Fishing for Fraud

Copyright held by The John Cooke Fraud Report. Reprint rights are granted with attribution to The John Cooke Fraud Report with a link to this website.

“And what other treatment did the doctor give you for your LEFT KNEE, Joe?” There’s nothing more gratifying than having Joe Claimant take the rope out of the investigator’s hands, tie a nice neat noose, slip it over his own head and tighten it – all because he made a faulty assumption about what might have been contained in his (apparently bogus) medical reports.

A variation on this theme is the “White Herring.” Basically, this occurs when the claimant is “in denial,” or in a mood to deny most everything asked of him. If a claimant is found to be in this mood, it is wise to try asking him to confirm a host of false symptoms first. Once he is into a pattern of “no” responses to fictitious symptoms, then an occasional symptom which really appears on his reports can be tossed in. He may well feel that he is being fed herrings and will then continue to deny the supposedly valid symptoms.

The whole premise of the Red or White Herring techniques is based upon those cases where a claimant was not injured to the extent (if at all) described in the medical records. The process is being used to determine if lie is willing to lie about (known) false symptoms, and thereby destroy his overall credibility.

Many, many times, I have personally used this technique in investigating legitimate collisions with adverse liability, where the issue was the injury claim. And many, many times I have had the claimant’s attorneys send me drop letters after seeing the major contradictions to which their clients testified.

Another technique, certain to put some gum into the multi-claimant interviewing machine, is left-field questioning. Asking only the standards (“How fast were you going? Who was sitting where? Which direction were you going?”) may not result in discrepancies between statements. But ask the unexpected (“When was the first time you ever met so-and-so? Had you spent any time together the day before the accident? When had you last seen each other before the accident? How long had you known each other?’_) and it is common to uncover two individuals who most certainly did not study the same script.

Other interview techniques involve the investigator’s demeanor with the claimant; aggressive or passive? If the claimant is nervous and perspiring and develops a nervous twitch when the “hard” questions begin, then it may be a good idea for the investigator to sit forward towards him and infringe on his psychological space. A hard stare and continual eye-to-eye contact may be effective. It is easier to trip up this sort of claimant than one who has ice-water in his veins, especially if the nervous claimant is kept off balance.

Speaking of keeping people off balance, the investigator should consider the environment where the statement is being taken. If it is an unrepresented claimant, or a potentially “dirty” insured, then it is advantageous to take the statement in an office and environment of the investigator’s choosing, so that he is comfortable, and so the subject does not feel totally at ease. If the designated venue is in the claimant’s attorney’s office, then the investigator should do everything in his power to make sure he is comfortable and relaxed. In many cases, the claimant will enter the conference room at his attorney’s office thinking that he has the upper hand; that it’s two-against-one. When the claimant finds a comfortable foe, one who is making himself at home, and even chit-chatting with the attorney like a long-lost friend, it tends to deflate the claimant’s balloon at the start and serves to “even the playing field.”

Certainly, a lengthy book could be written (and probably there are already a few out there) about interview techniques, but the bottom line is that the con artist comes into the statement prepared to reveal “X” number of details. The wise and effective investigator will need to be prepared to ask “X + Y” number of questions. It is not until the “Y” questions are posed that the credibility of the claimant will be able to be discerned. Everyone looks good when only the “X” questions are asked.

In the words of my mentor from 12 years ago (Bob Barrie – Mercury Casualty); “If you are not looking for fraud, you will not find it!”

—

Pete Brown is the manager of the Special Investigations Unit of the George Hills Company and works out of the Walnut Creek, CA, office. He is the current Vice President of the Northern California Fraud Investigators Association and has taught numerous seminars on the above and other related topics.