Claims Investigations
What is a Jury Pool Investigation and Why Does it Matter?
When a case is heading toward trial, every piece of preparation matters, including understanding who may end up serving on the jury. A jury pool investigation i...
Learning Center
Insights on claims investigations, medical management, fraud detection, and industry trends.
Case Management Claims Investigations Complex Litigation Digital Investigations IME Medical Bill Review Medical Canvassing Medicare Solutions Surveillance Utilization Management
Claims Investigations
AI-Generated Medical Records: What Claims Teams Need to Know
Creating a convincing fake medical record once required extensive knowledge of clinical terminology, billing codes, and provider documentation practices. Today,...
Claims Investigations
Lessons from the Largest Healthcare Fraud Takedown
Picture this: A doctor reviews a young athlete�s heart screening. Not in eleven minutes � in eleven seconds. According to federal prosecutors, that�s exactly wh...
Case Management
What are Psychosocial Factors in Workers� Compensation?
Claims professionals know that two workers with identical injuries don�t always follow the same recovery path. They may have the same diagnosis and same treatme...
Claims Investigations
Agentic AI: What Claims Professionals Should Know
AI has mostly been used as an assistant, helping generate content, answer questions, or complete tasks when prompted. Agentic AI works differently. Instead of w...
Claims Investigations
What is Embedded SIU and Why Does it Matter?
For many insurance organizations, claims and SIU operate in separate lanes. Claims teams manage the claim, and SIU gets involved when something raises concern....
IME
Peer Review vs. IME: What�s the Difference?
A peer review and an independent medical exam (IME) both help answer medical questions within a claim, but they serve different purposes. Choosing the wrong one...
Claims Investigations
Hurricane Season Fraud Risks for Claims Teams
In September and October 2024, Hurricanes Helene and Milton made landfall on Florida�s Gulf Coast just two weeks apart, generating more than 436,000 claims acro...
Utilization Management
AI in Utilization Review: Current Uses and Regulations
Artificial intelligence is becoming more visible across healthcare and claims operations, including utilization review. As AI tools become more integrated into...
Claims Investigations
Fraud Detection Without Exposure in Claims Investigations
Bad faith verdicts rarely start with a carrier paying a fraudulent claim. More often, they start with a carrier denying a legitimate one, and a claim file that...
Digital Investigations
Why Image Authentication Matters in Modern Claims
In 2025, a UK-based insurer reported a 71% increase in detected fraudulent claims, a trend the company linked to both rising AI-assisted fraud attempts and impr...
Claims Investigations
Device and Location Data in Claims Investigations
Nearly half of American adults own a smartwatch or fitness tracker, and almost every claimant today carries a GPS-enabled smartphone. That means many claims now...
Medical Bill Review
What is Liability Bill Review and Why Does it Matter?
A bodily injury claim may come with hundreds, sometimes thousands, of dollars in medical charges. Some are well-supported and appropriate. Others may contain bi...
Claims Investigations
Why a High-Performing PPO Network Delivers Value
Medical costs in workers� compensation continue to rise. As claims become more expensive and complex, the quality of a PPO network can play a significant role i...
Case Management
How PBM Data Can Reveal Workers� Compensation Claim Trends
When a workers� compensation claim starts to go off track � costs rising, recovery slowing, and prescriptions increasing � the warning signs are usually there e...
IME
Five Red Flags that Signal a Claim Needs Peer Review
Many treatment plans are straightforward. An injury occurs, a provider recommends care, and the claimant recovers. But some claims follow a different pattern, o...
Claims Investigations
Complex Medical Claims: A Guide for Claims Professionals
Those working in claims management know that not all claims carry the same level of complexity. A straightforward soft-tissue injury from a minor fender-bender...
Medical Bill Review
What is Workers� Compensation Bill Review?
Medical costs are the dominant financial driver in workers� compensation. For claims professionals, keeping those costs accurate and defensible is crucial. Work...
Claims Investigations
How to Spot Automotive Arson: Was it Really an Accident?
Automatic arson might spark curiosity, but for insurance adjusters, investigators, and claims professionals, a burning vehicle is far less cinematic than it see...
Case Management
Should You Assign a Peer Review Before an IME?
When a claim reaches a medical crossroads � disputed diagnoses, questions about causation, unclear treatment plans � the instinct for many adjusters, nurse case...
Case Management
What Makes Mental Health Claims so Difficult to Resolve?
A back strain comes in and, at first, the claim seems fairly routine. But six months later, the file is still open. Treatment continues without a clear endpoint...
Claims Investigations
Social Media Investigations and Surveillance in Summer
Every summer, millions of Americans pack their bags, head outdoors, and document nearly every moment of it online. For claims professionals, this seasonal shift...
IME
The 2026 IME Market Report
Executive Summary We surveyed claims professionals across the United States to understand how Independent Medical Examinations (IMEs) � evaluations conducted by...
Claims Investigations
Medical Fraud Rings: Transnational Fraud
The most dangerous fraud rings in healthcare today don�t operate out of a single clinic, city, or even country. They operate everywhere at once, and they�re get...
Claims Investigations
How Ordinary Providers Get Recruited into Criminal Networks
In June 2025, the Department of Justice announced the largest healthcare fraud takedown in its history: 324 defendants charged, $14.6 billion in alleged losses,...
Claims Investigations
AI in SIU Investigations: Tools, Threats, and Trends
Insurance fraud is no longer just exaggerating a fender bender claim or a slip-and-fall at a grocery store that never quite happened. Those cases still exist, b...
Claims Investigations
Medical Fraud: How to Spot Patient vs. Provider Red Flags
Medical fraud starts small, maybe a therapy session that never actually happened, then one line item turns into a dozen. Multiply that by thousands of providers...
Claims Investigations
5 Mistakes That Can Lead to Bad Faith Claims
Every claims professional knows the goal: investigate thoroughly, document everything, and resolve claims fairly. But in practice, the pressure of high caseload...
Utilization Management
Utilization Review Services Explained
Healthcare costs in the U.S. aren�t slowing down. National health expenditures reached roughly $5.3 trillion in 2024, growing about 7% year-over-year. At that l...
IME
Medical Management: Containing Workers� Comp Costs
Healthcare costs are climbing, and in workers� compensation, that means claims are becoming more expensive, more complex, and harder to close. For claims profes...
Claims Investigations
Insurance Fraud Prevention Tools: Guide for Claims Managers
Insurance fraud prevention tools have never been more necessary or more urgent. The Coalition Against Insurance Fraud estimates that fraud costs U.S. consumers...
Claims Investigations
$20 Million Mount Everest Insurance Fraud Scam
A helicopter evacuation on Mount Everest runs $5,000 to $10,000 a flight. These evacuations happen constantly in the Himalayas�altitude sickness, injuries, exha...
