Most claims are honest and should be paid quickly. A smaller share arrive with a story that doesn't hold together: an injury that changes with the audience, a loss reported just after a policy started, a witness nobody can find. We collect verifiable facts about those claims, lawfully and without prejudging them, so the adjuster, SIU or defense counsel can make a decision that survives scrutiny. When the facts support the claim, that clean result closes the file with confidence.
What is an insurance claim investigation?
A claim investigation is the independent gathering of evidence that confirms or disputes what a claimant has reported. It combines field work (observation, interviews, a scene visit) with research (public records, court files, public online activity). It is not a verdict: we establish what happened and what can be documented, and the people who decide the claim take it from there.
We handle claims across the major lines: auto and bodily-injury claims, property and storm-damage losses, premises-liability and slip-and-fall claims, disability claims, health-care billing questions, and workers' compensation claims.
Who needs a claims investigator?
- Carriers and SIUs that need field capacity in Miami-Dade or elsewhere in Florida.
- Third-party administrators and self-insured employers managing liability or workers' comp programs.
- Defense attorneys preparing for deposition, mediation or trial. Our insurance defense investigations page covers litigation support in more depth.
When should a claim be referred for investigation?
No single indicator proves fraud, and many have innocent explanations. What justifies a closer look is a combination that doesn't add up:
- Statements that shift between the first notice of loss, the recorded statement and the medical history.
- Thin or missing documentation for the loss, the injury or lost wages.
- Suspicious timing, such as a claim just after coverage began or just before a layoff.
- A claimant who avoids contact or pushes for a fast cash settlement.
- Damages or injuries that look exaggerated against the physical evidence at the scene.
- Staged-collision patterns: the same passengers, providers or repair shops across unrelated claims.
- The same loss reported more than once, to different carriers or under different claim numbers.
What does a claims investigation include?
Claim verification and background research
We confirm identity, addresses and employment, and check court records for prior claims, lawsuits and criminal history. Motor vehicle records are used only for a purpose the federal Driver's Privacy Protection Act permits, such as a pending civil proceeding (18 U.S.C. § 2721(b)). See our background investigations and asset searches.
Activity checks
An activity check is lawful observation of a claimant's routine from public places, timed around what the file says they can't do: lifting, driving, working a second job, playing sports. Good checks are targeted at the days and places the file points to, not open-ended. More on method is on our surveillance page.
Recorded statements, with consent
We record statements from claimants, insureds and witnesses only when the person agrees, and the recording captures that agreement. If a claimant has a lawyer, contact goes through the channel you and counsel direct.
Scene and witness canvassing
We photograph the loss location, note sightlines, lighting and signage, and identify businesses whose cameras may have covered the event. We then canvass nearby residents and employees for people who saw it, and locate witnesses named in police reports who have since moved. Related pages: witness location, surveillance video retrieval and scene documentation for injury cases.
Social-media and open-source review
Public posts, photos and check-ins often show a claimant's activity level clearly. We capture public content with its date, URL and account so it can be authenticated later. We never use fake profiles to get behind privacy settings or log into anyone's account. See social media investigations.
How are workers' compensation claims investigated?
A workers' comp file usually has three parts: an injury reported at work, restrictions from a treating physician, and benefits paid while the claimant can't work. The investigation tests whether they line up. Is the claimant working elsewhere, perhaps for cash? Doing things the restrictions rule out? Did coworkers see the injury happen as reported?
A short clip of someone carrying groceries rarely settles anything. What matters is sustained, documented activity that conflicts with the specific restrictions, so we ask for them before planning the checks. Florida's DFS Division of Workers' Compensation serves injured workers, employers, providers and carriers, and the DFS Bureau of Insurance Fraud investigates workers' comp fraud among other types. Our workers' comp investigations page has more detail.
What a Florida PI can and can't legally do in a claim investigation
Private investigators and agencies in Florida are licensed under Chapter 493, Florida Statutes by the FDACS Division of Licensing. A license does not make an investigator a law enforcement officer. Some shortcuts also make the evidence useless: an illegally intercepted conversation, and anything derived from it, is barred from every proceeding (s. 934.06, F.S.), which leaves the carrier with a liability instead of evidence.
Lawful and routine in claim work
- Observing and filming a claimant in places open to public view, from locations where the investigator is lawfully present.
- Taking recorded statements when every party to the conversation has agreed to the recording beforehand, which s. 934.03, F.S. expressly allows.
- Researching court files, property and corporate records, and other lawful data sources, including motor vehicle data for a DPPA-permitted purpose.
