AOE/COE

Arising Out of Employment/ Caused Out of Employment

  • Identify existing and potential fraud issues
  • Document and obtain evidence
  • Identify existing and potential subrogation
  • Obtain recorded statements
  • Provide prompt, clear and concise written reports and evidence documentation
  • Provide all services in accordance with all applicable legal codes and statutes
  • Obtain written and signed statements from persons with material information regarding the claim
  • Obtain signed releases for medical and outside records
  • Obtain all medical, personnel records and/or civil court records

What is your average response time to new injuries? We make contact with the insured and/or the claimant immediately as we recommend initiating the investigation within 24 hours, no later than 48 hours, depending on the insured and claimant availability.  This means quicker delivery of service and more time to make early decisions and cut off the $10,000.00 medical coverage benefit while your claim is in delay status.

Sub Rosa

Proven Experience, Proven Results

  • Our investigators are educated, diverse, flexible and experienced
  • Covert operations (Pursuit into stores, restaurants, gyms, retail stores, etc.)
  • Pretext: Obtain information by discreet means via telephone, door knocks and neighborhood canvassing
  • Mobile surveillance vehicles that are specially equipped for surveillance
  • Activity checks
  • We set out to obtain new information each day we go out on a sub rosa investigation

SIU

Special Investigation Unit

  • Further analyze Sub Rosa investigation for fraud
  • Make well informed recommendations
  • Educate our clients about the SIU process so that they will be able to coordinate a false claim in future claims
  • Coordinate the referral of fraudulent claims to the Department of Insurance's Fraud Division and the county district attorneys.
  • Rene Garza & Associates, Inc. is one of only a few investigation companies in California qualified to provide a compliant SIU to an insured company, insurance company, third-party administrator (TPA) or self-insured.

Ten Indicators of Fraud!

  • The claimant gets injured soon after being hired
  • There are no witnesses to the incident
  • The doctor finds nothing wrong with the claimant
  • The claimant immediately retains an attorney
  • The claimant refuses to communicate with employer
  • Changes in the story on how things happened or when things happened
  • Witnesses provide contradictory information to what is being said by the claimant
  • Malingering or exaggeration of symptoms
  • Claiming a non-work related injury as a work-related injury
  • Claiming a work-related injury that never occurred