IME
When are Remote Independent Medical Exams the Right Choice?
Telehealth now accounts for millions of patient interactions in the U.S. and continues to play a meaningful role in how care is delivered. As its use has expand...
Claims Investigations
The Psychology Behind Insurance Fraud
Did you know more than one-third of Americans think it�s acceptable to exaggerate an insurance claim? Did you millions of Americans don�t even consider insuranc...
Surveillance
Surveillance: How Data-Driven Planning Leads to Success
Traditionally, one of the most common questions in surveillance has been simple: How long should it last? The standard answer was typically a minimum of four ho...
Claims Investigations
Marine Insurance: Shaping the Flow of Global Trade
Global trade is widely understood to depend on supply chains, geopolitics, and infrastructure. Marine insurance is just as critical, as it plays a central role...
IME
Independent Medical Exams: Top 5 Trends in 2026
Independent medical exams (IMEs) are are becoming a central part of how complex claims are evaluated, validated, and resolved. That shift is being driven by ris...
Claims Investigations
KitKat Truck Heist: What It Reveals About Transport Fraud
Over 400,000 KitKat bars�gone. In early 2026, a truck carrying roughly 12 tons of KitKat chocolate bars disappeared while in route across Europe. The shipment,...
Claims Investigations
2025 State of Insurance Report
A Note from the CEO If there�s one thing we can all agree on, it�s that 2025 hasn�t given us much time to catch our breath. Between shifting regulations, emergi...
Claims Investigations
5 Red Flags That Should Trigger SIU Investigations
Most questionable claims look routine at first. The details seem consistent and the documentation appears complete. But as the claim develops, small inconsisten...
Claims Investigations
What is Claim Verification and Why Does it Matter?
For most claims professionals, the pressure is constant: move quickly, make sound decisions, and keep claims progressing. Today, claims are more complex, docume...
Case Management
Field Case Manager vs. Telephonic Case Manager
Understanding the difference between a field case manager and a telephonic case manager is critical in workers� compensation claims. While both roles support in...
Claims Investigations
Hard vs. Soft Fraud in Auto Claims: What�s the Difference?
Fraud in auto insurance claims doesn�t always look the way people expect. Sometimes it�s a fully staged accident, carefully planned from start to finish. Other...
Case Management
Return-to-Work Planning for TBI Claimants
This article was written by Julie Dunn, RN, CCM. He was ready to go back. At least, he thought he was. Eight weeks after a fall from a maintenance platform left...
IME
Why Peer Review Should Come Before an IME
In claims management, the order of operations matters more than most people realize. One of the simplest ways to improve both efficiency and outcomes is to reth...
Case Management
The Role of the Nurse Case Manager in TBI Recovery
This article was written by Julie Dunn, RN, CCM. She was a 42-year-old warehouse supervisor, a mother of two and a team leader her coworkers counted on. After a...
Case Management
What Defines a High-Quality Case Manager?
In today�s claims environment, the role of a case manager is more critical than ever. When someone is injured, whether from a workplace incident or another type...
IME
Why IME Cover Letters Make or Break Claims
Independent Medical Exams (IMEs) play a critical role in claim resolution. But here�s the reality that often gets overlooked: An IME is only as effective as the...
Case Management
Traumatic Brain Injury Claims in Workers� Comp
This article was written by Julie Dunn, RN, CCM. A construction worker takes a fall from a ladder and hits his head. He�s conscious, alert, and insists he�s fin...
Claims Investigations
Can Autonomous Vehicles Be Used to Stage Accidents?
Self-driving vehicles are often promoted as the future of safer transportation. With cameras, sensors, and artificial intelligence assisting with driving decisi...
IME
When is it Time to Schedule an Independent Medical Exam?
In injury claims, medical information often plays a central role in how a case unfolds. Treatment recommendations, disability status, and projected recovery tim...
IME
What is a Full File Peer Review in Insurance Claims?
In complex insurance claims, medical evidence often shapes the financial exposure of the case. One tool used to evaluate medical issues is full file peer review...
Claims Investigations
Why are Zelle and Venmo Scams So Hard to Reverse?
In 2023 alone, consumers reported over $10 billion in fraud losses, according to the Federal Trade Commission, with bank transfers and payment apps among the fa...
IME
What Happens After an IME? Next Steps for Claims Teams
The Independent Medical Exam (IME) provides an objective, third-party medical opinion. Once the report is received, the focus shifts to evaluating the conclusio...
Digital Investigations
OSINT Investigations: Emerging Trends and Modern Tools
There was a time when most claim reviews were manual. Adjusters opened files, searched databases, reviewed documents, and made decisions based on what they coul...
Digital Investigations
Image Authentication in Claims: A Checklist to Reduce Risk
Photos carry weight. A single image can influence a claim decision, compliance review, legal strategy, or security response. For that reason, image authenticati...
Claims Investigations
When AI Flags a Claim, What Happens Next?
Artificial intelligence is no longer the �future� of claims operations, it�s the present. From automated intake to fraud detection, AI now powers some of the mo...
Claims Investigations
Smart Surveillance: Privacy in Claims Investigations
Public attitudes toward surveillance and AI are shifting quickly. If you�ve been paying attention to recent headlines, you�ve probably noticed that the backlash...
Claims Investigations
Understanding Claims Triage and Resource Allocation
A useful way to understand claims triage is to think about how an emergency room operates. When patients arrive, a triage nurse assesses each one. A broken arm...
IME
What Makes an Independent Medical Exam Valuable?
In a claims environment where every expense is scrutinized, it�s natural to compare Independent Medical Exam (IME) vendors based on price. But here�s the realit...
Digital Investigations
5 Essential Tools in OSINT Investigations
OSINT investigations involve collecting and analyzing publicly available information to support decision-making, verify claims, and detect fraud. OSINT investig...
Utilization Management
6 Documentation Gaps That Slow Down Utilization Review
Utilization review (UR) plays a key role in making sure patients get medically necessary care while keeping healthcare costs in check. But in practice, most del...
IME
Why an Independent Medical Exam Faces Scrutiny
An Independent Medical Exam (IME) is intended to be straightforward: a clinical evaluation conducted by a qualified, independent physician. In litigation, howev...
Medical Canvassing
Medical Canvassing: What it Delivers & What�s Next
Medical canvassing can provide major value to claims teams and help surface potential fraud, but only when it�s done correctly and professionally. At its core,...
Digital Investigations
What�s the Difference Between the Deep Web and the Dark Web?
When people hear the term dark web, the mental image is usually dramatic: hooded hackers, shadowy computer setups, and a hidden internet where everything is ill...
Case Management
What Does a Case Manager Do and Why Does it Matter?
