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 companies, law enforcement agencies, or other organizations to investigate suspicious or potentially fraudulent activities. Their primary role is to investigate suspected insurance fraud claims. SIU investigators play a crucial role in protecting the interests of their employers by ensuring that legitimate claims are paid while detecting and preventing fraudulent ones.

Function of SIU:

Many states require insurance providers to have an in office Special Investigations Units team. However, it is not always required and there is no federal mandate that requires it. Insurers will proactively dedicate in-house SIU teams to detect, prevent, and investigate fraudulent activities related to insurance claims.

• Reviews cases submitted to SIU which have red flags
• Directs/conducts the investigation of suspicious claims
• Reports investigative findings to claims or underwriting division
• Coordinates fraud prosecutions with the state DIF

Special Investigation Unit Solutions:

SIU investigators posses strong communication skills and are analytical, problem solvers in nature. They are tasked with sorting out minor details the majority would overlook which is why strong attention to detail is top of the list for this position. They need to understand how insurance claims work and be on the field collecting statements and conducting scene investigations that will propel the case. The following are solutions the SIU team provides:

Event Data Recorder Retrieval:

Limited investigators have access to an Event Data Recorder (EDR) device that is attached to a motor vehicle. This device records vehicle and occupant information for a very brief period of time before, during and after a crash solely for the purpose of monitoring and assessing vehicle safety system performance. Ethos has an EDR device that is nationally recognized and approved in Federal, District, Criminal and Small Claims Courts. Indisputable facts are read directly from the vehicle airbag control module. This information is then used to validate the driver, witness statements and their testimony.

Recorded Statements:
Interviews are conducted and recorded, or written statements are obtained with the goal of uncovering vital information related to said accident.

Scene Investigations:
Effective for motor vehicle accidents, property loss, etc., this service traditionally includes photographs, video documentation, diagrams/charts, and a detailed report.

SIU/ Vendor Management:
SIU teams ensure your company is fully compliant with all state fraud reporting requirements. In most states, it is mandatory to report suspicious activity to the respective state fraud bureau. Experienced SIU investigators are knowledgeable of state requirements and provide clients with peace of mind that they are meeting all compliance-related matters.

Alive and Well Checks:
An in-person or over-the-phone interview that confirms: if the claimant is alive or deceased, their Social Security Number, contact information, current health status/current medications, and the claimant’s benefit check status. A photo of the claimant and his/her ID will be obtained.

AOE/COE:
Provides detailed information concerning all the facts and circumstances surrounding an employee’s initial claim and whether it meets the criteria of Arising Out of Employment (AOE) or Course of Employment (COE). This confirms employment status, a description of the accident, and the nature of the alleged injury.

How They Help:

SIU investigators are familiar with laws and regulations in any given jurisdiction nationwide. Their goal is to uncover details about accidents, occupational diseases, unexplained deaths, recreational injuries, and other unusual circumstances. Insurance fraud can lead to skyrocketing premiums for everyone.

These brave investigators help ensure that only genuine claims get through, which translates into cost savings for you and your company. It’s like paying for insurance without subsidizing the fraudsters.

Conclusion

In essence, partnering with an SIU investigator brings you the expertise to navigate the treacherous waters of insurance claims and fraud. They bring knowledge to the table, ensuring that your interests are safeguarded and your costs are controlled. Not only do these investigators spend countless hours monitoring and collecting evidence to validate or refute a claim – they are integral in maintaining the integrity of the our industry.