Insurance Claim Investigations by tdh65102


More Info
									 J.D. WESSON & ASSOCIATES, INC.                                 STATEWIDE CA COVERAGE
Claim Professional,
I would like to take a few minutes and introduce our                                                           QUALITY CLAIM
organization to you and your staff. As a former                                                           INVESTIGATIVE SOLUTIONS
insurance professional, I know firsthand the challenges
in finding a quality insurance investigative firm.
For this reason, I founded J.D. Wesson & Associates,
Inc., a professional investigative services organization.
We bring a cadre of experience to the insurance investi-
gations arena:
  ♦     Field Claim Adjuster, multi-line with a national
        commercial carrier, with primary focus on
                                                                                                              J.D. WESSON
        worker’s compensation.
  ♦     Field Claim/Special Investigations Unit Re-
        gional Supervisor for national commercial car-
        rier, with primary focus on worker’s compensa-

        Director of the Special Investigations Unit for a
                                                                                                          ASSOCIATES, INC.
        national commercial carrier, with primary focus
        on worker’s compensation.
  ♦     240 years of combined law enforcement ex-
        perience working as investigators.
  ♦      Adjunct faculty community college instructor,      Coverage throughout the State of California
         teaching criminal & civil investigations.
In addition to our investigative experience, we also pro-     Spanish speaking personnel available
vide training expertise on suspicious claim investiga-
tions and Department of Insurance Fraud Unit compli-              Fraud investigative specialists
J.D. WESSON & ASSOCIATES, INC. employs a group of
42 professional insurance investigators throughout Cali-
fornia and Oregon. Since many of these investigators
have former insurance investigative experience, we
bring tremendous insight to our work product. We have
a personal commitment to excellence for all work per-
formed and customer satisfaction is the most important
focus within our group.                                                 ASSIGNMENTS
Our mission is to provide quality investigative
                                                                        Email assignments to:
services in order to assist our customers in the            
mitigation of their claims.                                                                               ♦   W o r k e r s ’ C o m p e n s a t i o n
                                                                           Fax Assignments to:                A O E / C O E
We truly look forward to working with you and your staff
to provide outstanding investigative services.                  619.374.2823 510.217.6531 707.255.6100    ♦   A p p o r t i o n m e n t
Sincerely,                                                                                                ♦   S u b r o g a t i o n
                                                                        Call-in assignments to:
                                                                                                          ♦   S I U I n v e s t i g a t i o n s
                                                                                                          ♦   A c t i v i t y E v a l u a t i o n
                                                                        3212 Jefferson St. Suite 206      ♦   S u r v e i l l a n c e
                                                                              Napa, CA 94558
                                                                           Phone: 877.357.4272            ♦   G e n e r a l L i a b i l i t y A u t o
   Jim Wesson                                                                Fax: 707.255.6100
                                                                          CA License #: PI16264
     AOE/COE INVESTIGATIONS                                      SIU INVESTIGATIONS                                  LIABILITY INVESTIGATIONS
When it comes to evaluating a worker’s compensa-         From time to time, a claim examiner is assigned a       Our firm specializes in handling many types of
tion claim, the main thrust for a claim examiner or      claim where fraud is suspected. These claims can        liability investigations, such as:
Law Firm is to have quality information in a timely      be extremely challenging, because of the dual re-       ♦   Construction Liability
manner, so they can make an informed decision.           sponsibility of the examiner, civil and criminal.
                                                                                                                 ♦   Slip & Fall
                             Our compensability                                       Our firm specializes in
                             investigations focus on                                  the investigation of       ♦   Auto Liability
                             just that. Our investiga-                                suspected fraudulent       ♦   Accident Reconstruction
                             tors are trained and                                     claim activity. We have
                                                                                                                 ♦   Product Liability
                             skilled in the art of in-                                investigative experts
                             terviewing, scene inves-                                 who have made a ca-        ♦   Personal Injury
                             tigation, and accident                                   reer of investigating      Our expertise in investigating construction site
causation, followed-up by thorough documentation.        insurance fraud, and know the law thoroughly when       accidents and the ability to manage contractors,
We use state of the art recording equipment, digital     it comes to handling these situations.                  sub-contractors and union personnel has proven
cameras, advanced computer systems, and quality          We work closely with the claim examiner, the De-        invaluable in handling these types of cases.
customer service to accomplish this. We are truly        partment of Insurance Fraud Bureau, and the local
your eyes and ears in the field.                         District Attorney’s offices in the investigation of
When a worker is injured, primary focus is placed on     these matters.
their health and welfare. An in depth investigation of
                                                           DATABASE INVESTIGATIONS
a serious accident can reveal many things, which
may be valuable to the claim examiner and the em-        When evaluating any insurance claim, there are
ployer.                                                  times when a claim examiner or attorney, needs
                                                         more information about a claimant, witness, or
SUBROGATION INVESTIGATIONS                               other involved party.
                                                                                                                 We have developed specific protocols for handling
Our investigators are trained to seek out causation      It is at this time
                                                                                                                 low impact auto and slip & fall investigations.
issues and identify if there is a third party recovery   that quality back-
                                                                                                                 These protocols involve detailed claimant ques-
potential. If a third party opportunity is discovered,   ground and data-
                                                                                                                 tionnaires and physical evidence documentation.
we immediately communicate this to the claim exam-       base     investiga-
                                                                                                                 Utilizing our court certified forensic/accident re-
iner or attorney.                                        tions become nec-
                                                                                                                 constructionist and our direct contact with two of
We secure that opportu-                                  essary. We have
                                                                                                                 the most noted PhD. Bio-Mechanist in the U.S., we
nity with proper source                                  access to one of
                                                                                                                 are able to offer a new dimension to full service
identification, securing                                 the most up to date database services available in
                                                                                                                 liability investigations.
of recorded statements,                                  today’s market.
                                                                                                                 Our approach to mitigating liability claims has
photographs, video-                                      Our expert computer investigative specialists can
                                                                                                                 proven successful not only in California, but across
taping, insurance deter-                                 obtain information on civil filings, driving history,
                                                                                                                 the nation.
mination, and evidence collection if applicable.         property ownership, bankruptcies, judgments, WCAB
                                                         filings, neighborhood demographics, and almost any      We guarantee timely response, open communica-
                                                         public record, that is automated.                       tion, state of the art photography/digital video
                                                                                                                 depiction, computer aided diagramming, and com-
                                                         One of the most challenging areas of insurance
                                                                                                                 prehensive documentation.
                                                         claim handling is in Commercial Liability.

To top