Those who work in claims have heard the term case manager thrown around in clinical, administrative, advocacy, and cost containment conversations. But what do t...
Claims Investigations
What Happens During Auto Accident Investigations?
Auto accident investigations play a critical role in determining what happened after a crash, who may be at fault, and how insurance claims should be resolved....
Case Management
What is Medical Peer Review and Why Does it Matter?
Medical peer review is a term that gets tossed around in medical management conversations, but the details don�t always get spelled out. Medical peer review is...
Claims Investigations
The Modern Claims Investigation in the Age of Skepticism
On paper, the insurance industry continues to grow. New fraud detection technology, new platforms, and new efficiencies are rolling out faster than ever. But if...
Utilization Management
Debunking Utilization Management Misconceptions
Utilization management touches nearly every corner of healthcare, yet most people only see it when something goes wrong. For adjusters, it�s part of the daily w...
Claims Investigations
Why Manual Claims Workflows Are Costing Insurers
In retail, finance, and healthcare, data drives decisions. Predictive analytics guide inventory management, real-time recommendations shape customer experience,...
Medicare Solutions
MSP Services: What They Are and Why They Matter
MSP services play a major role in healthcare and claims, yet they�re often misunderstood. MSP stands for Medicare Secondary Payer, the federal rules that determ...
Digital Investigations
What is an OSINT Investigation and Why Does it Matter?
An Open-Source Intelligence (OSINT) investigation involves collecting and analyzing publicly available information to uncover insights, verify claims, and ident...
Claims Investigations
SIU Investigations in the Age of AI-Generated Fraud
Insurance fraud has always adapted to new technology, but artificial intelligence is accelerating that evolution at an unprecedented pace. Today, AI isn’t just...
Claims Investigations
Why Mental Health Claims Differ from Traditional Claims
Mental health claims have increased sharply in recent years, reflecting a sustained rise in demand for behavioral health services. Between 2019 and 2023, mental...
Claims Investigations
When to Use a Complex Claims Investigation
Not every claim follows a straight path to resolution. While many cases move through standard processes, others quickly become more complicated due to medical,...
Claims Investigations
What are Activity Checks in Claims Investigations?
Claims investigations are often about verifying whether a claim aligns with real-world behavior. Activity checks are one of the most efficient tools investigato...
Case Management
Case Management in the Era of Wearable Health Devices
Medical case management has traditionally relied on snapshots in time, including office visits, progress notes, and patient self-reporting. Wearable health devi...
Claims Investigations
How to Analyze Recorded Statements as an Adjuster
Recorded statements are one of the earliest and most influential tools in the claims process. When conducted and analyzed correctly, they help establish facts,...
Claims Investigations
What are Liability Demand Reviews in Claims?
Liability claims often arrive with attorney demand packages, including bundles of medical records, billing statements, injury narratives, wage documentation, an...
Surveillance
Manned Surveillance vs. Unmanned Surveillance
Today, insurers rely on two primary surveillance approaches: manned surveillance, conducted by a trained investigator in the field, and unmanned surveillance, w...
Digital Investigations
What is a Social Media Investigation and Why Does it Matter?
When someone files a claim, opens a case, or reports an injury, investigators rely on many tools to understand what really happened. One of the most effective a...
Claims Investigations
Navigating Work-From-Home Injury Claims: How to Investigate
When the office becomes a kitchen table or spare bedroom, the rules of Workers’ Compensation don’t always feel so clear. Work-from-home (WFH) has become a perma...
Case Management
What Does a Telephonic Case Manager Do in Workers� Comp?
Telephonic case management is a core service in Workers� Compensation and disability programs, designed to guide injured employees through recovery while helpin...
Case Management
What is Vocational Case Management and Why Does it Matter?
When someone is injured, displaced from work, or facing a disability that makes employment difficult, getting back into the workforce isn’t just a matter of “fi...
Claims Investigations
Why the Holidays Increase Insurance Fraud Risk
When severe weather collides with year-end pressures and a surge in claims, the holiday season creates a perfect environment for insurance fraud to slip through...
Case Management
What Does a Catastrophic Case Manager Do?
When most people think about Workers’ Compensation, they picture routine injuries, such as sprains, minor fractures, and maybe a short course of physical therap...
Claims Investigations
The Florida Shuffle Explained: Over $100M Fraud Scheme
For a scheme that generated millions in fraudulent activity, the Florida Shuffle remains surprisingly unknown outside fraud and legal circles. While it rarely m...
Case Management
What Every Case Manager Should Know About RTW Technology
For years, return-to-work decisions were driven by experience, instinct, and a lot of time-consuming guesswork. The case manager has had to make tough calls wit...
Claims Investigations
Debunking Myths About Privacy in Claims Investigations
Privacy has become one of the most misunderstood parts of claims investigations. Claimants often assume insurers have limitless power to monitor, record, or fol...
Medical Canvassing
Is Medical Canvassing Still Useful Today?
Technology has transformed claims investigations: faster access to medical records, more connected data systems, and deeper digital insights into claimant behav...
Surveillance
Surveillance Limits: What’s Lawful vs. Intrusive?
Technology has expanded what’s possible in claims surveillance, but it hasn’t changed the legal and ethical boundaries. Investigators must balance evidence-gath...
Claims Investigations
Claims Investigations: Dos and Don�ts for Investigators
Insurance investigations walk a careful line. On one hand, insurers have a duty to verify claims through thorough claims investigations and protect themselves f...
Surveillance
Surveillance 101: Strategies for Investigators
Insurance fraud costs the U.S. an estimated $308.6 billion every year, which means strong surveillance is essential. It remains one of the most effective tools...
Digital Investigations
Deleted Posts in Social Media Investigations
The biggest misconception in social media investigations is the idea that once a social media post is deleted, it disappears forever. However, that couldn�t be...
Claims Investigations
The Rising Threat of Long-Term Care Fraud
Long-term care (LTC) fraud has rapidly evolved from a niche concern into a major industry challenge. According to the Coalition Against Insurance Fraud (CAIF),...
Utilization Management
How Much Does Utilization Review Really Save?
Medical costs are climbing. In fact, for many carriers and self-insured employers, the medical spend in workers� compensation and liability lines is outpacing w...
Case Management
5 Trends Shaping Medical Case Management in 2025
Medical case management is evolving faster than ever, and 2025 is shaping up to be a year defined by new tools, new expectations, and new pressures on care coor...
Medical Bill Review
Bill Review: How AI is Transforming the Process
Bill review has always been one of the most time-consuming and expensive parts of medical management. Manual data entry, coding complexities, and accuracy issue...
Case Management
Why Medical Case Management is on the Rise
The world of healthcare is changing. There are more older patients, more chronic diseases, and more pressure on already stretched systems. Advancements in medic...