- Capturing publicly posted social-media content and interviewing witnesses who are willing to talk.
- Testifying as a fact witness about what was observed.
Off limits, whoever is paying
- Secret recording. Intercepting a phone call or private conversation without the prior consent of all parties is a third-degree felony under s. 934.03, F.S.. Under s. 934.06, F.S., no part of an illegally intercepted communication, and no evidence derived from it, may be received in any trial, hearing or other proceeding.
- GPS trackers. Installing a tracking device or app on another person's property, or using one to follow them, without consent is a felony under s. 934.425, F.S.. The statute's exemptions do not cover a private investigator unless the client would be exempt personally, and placing a device unlawfully is a separate ground for license discipline under s. 493.6118(1)(y), F.S..
- Trespass. We don't enter a claimant's home, fenced yard, gated community or vehicle. Unauthorized entry into a structure or conveyance is trespass under s. 810.08, F.S., and entering posted, fenced or otherwise noticed property is trespass under s. 810.09, F.S..
- Pretexting for records. Getting someone's phone calling records through false statements is prohibited by s. 817.484, F.S. and federally by 18 U.S.C. § 1039. Bank and financial records obtained by misrepresentation fall under 15 U.S.C. § 6821.
- Posing as police or another officer. Falsely acting as a listed officer is a felony under s. 843.08, F.S., and impersonating law enforcement is grounds for discipline under s. 493.6118(1)(i), F.S..
- Harassment. Florida's stalking law, s. 784.048, F.S., defines harassment as a course of conduct causing substantial emotional distress that serves no legitimate purpose. Our activity checks are planned, limited and stopped when unproductive.
How is suspected insurance fraud referred to Florida DFS?
In Florida, insurance fraud is investigated by the Department of Financial Services' Criminal Investigations Division, whose work covers insurance fraud, workers' compensation fraud, public assistance fraud and arson. Suspected fraud can be reported, or an existing tip checked, through the DFS portal at first.fldfs.com or the fraud hotline at 1-800-378-0445. Suspected arson has its own channel: arsonreporting.fldfs.com or 1-877-NO-ARSON (1-877-662-7766).
The decision to refer belongs to the carrier or its SIU. Our report is built for that step: a clear chronology, the source of each fact, the media, and the people who can speak to what they saw.
What evidence and reporting do you receive?
- Time-stamped photos and video from each activity check, with the location and vantage point recorded.
- A chronological written report with dates, times, addresses, vehicles, what was observed and what was not.
- Statement recordings and summaries, with the consent captured at the start of each recording.
- Canvass logs of who was contacted and which cameras may hold footage.
- Dated social-media and records captures, each with its source URL.
- Testimony when the claim goes to litigation. Evidence has to be authenticated before it is admitted (s. 90.901, F.S.); the investigator does that by explaining how it was captured. A party's own statement offered against them is a hearsay exception (s. 90.803, F.S.), one reason a consented recorded statement is so useful.
What affects the timeline and cost of a claim investigation?
We scope each assignment to the file rather than publishing a rate sheet. The real drivers are:
- Days of activity checks. A predictable routine needs fewer days than an unknown schedule.
- Investigators per shift. Heavy traffic or a claimant who moves between locations can call for two investigators.
- Statements and canvassing. Each witness and camera request adds field time.
- Research depth. Litigation history, social-media and asset research vary by file.
- Travel. Work outside Miami-Dade or out of state adds time and expense.
- Litigation needs. A report for claim handling is lighter than one prepared for deposition or trial testimony.
Authorization limits are agreed before work starts, and we check in before exceeding them.
Why carriers and defense counsel work with us
- Licensed and verifiable: Florida agency license A1800135, searchable on the FDACS agency lookup.
- Veteran-led and bilingual: interviews and canvasses in English or Spanish.
- Rated 4.9★ from 88 Google reviews.
- Attorneys vouch for us on the record: watch the attorney testimonials.
- Confidential by law and by habit. Unauthorized release of information gathered in an investigation is grounds for discipline against a licensee (s. 493.6118(1)(e), F.S.). Findings go only to the client.
Related services
Activity checks measured against documented restrictions.
Fact development for defense counsel through trial.
Corporate, financial and insurance fraud beyond a single claim.
Accident scenes, witnesses and liability facts.
How fraud schemes are uncovered and documented.
Witness location, statements and litigation support.
Available across Florida
Our office is at 4000 Ponce de Leon Blvd, Suite 470, Coral Gables. From there we take claim assignments throughout Miami-Dade, where civil cases are heard in the 11th Judicial Circuit, and across the state.
Miami Private Investigations