Third-Party Administrators

Justice Solutions Group maximizes carrier and third-party administrator fraud prevention by utilizing skilled claims investigators experienced in:

Covert surveillance
Digital monitoring of social media and background information
Interviewing potential witnesses
Other industry accepted means of gathering evidence

Our investigative services help third-party administrators prove insurance claim fraud, reduce costs and ensure that claims are paid appropriately.

Justice Solutions Group Can Help Third-Party Administrators

Proving insurance fraud is often a complex and time-consuming issue, but the Special Investigations Unit (SIU) at Justice Solutions Group (JSG) has the skill and experience to reduce costs and produce timely results for our clients.

False insurance claims, or the exaggeration or the feigning of a loss, injury, or illness, are far too common and costly for carriers and third-party administrators. Our investigators are skilled at gathering sufficient evidence through ethical and efficient means, enabling our clients to resolve fraud cases quickly and cost-efficiently.

Red Flags that Warrant Investigation

Red flags are indicators of potential fraud, abuse, and waste in the claims process. The red flags that warrant further investigation and potential intervention will depend on the types of claims being administered. As part of due diligence, each carrier or third-party administrator will establish red flags that warrant further investigation. These may include:

Specific details missing from the initial report of injury or illness
A history of suspicious claims
The claims examiner has a difficult time reaching the claimant
A claim is made shortly after the inception of a policy or after the claimant has increased the policy limits
Documentation is missing or contains irregularities
The claimant is defensive or evasive in answering questions
An initial investigation reveals financial problems for the claimant
The claimant has a history of substance abuse issues
Scene investigations do not match the claim
Asset investigations warrant a closer look
Witnesses are evasive or difficult to track down
Reports of potential fraud from friends, family, coworkers, or associates
Non-compliance with the claims process

Whatever the red flags are, JSG can establish an investigative process to prove fraud if it exists and help mitigate losses for our clients.

Experience Matters

Our team of investigators are highly trained and come from backgrounds that include law enforcement and military special forces. The background of our investigators form the foundation, and we build on that with extensive specialized training to make our SIU operators among the best in the industry. We work with some of the largest carriers and third-party administrators in various industries and have a proven track record of success.

We have a rapid deployment response team ready to assist at any stage of a claim investigation. JSG can work with in-house teams and other assets if a problem arises beyond the scope of fulfilling standard due diligence.

Our primary goal is to deliver accurate information that guides informed decisions about claim payouts, potential settlements, and trial preparation. Our investigators can assist or take over during any part of the claims process. Our clients can have confidence that they are dealing with professionals willing to go the extra mile to gather the evidence and information needed.