Claims Investigations
Biometric Data in Claims and Medical Management
Have you ever wondered how your phone can identify your face in a split second? That�s biometric data at work. Biometric data is the physical and behavioral tra...
Claims Investigations
Forensic Verification in Claims Investigations
What used to be a reliable source of truth is now frequently fabricated. With AI-driven image editing, synthetic media, and deepfake tools readily available, vi...
Surveillance
The Legal Landscape of Modern Surveillance
Surveillance tools are advancing faster than the laws that govern them. Drones, AI-driven video analytics, biometric recognition, and high-resolution imaging ha...
Case Management
Medical Case Management Amidst Viral Trends
In a world where Google searches and social media feeds often replace doctor visits, one question keeps coming up: has online health advice replaced human guida...
Digital Investigations
How Digital Investigations Have Evolved in 2025
Ten years ago, digital investigations were simple: scroll through a claimant�s social media, take screenshots, and document inconsistencies. In 2025, digital in...
Claims Investigations
Where Medical Bill Review Meets Investigations
For many carriers, medical bill review and claims investigations operate in separate corners of the claims lifecycle. Bill review teams focus on cost containmen...
Digital Investigations
How Digital Investigations Strengthen Claims
When it comes to claims work, evidence is everything. The medical reports, witness statements, and surveillance footage are all important. In today�s connected...
Claims Investigations
Bundled Investigations: Smarter Claims Strategy
When managing a complex claim, the pressure is real: rising medical bills, ambiguous treatment narratives, and the hunt for evidence that holds up under scrutin...
Claims Investigations
Top EDR Mistakes in Claims Investigations
In today’s world of increasingly complex claims investigations, the event data recorder (EDR) has become one of the most valuable tools available. Sometimes cal...
IME
What’s the Difference Between an IME and a CME?
Those who handle injury claims have probably heard the terms “IME” and “CME” tossed around, but they don’t mean the same thing. Independent medical exams and co...
Claims Investigations
What’s the Real Cost of a Staged Auto Accident?
Let’s start off with some cold, hard facts: Industry experts estimate that staged auto accidents cost insurers around $20 billion annually in the U.S. alone. Th...
Claims Investigations
Insurance Trust Gap with Younger Generations
The insurance industry is experiencing record growth. Premiums are rising, new technologies are transforming claims processes, and more products are available t...
Case Management
The Impact of Telehealth on Medical Case Management
When telehealth surged during the pandemic, many people saw it as a temporary fix to bridge the distance between patients and providers. Five years later, it’s...
Case Management
Medical Case Management: The Evolution from Manual to Modern
Medical case management has come a long way. Once a paper-heavy process focused largely on scheduling and claims paperwork, it’s now a sophisticated, patient-ce...
Case Management
Recognizing Fraud in Medical Case Management
Whether coordinating care, managing return-to-work plans, or liaising with medical providers, case managers are working with many moving pieces. While case mana...
Claims Investigations
Exposing Auto Fraud Rings with Claims Investigations
When most people think of staged auto fraud, they picture a car cutting off another driver, slamming the brakes, and causing an inevitable rear-end collision. F...
Case Management
Health Literacy in Medical Case Management
In the realm of medical case management, professionals often focus on clinical assessments, treatment plans, and cost containment. However, one critical element...
Case Management
How Medical Case Management Addresses Burnout
Burnout is emerging as a major factor in Workers� Compensation claims. The World Health Organization (WHO) recognizes burnout as an �occupational phenomenon� ti...
IME
Common Pain Points in Independent Medical Exams
Independent Medical Exams (IMEs) are supposed to bring clarity to complex claims. When done well, they provide defensible, evidence-based opinions that support...
Claims Investigations
Claims Investigations and Subrogation Recoveries
When a loss occurs, claims investigations start with the basics: What happened? Who�s responsible? And how much should be paid? But there�s a fourth question th...
IME
Independent Medical Exams: 5 Must-Have Records
When it comes to Independent Medical Exams (IMEs), the outcome is only as strong as the information provided to the physician. Without the right background, IME...
IME
Independent Medical Exams: Red Flags to Watch For
Independent Medical Exams (IMEs) should clarify medical facts, not create new disputes. When an IME is defensible, transparent about conflicts, thorough in reas...
Case Management
Medical Case Management: Early Intervention
When it comes to Workers’ Compensation, timing is everything. The earlier a case manager gets involved, the better the chance of keeping recovery on track, cont...
Case Management
Medical Case Management: Old vs. New Injuries
Pre-existing conditions are among the trickiest variables in Medical Case Management. Many injured workers come into claims with past injuries, chronic health i...
IME
The Ethics Behind Independent Medical Exams
Independent Medical Exams (IMEs) play a pivotal role in Workers’ Compensation and liability claims. They’re designed to deliver an objective, expert medical opi...
Claims Investigations
Drone Advancements in Claims Investigations
Picture this: a homeowner files a claim for roof damage after a hurricane. Instead of waiting days for an adjuster to climb a ladder and manually document the d...
Case Management
The Impact of Psychosocial Factors in Case Management
Physical injury no longer tells the whole story in Workers’ Compensation. Psychosocial factors, including fear of re-injury, poor recovery expectations, and low...
Case Management
Why is Catastrophic Case Management Essential?
Catastrophic claims represent fewer than 1% of all Workers’ Compensation cases, but they often drive a disproportionate share of costs. Life-altering injuries,...
Case Management
Case Management Guide: Field vs. Telephonic
Case management, as defined by the Case Management Society of America, is �a collaborative process of assessment, planning, facilitation, care coordination, eva...
IME
Independent Medical Exams and Return-to-Work
When an employee gets hurt, everyone shares the same goal: help them recover and return to work safely, without unnecessary delays or costs. But returning to wo...
Claims Investigations
When to Use a Medical, Neighborhood, or Witness Canvass
A witness canvass, neighborhood canvass, and medical canvass each serve a distinct purpose and it’s important to know which one works best with a claim. Missing...
Claims Investigations
Activity Checks vs. Surveillance: What�s the Difference?
You may have heard activity checks and surveillance tossed around interchangeably in claims discussions. Using the right term and, more importantly, the right m...
Claims Investigations
AOE-COE Investigations in the Remote Work Era
In Workers� Compensation, every claim comes down to one core question: did the injury really happen on the job? That�s where AOE-COE investigations come into pl...
Claims Investigations
The Value of Geolocation Data in Claims Investigations
Geolocation data is transforming insurance for both carriers and customers, offering new tools to enhance claims investigations and improve outcomes. By analyzi...
Claims Investigations
Fraud-as-a-Service Exposed: New Threat Facing Insurers
We�ve entered the era of subscription-based fraud, where criminals don�t need skills, just a login. Sophisticated crime tools that once required expertise are n...
