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Q: Recently I was assigned a claim on a slip and fall at a bank. The injuries were severe and did not coincide with the facts of the incident. We elected to do a background investigation on the claimant. Based on information you provided, we discovered an element of fraud. I thought you might like to let JCFR readers know some of the things that your investigation uncovered.
A: Thank you. I only wish that your name could be included so readers would not suspect a plant.” Nonetheless, on this case we discovered your claimant had two other accidents. One was a rear end collision and the other was a prior slip and fall. This was interesting because she had answered interrogatories stating she hadn’t had any “accidents” in the past seven years – yet these other two accidents occurred during the past three years. The index information was filed under her maiden name (always a good place for a knowledgeable investigator to look) and
I believe she thought they wouldn’t be uncovered. Also, the social security number she used in the earlier claims contained a transposition of two of her true numbers.
Q: In a recent issue, you pointed out information about fraudulent drivers licenses. My supervisor said she overheard that there is something about way the name is signed on California drivers licenses that can be used to determine if it is a forged license. Perhaps I could earn an “atta boy” by finding out some additional information. Can you help me?
A: The only thing I can add specific to California is this: CDLs now feature a new hologram format and all of the printed information that appears on the actual license, including the signature, is actually imprinted right onto the license. Many forgeries will have an actual signature, not a printed-on one. State licenses are changing all of the time. The book that I refer to when checking for visual authenticity is put out each year by the Anheuser-Busch Company (R.L. Polk is the publisher) and distributed to establishments that serve liquor, aiding them in checking IDs. It’s a full color publication and greatly beneficial.
Q: Settle this argument for me, please. I say it is illegal for an investigator to talk to a claimant who is represented by counsel. My desk partner said that it is not. What do you say?
A: I can speak only for California. I would have to know what it is you intended to say to the represented claimant before I could comment on the legality of the conversation. The general rule of thumb is DO NOT speak to a represented claimant. Basically, however, there are two types of exceptions to this rule.
First is the situation where the investigator does not know the claimant is represented and may develop a certain amount of information before the claimant advises of the representation. In this case, the information gleaned prior to the admission of representation is usable, but as soon as the investigator
learns of the attorney involvement, he must cease and desist from all further contact.
The second exception has to do with a document specifically called the Rules of Conduct in Adjustment of Claims – California Conference Committee of Adjusters but more commonly referred to as the Gentleman’s Agreement.
The document was approved by the Board of Governors of the State Bar of California and the insurance company representatives to the California Conference Committee of Adjusters in January of 1969. To my knowledge, it still stands.
In short, the document allows an adjuster or investigator to contact a represented claimant for only two narrow purposes.
1) 10 establish certain identity.
2) To establish the bona fides of the attorney representation.
Certain highly aggressive insurers will make claimant contact under the auspices of the Gentleman’s Agreement, most often when investigating fraud of the blatant ring variety. Defense attorneys I have spokc-n to, in general, approve of the practice on only a small fraction of cases. Utilization of this “grandfather type” document is a major irritant to personal injury attorneys. The consensus among defense attorneys seems to be that it makes sense in hard fraud cases but causes more harm than help in soft fraud cases.
If the investigator is a member of a company SIU force, consideration should be given to the adjuster as well. A single “In Your Face Cowboy Contact” with a represented claimant can turn an otherwise cooperative PI attorney into an angry, snarling and unwilling-to-negotiate maniac and it’s the adjuster who ends up taking the brunt of it.
On the other end of the spectrum is the fact that certain pieces of information that can be gleaned from this type of a contact can prove invaluable.
In short, it’s a judgment call, with no two cases being identical. It should never, however, be approached as an automatic list item and applied to all suspected fraud cases. “Caution” is the operative word!
Any readers desiring a copy of this California document may request same by contacting me (address/phone listed below) and I will see that you get one. Those of you in other states might consider contacting your State Bar Association to see if a similar document exists in your state.
SHERRY HOWARD, PRESIDENT
Exclusive Investigations, Inc.
1913 E. 17th St., Ste 203
Santa Ana, CA 92701
© 1995 John Cooke Fraud Report