and other online sources.
Collection & Preservation of Probative DataOSINT tools identified many sources of social media accounts contextually and directly linked to the matter. We used our array of forensic data acquisition tools tools to access, collect and preserve all public social media information available. All posts / ESI were collected in a logical evidence container that does not allow content alteration or unmonitored access to items collected. All items were given an algorithmic hash-value (fingerprint) generated on the basis of item-specific attributes and the date and time of collection – this ensures that items cannot be altered.  The metadata also included all of the online social network published metadata in relation to the items collected.
CollationItems were tagged according to themes that were relevant to observations we made that conflicted with assertions made by the insured. Example themes were: “Time and Place”, “Degree of incapacity / impairment”, “Commercial Activity”.  Other categories were derived from clinical sources including American Medical Association Guides to the evaluation of permanent impairment, 6th edition (AMA6).  
AnalysisWe compared declarations made in claims forms and in other dialog with insurance company representatives and medical professionals. Material differences in  function compared to self-reported impairment were further investigated. Patterns of postings and communications were identified with reference to content to substantiate function or incapacity at different points in time.
ProductOnline access to collection for external legal counsel and claims assessor to search and review material for their own tagging / subjective organisation of collection. Legal load-file export of collection. Report summarising our findings specifying observations and open questions in relation to the claim. Presentation of data in a report format for Independent Medical Examiner (IME) recategorization or consideration. Videos posted by the plaintiff to TikTok and Instagram were also provided for review.
OutcomeOur collection provided material that led to the claim being declined, after the material was presented to the plaintiff in a legal conference. The financial result was a significant saving to the insurer. The reasonable basis for the declination of the claim was based on our OSINT report and data collection.
CommentsThis is a common category of our work for. Recently we took on a portfolio of suspicious matters under investigation by various claims managers who had been unable to progress the investigation using conventional methods. We drilled-down on assertions in the claims to better inform claims teams about the genuineness and honesty of claims. Our approach provided information not available using commonly available alternatives. We found important revelatory material when other approaches had been exhausted. In over 30% of psychological claims investigated by us, we have identified material inconsistencies between the claim and the actual status. It is not unusual for us to identify claimants working or leading active and interesting lives when they assert that they are unable to perform basic activities of daily living. We aim to augment other claims management processes to ensure faster negotiations and better settlements.