Claims Investigations
The Role of Quality Reporting in Claims Investigations
When it comes to choosing a claims management partner, a lot of factors are important to consider. But according to a 2025 survey, one factor rose to the top: q...
Claims Investigations
Synthetic Identities & Life Insurance Fraud in 2025
Imagine approving a solid life insurance application: documents look accurate, the Social Security number (SSN) checks out, and everything appears legitimate. F...
Utilization Management
Utilization Review: Level 1 vs. Level 2
In the world of claims management, from Workers’ Compensation to auto, disability, and group health, Utilization Review (UR) plays a critical role in ensuring c...
Claims Investigations
How Do Insurers Demonstrate Intentional Fraud?
When it comes to proving intentional fraud, suspicion isn�t enough. In claims investigations, insurers need to build a case that shows intent. But how do you pr...
Claims Investigations
Insider Insurance Fraud: Former Agents Fueling a New Wave of Deception
Trust is a cornerstone of the insurance industry. Whether it�s a policyholder trusting their carrier, or an employer trusting their claims administrator, the wh...
Medical Canvassing
Busting the Top 5 Medical Canvassing Myths
Medical canvassing is one of the most effective tools in modern claims investigations, yet there are many misconceptions about it. Is it legal? Is it a HIPAA vi...
Medical Bill Review
Risks of Skipping Utilization Review and Medical Bill Review
In Workers’ Compensation claims management, every dollar counts. Claims teams are constantly balancing quality care for injured workers with the need to contain...
Utilization Management
Utilization Review and Nevada’s New ODG Formulary
Nevada is joining a growing list of states changing their Workers’ Compensation systems by adopting the Official Disability Guidelines (ODG) Drug Formulary, whi...
Claims Investigations
Why Do Fraudsters Target Commercial Fleets for Fraud?
Commercial fleets like delivery trucks, big rigs, and company vans are prime targets for organized fraud. The bigger the fleet, the more resources criminals wil...
Medical Bill Review
Bill Review Errors Costing Adjusters Billions
Medical bill review plays a critical role in preventing unnecessary costs and ensuring accurate claim outcomes. However, when the bill review process overlooks...
Claims Investigations
Insurance Fraud in the Wake of Innovation
For the insurance industry, the fight against insurance fraud is a perpetual arms race. Just when we think we�ve developed airtight defenses, fraudsters find ne...
Claims Investigations
Social Media Investigation in the Age of Quit-Tok
From sobbing in parked cars to calling out toxic bosses by name, more employees are taking their resignations due to mental health public and going viral for it...
Utilization Management
Prior Authorization: Stop Overbilling Early
Overbilling is one of the biggest frustrations in claims handling, especially when the extra costs could have been avoided. That’s where strong prior authorizat...
IME
Behind the Scenes of a Reliable IME Provider
When a claim hinges on medical evidence, a strong Independent Medical Examination (IME) can make or break your case. Whether you�re dealing with a liability cla...
Claims Investigations
How Marine Cargo Fraud Slips Through The Cracks
Every year, millions of tons of cargo move through U.S. ports. While most shipments reach their destinations safely, marine cargo fraud quietly costs insurers a...
Claims Investigations
5 Telehealth Fraud Red Flags to Watch For
Telehealth was one of the biggest pandemic success stories�suddenly, patients could see a doctor without leaving the house. But when healthcare went remote almo...
Claims Investigations
The Hidden Business of Healthcare Fraud Rings
You might picture organized crime as something out of The Sopranos — drug deals, stolen cars, or money laundering. But what if we told you that one of the bigge...
IME
5 Steps to Finding the Right IME Doctor for Liability Claims
In liability claims, the credibility of your Independent Medical Examination (IME) physician can make or break your defense. Whether you�re handling bodily inju...
Claims Investigations
5 Ways to Start Using AI In Your Claims Today
AI isn�t the future of claims � it�s already transforming it. If you�re on a claims desk today, you�re likely dealing with tight timelines, compliance pressure,...
Digital Investigations
AI vs. AI: Deepfake Creators vs. Investigators
Artificial intelligence is reshaping the way we live, work, and investigate fraud. While AI tools have helped insurers improve claims processing and detect susp...
Claims Investigations
Who’s Liable in Self-Driving Car Accidents?
As self-driving cars become more common on the roads, they’re bringing major changes to the insurance world. When a crash happens and no one is physically behin...
Claims Investigations
The Ethics of Surveillance in Workers’ Comp: What’s Too Much?
This article explores the ethical boundaries of surveillance in Workers’ Compensation, with a focus on how you as the employer or insurer can approach due dilig...
Claims Investigations
10 Disability Claim Red Flags You Can�t Miss
When it comes to managing disability claims, timing and accuracy are everything. A single missed red flag can lead to prolonged claims, inflated payouts, or wor...
IME
Understanding the Compulsory Medical Exam Process
A Compulsory Medical Examination is a court-sanctioned evaluation of a plaintiff’s physical or mental condition, requested by the defense. It’s not optional for...
Claims Investigations
Natural Disaster Fraud: 10 Signs of Contractor Fraud
In May 2025, communities across Kentucky, Missouri, and Texas were rocked by a wave of destructive tornadoes that left thousands in urgent need of repairs and r...
Case Management
5 Tips for Writing Strong Peer Review Questions
When you�re managing a Workers� Comp claim and things start getting complex, a peer review, Designated Doctor (DD), and Required Medical Exam (RMEs) are usually...
Case Management
How to Spot Provider Schemes?
Provider schemes start small�an oddly inflated bill, a flurry of unnecessary diagnostics, or a durable medical equipment (DME) rental that seems to outlast the...
Case Management
Workers’ Comp: Teletherapy for Mental Health Claims
Let’s paint a picture of a real-life scenario: Meet James, a 36-year-old firefighter, who began missing shifts after responding to a traumatic car accident, his...
Case Management
What Affects the Duration of a Disability Claim?
When a worker files a disability claim, it sets off a chain of decisions, timelines, and responsibilities that result in a swift, safe return to work or extend...
Claims Investigations
Workers’ Comp Fraud: How Surveillance Tech Is Catching Up
Workers’ compensation exists to protect employees who suffer unfortunate injuries on the job. WC offers them a pathway to recovery and income replacement while...
Claims Investigations
Psychology of Fraud: What is Rationalization?
We’ve all heard and maybe said, “It’s not that big of a deal.” Or maybe, “They won’t even notice.” These are the kinds of quiet justifications that are often an...
Case Management
How to Spot a Fake Job Offer: 5 Red Flags to Watch For
Job scams thrive when unemployment rates rise. It�s a harsh reality but as more people search for work, scammers seize the opportunity to take advantage of peop...
