Insurance & Fraud Investigations

PI Specialists, LLC provides specialized insurance investigations and fraud investigations for carriers, TPAs, SIU units and defense counsel, focusing on staged accidents, false claims, exaggerated injuries and organized fraud schemes. Leveraging extensive SIU experience and a strong background in criminal justice, the firm builds files that support confident claim decisions, litigation strategy and fraud referrals.

Types of Insurance & Fraud Investigations

Insurance and fraud investigations are tailored to the line of coverage, claim complexity and jurisdiction. Typical assignments include:

• Questionable workers’ compensation claims involving alleged disability, off work status or inconsistent restrictions.
• Suspicious auto liability claims, including low speed impact, staged collisions and suspect bodily injury.
• Property and commercial lines claims with red flags such as prior loss patterns, inconsistent damage or suspect inventory.
• Multi claimant and multi line fraud patterns, including organized rings, repeated providers or repeat claimants.

By focusing on red flag indicators and claim facts, PI Specialists, LLC helps SIU units prioritize resources and support denials, negotiations or referrals.

Core Services for Insurers, SIU & Legal Teams

Services for insurance carriers, self insured employers and law firms include:

• Surveillance and activity checks – Covert video, neighborhood canvassing and lifestyle/activity documentation to compare observed function with reported or medically claimed limitations.
• Claim file and medical background reviews – Analysis of prior claims, treatment history, coding patterns and inconsistencies in reported injury, mechanism or recovery.
• Social media and open source intelligence (OSINT) – Targeted reviews of social platforms, public records and online footprints to identify activity, travel, hobbies or work inconsistent with claimed injury or restrictions.
• Claimant and witness interviews and recorded statements – Structured interviews designed to clarify timelines, mechanisms of injury, employment status and discrepancies in testimony.

These services can be deployed individually or as part of a comprehensive SIU investigation strategy.

SIU Focused Analysis & Fraud Detection

With a strong SIU background, PI Specialists, LLC understands fraud indicators, regulatory expectations and the documentation standards required for internal and external review. Investigations may include:

• Identification of provider, attorney or claimant patterns suggestive of fraud or abuse.
• Comparative analysis of medical records, billing and claimed functional limits.
• Development of timelines and visual aids summarizing surveillance, treatment and work activity.
• Support for referrals to fraud bureaus, NICB or law enforcement when warranted.

This SIU minded approach ensures investigative work product supports both claims handling and potential criminal or regulatory action.

Court Ready Investigative Work Product

Every insurance investigation is completed with litigation and admissibility in mind. Files are prepared to be easily understood by adjusters, examiners, attorneys, judges and juries and may include:

• Clear, concise written reports with findings, analysis and references to exhibits.
• Time stamped video, photos and stills formatted for court or hearing use.
• Organized exhibits such as social media captures, maps, timelines and document summaries.
• Affidavits and, when needed, fact based or expert style testimony from a licensed investigator.

This gives claims and legal teams credible, defensible evidence for denials, settlements, mediations and trials.

Insurance Investigations in Arizona, Oregon & Beyond

PI Specialists, LLC provides insurance and fraud investigations in Arizona and Oregon, with the ability to coordinate select nationwide assignments depending on case type and jurisdiction. Whether you need discreet surveillance on a high exposure claim or a full SIU investigation into suspected organized fraud, the firm can design a targeted investigative plan aligned with your claim, legal and regulatory objectives.