Insurance Fraud Investigations

The purpose of the investigation is to establish and document relevant facts. Exero Claims does not determine whether fraud has occurred. That assessment remains with the insurer, claims administrator or other instructing client.

When a Fraud Investigation Is Assigned

An insurance fraud investigation may be assigned when:

• Information provided in the claim conflicts with other available information
• Material inconsistencies have been identified that require factual verification
• Suspected misrepresentation about a loss, injury or incident needs investigation
• A claims or SIU team needs investigative work carried out in the Czech Republic

Referral for investigation does not establish that fraud has occurred. The purpose is to verify the facts, which may confirm or resolve the concern.

Personal Injury and Disability Claims

Investigation can support personal injury, disability and benefits claims where additional information is required concerning reported circumstances or publicly observable activity.

Investigators do not make medical assessments or determine whether observed activity is medically appropriate.

Motor and Liability Claims

Investigation may address inconsistencies concerning the circumstances of an incident, people involved, location, witnesses, prior information or other matters relevant to a motor or liability claim.

Property and Other Claims

Property and other insurance claims may require verification of locations, businesses, ownership interests, circumstances surrounding a loss or information provided during the claim.

Workplace Injury and Benefits Claims

Investigation can also support workplace injury, sick leave, disability and benefits matters where factual verification or additional field investigation is required.

• Workplace Injury Investigations
• Compliance Services

What the Assignment May Include

Depending on the issues identified by the client, the investigation may draw on:

• Surveillance & Activity Verification
• Background & Prior Claims Investigations
• OSINT & SOCMINT Investigations
• Scene Investigations
• Witness Interviews & Recorded Statements

The investigative scope is agreed with the client and extended only with the client's authorization. For claims that need general verification without specific concerns, see Insurance Claims Investigations.

• Insurance Claims Investigations

What the Client Receives

The client receives a factual investigation report describing the work performed and the information developed.

Investigator observations, witness information, third-party information and research findings are distinguished from one another. Depending on the assignment scope, supporting photographs, statements or documents are included where obtained during the authorized assignment.

What Remains With the Client

Exero Claims investigates and reports factual findings. The instructing client determines what those findings mean for its fraud, coverage, liability, benefit or payment decisions, including whether any further step is taken.

Continuing Investigative Support

Insurers and TPAs that need continuing investigative support in the Czech Republic, rather than individual assignments, can use Exero Claims as an outsourced SIU resource.

• Outsourced SIU Services

Czech Republic Coverage

Insurance fraud investigations can be conducted throughout the Czech Republic.

International insurers and claims professionals can instruct Exero Claims directly when investigation is required in the Czech Republic.

• Insurance investigation services in the Czech Republic
• Insurance Carriers
• Third-Party Administrators

Data Protection and Privacy

Investigations are conducted for an identified investigative purpose and with regard to applicable Czech and EU privacy and data protection requirements.

Assigning an Investigation

Investigations are submitted through the Exero Claims Assignment Portal. How Assignment Works explains the steps from submission to report.

• How assignment works