Claims Investigations
Medical Fraud: How to Spot Patient vs. Provider Red Flags
It starts with a routine bill. A quick office visit, a follow-up appointment, maybe a therapy session that never actually happened. One line item turns into a d...
Digital Investigations
OSINT: The Intelligence Cycle
Open Source Intelligence is one of the most valuable tools at your disposal today. It’s become a critical resource in fraud detection, claims validation, and mo...
Claims Investigations
Federal Black Lung Claims: The Real Cost of Coal
The Black Lung Benefits Act (BLBA) was passed by Congress in 1969 to fill the gaps left by state Workers� Compensation programs. It provides financial and medic...
Claims Investigations
5 Most Common Red Flags in Water Damage Claims
Water damage claims have long been a challenge for adjusters like yourself, but recent trends show an alarming rise in fraudulent activities, particularly in st...
Claims Investigations
Medical Bill Review: Staying Ahead in a Changing Landscape
Medical bill review is no small feat in the world of insurance claims. Whether you’re handling Workers’ Compensation, disability, or personal injury claims, acc...
Claims Investigations
IME Red Flags: Low-Speed Collisions & Questionable Injuries
When a minor fender bender results in a major injury claim, it inevitably sparks some red flags. As an adjuster, low-speed collisions often present a challenge�...
Claims Investigations
Arson or Accident: How Experts Determine the Cause of a Fire
Understanding the red flags of arson is essential for insurance adjusters, risk managers, and law enforcement. Once you�ve learned to find the first signs of an...
Claims Investigations
How Long Do Independent Medical Exams Take?
An Independent Medical Exam (IME) is a comprehensive medical evaluation conducted by a neutral and independent medical professional. Click here to get a quick r...
Claims Investigations
How do Case Managers Support the Utilization Review Process?
When it comes to managing costs while ensuring quality patient care, the utilization review (UR) process is a requirement. But who makes sure this process runs...
Case Management
Why Are Nuclear Verdicts on the Rise?
Nuclear verdicts aren’t just a buzzword anymore – they are becoming a real threat to the insurance industry, and in this blog, we’ll dig into why claims that on...
Claims Investigations
Image Authentication Strategies from OSINT Certified Experts
Image Authentication is an essential process for verifying the integrity of images and videos, ensuring they haven�t been altered or manipulated. As technology...
Case Management
What is the Role of Case Managers in Workers Compensation?
If you�re an insurance adjuster handling workers� compensation claims, you�ve likely encountered case managers (CMs) but may not fully understand their role. Ca...
Claims Investigations
Medical Canvassing: 3 Key Tips for Consistent Success
Before diving into the common problems, let’s take a quick look at what medical canvassing is and why it’s important. Medical canvassing involves gathering info...
Utilization Management
UR Nurses’ Guide to Compliance and Treatment Approvals
Utilization Review (UR) nurses play a pivotal role in workers’ compensation claims. They balance regulatory compliance with ensuring appropriate medical care. H...
Claims Investigations
Disability Fraud: How Social Media Searches Can Help You
As a claims adjuster, you know that detecting fraud is a constant part of your job. Unfortunately, disability fraud is all too common, and it costs our industry...
Case Management
Do Case Managers Coordinate Independent Medical Exams (IMEs)?
Independent Medical Exams (IMEs) play a critical role in the claims process. They can help insurance adjusters like you, validate injuries, confirm treatment ne...
Claims Investigations
Claims Litigation: The Adjusters Guide
The insurance litigation process is not for the faint of heart. Think of it as a high-stakes chess match�one wrong move, and you�re facing costly setbacks. But...
Medical Bill Review
Navigating the Complexities of Out-of-Network Billing
Out-of-network billing is one of the most complicated areas in medical bill review, and it’s becoming even more of a headache for insurers. When a patient recei...
Claims Investigations
Claims Management: When and How to Engage Vendors
Whether it�s a surveillance expert, medical management service, or digital investigator, bringing in the right vendor at the right time can make all the differe...
Case Management
Long Term Disability: Does Your Claimant’s Condition Qualify?
When handling long term disability (LTD) claims, one of the most critical questions adjusters and case managers face is: Does this claimant’s condition qualify...
Claims Investigations
How to Read an Event Data Recorder Report
When a crash is submitted to an insurance company, reviewing an Event Data Recorder (EDR) report is often a critical step in determining liability, verifying cl...
Claims Investigations
Is Medical Canvassing Legal?
You’re an insurance adjuster or risk manager trying to assess the validity of a claimant’s medical history. You need reliable, actionable information to make in...
Medical Bill Review
How Healthcare Price Transparency is Reshaping Medical Bill Review
How Price Transparency is Transforming Medical Bill Review Healthcare costs have been a bit of a mystery for years � unpredictable, complex and hard to navigate...
Claims Investigations
Workers’ Compensation Settlement: 3 Important Steps
All insurance claims go through an inspection process before legitimacy can be established but today we’ll be discussing specifically the circumstances of Worke...
Claims Investigations
AI Liability and Negligence Cases: Who�s Responsible?
For the first time ever, Adjusters are dealing with AI liability and negligence cases, from automated driving systems to decision-making algorithms, AI introduc...
Claims Investigations
The Growing Investment in Generative AI for Claims Handling
Artificial Intelligence (AI) has quickly evolved from a futuristic concept to a game-changer in industries worldwide, particularly in claims management. Accordi...
Medical Bill Review
What is a Medical Bill Review? How Long Is the Process?
What is a Medical Bill Review? In simple terms, a medical bill review is a process where qualified experts review a patient�s medical bill to ensure all charges...
Case Management
Ethos 2024 Industry Analysis: The Power of AI
Ethos� 2024 Annual Publication delivers a comprehensive analysis of emerging trends in AI and its transformative role within the insurance industry and medical...
Claims Investigations
Exposing Staged Accidents with Cross-Referenced Evidence
Staged accidents are a costly threat to insurers. From fraudulent injury claims to inflated damages, these deceptive practices drive up premiums, increase payou...
Claims Investigations
5 Must Know Workers� Compensation Regulations Coming in 2025
With the end of the year quickly approaching here are some of the most important trends, regulations, and laws being introduced as of January 2025. Regulations...
Claims Investigations
How Technology Impacts Medical Claims Management
Technology plays a transformative role in streamlining medical claims management. Cutting-edge tools like Artificial Intelligence (AI), automation, and predicti...
Utilization Management
Why Does Value-Based Care Matter in Utilization Management?
As the healthcare industry continues to evolve, value-based care (VBC) has emerged as a transformative approach designed to improve patient outcomes while manag...
Medicare Solutions
What is Medicare Secondary Payer (MSP) and How Does It Work?
Understanding Medicare Secondary Payer In the world of insurance claims, navigating Medicare Secondary Payer (MSP) rules can be challenging. In this article, we...
Utilization Management
Simplifying Utilization Management
Utilization review goes hand in hand with Medicare and Medicaid. This process was developed as a cost-containment strategy to combat against overuse of services...
Utilization Management
Prior Authorization Compliance 2026: Are You Ready?
For years, healthcare providers and patients have criticized the Prior Authorization process for causing unnecessary delays in care. However, upcoming regulator...
Claims Investigations
5 Signs of Storm Fraud Post-Hurricane
Let us understand why it�s important for adjusters, risk managers, and anyone who�s ever experienced a natural disaster to be aware of the post-storm fraud risk...
Claims Investigations
Detect Insurance Fraud: A Guide for Claims Managers
With insurance fraud becoming more advanced every day, understanding the complexities is important for effective claims management. Tackling this problem requir...
Claims Investigations
What is the Psychology of Fraud?
We all know that insurance fraud costs insurers and insureds billions annually. The real question is why do people commit fraud? Is it always because of monetar...
Digital Investigations
Traditional vs. Generative AI: What’s Better for Insurance?
Generative AI has garnered great attention in the insurance industry because of its promising potential, but is it really that much better than Traditional AI?...
Digital Investigations
Digital Fraud: How to Protect Your Claims?
The rise of digital fraud has become a pressing concern for all insurance professionals. Whether you�re a risk management director, claims manager, or any role...
Utilization Management
3 Steps to Mastering Utilization Review
Efficient UR management is essential not only for compliance but also for enhancing the well-being of employees, reducing costs, and minimizing legal risks. Bel...
Claims Investigations
Price Gouging During Hurricane Beryl – Explained
As Hurricane Beryl tore through Houston, residents were met with another storm—this time at the gas pump. The skyrocketing fuel prices left many Texans frustrat...
Case Management
Telehealth: What Insurers Need to Know in 2025
The main benefit of telehealth for claims management is ensuring OSHA compliances are met by allowing employees to make prompt appointments with their physician...
Claims Investigations
What Should Employers Know About Remote Work Injuries?
Despite the decline following the pandemic, remote work is three to four times more common than in 2019. The World Economic Forum projects that by 2030, the num...
Claims Investigations
SOC 2 Type 2: The Golden Standard
What Does A SOC 2 Report Mean? In our industry, we deal with a wealth of sensitive information, including personal identification details, medical records, and...
Claims Investigations
Do Insurance Regulations Preclude Carriers from Using Drones in Claims?
Seems the best way to approach technological advancements in a historically �traditional� industry is through the frontline employees. That means you! Let�s exp...
Claims Investigations
How To Combat Auto Theft Fraud
Let’s dive into the different types of auto theft fraud, the explosive growth of this fraudulent market, and how we’re leveraging cutting-edge technology to fig...
Claims Investigations
Generative AI: A Balance Between Innovation and Privacy
Generative AI has long been praised as a tool for extending creativity and improving the efficiency of how people do their jobs. However, many of the most high-...
Claims Investigations
Can an IME determine Maximum Medical Improvement (MMI)?
MMI is when an injured worker�s condition hits a plateau. This doesn�t mean the worker is fully healed, but it�s the best they�re going to get under the circums...
Claims Investigations
Identify Fraud With Techniques From OSINT-Certified Instructors
OSINT, AI, and technology in general are revolutionizing our jobs and lives. Insurance is an industry that began adopting these a bit late but is now recognizin...
Claims Investigations
The Benefits of Pharmacy Canvassing in 2024
Who gets canvassed really depends on the nature of the injury itself, but there is more overlap into areas you might not normally consider, and is why we are go...
IME
Debunking 5 Myths About Outsourcing IME�s
As adjusters in the workers� compensation field, you are well-versed about the benefits of Independent Medical examinations. IMEs can be highly beneficial if yo...
Case Management
The Red Flags Of Life Insurance Fraud
The Effects of Life Insurance Fraud Besides the obvious financial gain, emotions like heartbreak, parental responsibility, anger, and depression can also drive...
Claims Investigations
Life Insurance Fraud: Types and Implications
In 2016, the Coalition Against Insurance Fraud (CAIF) was surveyed to get a handle on the issue. They asked insurers about the problem of people faking their ow...
Claims Investigations
Baltimore Bridge Collapse � A Breakdown of the Losses
It has been almost four weeks Since the Baltimore Key bridge collapsed at the impact of the Dali � a Singapore-owned vessel. The tragic incident on this histori...
Medical Canvassing
What Medical Providers Should You Canvass?
Medical canvassing is a helpful process of scouring through a claimant’s medical history by contacting past providers and obtaining a comprehensive medical back...
Medical Bill Review
Control Costs: Utilization Review and Medical Bill Review
In claims management loss reduction is a constant priority. Previously, insurance adjusters accomplished this through their expertise and use of resources when...
Claims Investigations
The Impact of Maritime Fraud on Developed Countries
It’s fascinating how maritime fraud encompasses such a wide array of illicit activities, from car theft to food fraud and everything in between. Maritime Cargo...
Claims Investigations
Strategies for Preventing Transport Fraud
Big fish means a bigger payout, right? Fraudsters think so. These individuals have figured out that large trucking companies have better insurance coverage than...
Utilization Management
How Does Utilization Review Contain Costs?
In the fast-evolving realm of healthcare, the priorities of third-party administrators (TPAs) and insurers lie in maintaining state compliance and managing cost...
Claims Investigations
Is This Auto Accident Worth an Investigation?
The FBI estimates that the total cost of insurance fraud (excluding health insurance) is more than $40 billion per year. To put this number into a quantitative...
Claims Investigations
What Are The Most Common Staged Auto-Accidents?
We’re all familiar with a claimant exaggerating their incident. Be that in workers comp or auto insurance. But today you will read about the schemes that frauds...
Claims Investigations
When to Consider an SIU Referral?
Insurance fraud has a fiscal consequence on Americans with up to $7,000 worth of premium increases in a 10-year period, but it also has emotionally devastating...
Medicare Solutions
Top 5 Best Practices for MSP Compliance
The toughest part of complying with Medicare Secondary Payer (MSP) rules is understanding the regulations. It can be a tedious, time-consuming, and inefficient...
Digital Investigations
Can You Access Deleted Social Media Posts?
The answer is not always no. However, you must note that social media posts cannot be retrieved once the user deletes them. In the most extreme cases, attorneys...
Claims Investigations
The Red Flags of Arson
One of the most common psychologically motivated fraud schemes is Arson. Arson fraud is defined as the purposeful burning of property to recoup an insurance pay...
Digital Investigations
What is a Due Diligence Investigation?
The importance of conducting a background check on a business is to be informed about the entity you are going into business with. This is when Due Diligence co...
Utilization Management
Utilization Management and Drug Review for Safer Prescriptions
Utilization Review and Utilization Management can be used interchangeably. These terms refer to the process of experts working for insurance companies reviewing...
Case Management
How Much Does Medical Case Management Cost in 2024?
Medical case management is one such service that plays a pivotal role in coordinating and optimizing patient care. Medical case management aims to manage the ca...
IME
Guide for Workers Comp Adjusters: When to Use an IME?
Quality IMEs can provide several benefits to the injured patient. Find out how to make a claimant more comfortable with the idea of an IME and the importance of...
Complex Litigation
Choosing An Investigation Company: A Guide for Complex Litigation Firms
In complex litigation, the success of a case often hinges on the quality and depth of the investigations conducted. Whether you�re dealing with multiple defenda...
Complex Litigation
Complex Litigation Must-Haves: Premium Investigative Services
In this article, we delve into how complex litigation lawyers can benefit from having the right resources in their corner. We will describe the different servic...
Medical Canvassing
Medical Canvassing Use Case for Claims
Medical canvassing aims to uncover medical treatment the claimant may not be sharing. It’s important to know if medical treatment related to the work claim inju...
Digital Investigations
What is the Dark Web and How Does It Work?
The origins of the Dark Web can be traced back to the U.S. Naval research in 2002 when looking for a secure communications channel that couldn�t be monitored. I...
Digital Investigations
Is Digital Investigation Really Worth the Price Tag?
Digital investigation is the process of using open-source intelligence (link) to gather and analyze information about a person. It includes; social media and ba...
Digital Investigations
What is Image Authentication?
The digitalization of the world emphasizes the importance of fraud detection. The need for the insurance industry to be tech-enabled is being widely accepted bu...
Claims Investigations
3 Challenges of Recorded Statements
What is a Recorded Statement in Investigations? A Recorded Statement is an SIU service that consists of taking a video or audio interview. During which the clai...
Medical Canvassing
Medical Canvassing: Use Case for Legal
Canvassing is performed by contacting the closest facilities of each type of provider to a claimant’s address and is designed to uncover pre-existing illnesses...
Digital Investigations
Cutting Human Error: AI in Insurance
Right now, claims processing is largely a manual function. This makes it prone to human error. Error means less efficiency and less efficiency means higher cost...
Claims Investigations
Open Source Intelligence – Advanced Search Tools
The digital revolution has exponentially increased OSINT capabilities with how much information is available in the cyber landscape. Instead of analysts sifting...
Claims Investigations
Event Data Retrieval: 4 Problems You Could Face
What is an EDR tool? This is one, if not the most useful tools available in crash investigations. Also known as a Crash Data Retrieval, 95% of all vehicles have...
Surveillance
How Long Does a Surveillance Last?
What is a (Traditional) Surveillance: An expert investigator provides you with qualified, comprehensive information on your claimant�s daily activities. Investi...
IME
Top 5 Reasons to Request an Independent Medical Examination
Whether it is workers’ comp, liability, physical injury, or property, verifying the medical diagnosis of your claimant can be a game changer. Having an impartia...
Medicare Solutions
Medicare Set Aside (MSA) in Workers’ Compensation Claims
What is Medicare Set-Aside? Medicare Set Aside is a financial safeguard that assigns a portion of a Workers’ Compensation settlement toward their future Medicar...
Claims Investigations
Common Mistakes in DIY Claims Investigation
DIY Investigations Investigations are debatably the most important time to work within legal and ethical boundaries as these cases go through litigation and can...
Claims Investigations
Top 5 Reasons to Use a Medical Cost Projection
What is a Medical Cost Projection: A medical cost projection creates a short term, synopsis of the funds that are needed for future medical expenses. It is a gr...
Case Management
Medical Peer Reviews in Workers Comp. Law
Importance of Medical Peer Review A Medical Peer review is the process where a second physician (employed by the insurer) reviews the treatment records of the c...
Claims Investigations
What is Unmanned Surveillance?
What is Unmanned Surveillance? Unmanned surveillance is the use of covert, stationary cameras that blend into their environment in the form of a prop and conduc...
Case Management
Case Management: FCM or TCM?
What is a Certified Case Manager (CCM)? Case managers are Medical professionals who do everything in their power to move your claim in the right direction. Thei...
Digital Investigations
Open Source Intelligence (OSINT) – Transforming Insurance Claims
What Is Open Source Intelligence? OSINT is the collection and analysis of open-source intelligence tools. This includes all publicly available information on on...
Medical Canvassing
Is a Medical Canvass HIPAA Approved?
Is a Medical Canvass HIPAA approved? Yes! The only information obtained during Medical Canvassing is, dates of treatment, hospital admission, outpatient emergen...
Digital Investigations
Artificial Intelligence vs Fraud
What is the role of Artificial Intelligence? Since the pandemic, we�ve been feeling the push of digitization but the insurance industry was it hard by the move...
Surveillance
The Legalities of Surveillance: What You Need to Know
Why It Matters: Surveillance has become an integral part of our lives. Whether it’s the security cameras at our workplace, the smartphone in our pocket, or the...
Case Management
Medical Case Management: Pros and Cons
What is Medical Case Management? In the complex world of insurance, where every claim can be a financial puzzle, the role of medical case managers is one key pi...
Case Management
Red Flags in Claims: What You Need To Know
What are the elements of fraud? Fraud is defined as an intentional misrepresentation of a material fact by a person who knows or believes it to be false. Fraudu...
Claims Investigations
What is an SIU Investigator?
What is an SIU Investigator? An SIU investigator, also known as a Special Investigations Unit investigator, is a professional typically employed by insurance co...
Case Management
What is SOC 2 Type 2 Compliance?
What is SOC Compliance? And What Does it Mean? SOC (System and Organization Controls) is a type of certification where a service organization has completed a th...
Claims Investigations
Spot the Red Flags: Monday Morning Injuries
Monday Morning Injury or Monday Morning Accident is a term for when an employee approaches you on the first morning of the working week to report an injury sust...
Digital Investigations
Social Media Vs. Internet Mining Investigation
Two powerful tools that have emerged to aid in verifying claims are social media investigation and internet mining investigation. It’s a great and bad thing tha...
Medical Canvassing
What is Medical Canvassing? (and Why You Need It)
What is Medical Canvassing? Canvassing is a meticulous, comprehensive research process that�s designed to uncover a claimant�s pre-existing injuries, illnesses,...
IME
What is an IME? (And Why They�re Needed)
What is an Independent Medical Examination (IME)? An Independent Medical Examination (IME) is a comprehensive medical evaluation conducted by a neutral and inde...