“You cannot litigate, if you do not investigate”
— F. Lee Bailey
These were the words that F. Lee Bailey spoke to a group of investigators at the National Association of Legal Investigators Conference in 2019. These words never ring truer today. It seems you cannot go one day without a blog or article discussing a lawsuit for fraud that has been filed by an insurance company in New York. These companies have filed claims accusing several Plaintiff law firms of filing false/fraudulent claims. One can only be reminded of the parallels to the Salem Witch trials and the damages that can take place when accusations begin to fly off the handle. Some organizations have been posting copies of the filed summons and complaints against the plaintiff firms with very damaging editorials on the matter. One could even suggest that they are borderline slanderous accusations. In one instance, if you took the time to actually read the verified complaint, it stated that a plaintiff firm was acting fraudulently because a video (in the possession of the defendant) disproved their theory about liability and subsequent injury. Now I am not an attorney, but I have been in this vertical for over 25 years. In my experience, when there is a question of fact, a motion for summary judgement is made and a case is dismissed if the merits are questionable. To simply sue a firm because a video was produced that questions the mechanics of the accident is irresponsible in my opinion. I can only imagine the slander cause of action claims that will be brewing in the near future. When you begin to understand the impact any accusation can make on the reputation of a law firm, you can understand the millions of dollars that are at stake. A “keyboard warrior” with an ax to grind can cause a significant amount of damage leaving a false review on Goggle or other web platforms. It is very concerning to see how this has escalated in the last three to four months.
As an investigator whenever I would do an “intake” over the years, I would also breakdown the explanation of how a lawsuit works in to layman’s terms to cover the legal process to the injured party. It comes down to three factors. The first factor is injury. This is pretty self-explanatory. How injured is the party? This is confirmed by medical records. When a doctor examines a patient, there are radiological images and different exams to prove an injury. Assuming the doctor is not falsifying claims, (there is no excuse for this and any doctor doing this should be prosecuted) a certain threshold must be met to prove injury.
The second factor is liability. You must be able to prove someone, or some policy was responsible for the injured party’s injury. In New York, there are very detailed Labor Laws and Industrial Codes that pave the way to prove a party was negligent. As investigators, establishing this is a standard that we shoot for. If we can establish a certain labor law or industrial code has been violated, a case is usually settled in pre-litigation or in arbitration. If we can prove the case didn’t meet the threshold, our clients can disengage early.
The third factor is insurance coverage. Who is the insured party and what type of coverage do they have? This goes into the formula for the injury and the assumed value of that injury. There are many factors when looking at valuation of a case that need to be considered. Age of the injured person, income, ability and likelihood of recovery are all factors to be considered.
When you consider these factors, it becomes crystal clear about the importance of using professional investigators from the onset to establish the much needed liability to get you over the threshold for litigation. Now more than ever the witch hunt that is out there to try and “get another one” listed as a fraudulent law firm demands that cases must be investigated early. The importance of getting fact witnesses, video and photographic evidence and establishing credibility can be the saving grace when a frivolous claim of fraud is waged against your firm. I am not defending any of the firms that have been accused of falsifying medical records, pushing for surgeries and handing out cash advances on cases through funding sources. Each of these claims are unique and should be investigated on a case by case basis. The cause for concern is the fever pitch to just accuse a firm of fraud and the damage it can do to a reputation.
My investigative team has always specialized in personal injury cases and over the years I have caught some criticism for only serving the plaintiff law firms in New York. This was an intentional decision based upon how I got into the business and the things some defendant carriers and firms ask me to do that I did not agree with. As an investigator, we are a third party. We are not employed by either side. We work within the law and look to establish liability through labor law and industrial codes. My investigative team has taken OSHA classes in safety and scaffolding laws to reinforce the assessment of each case we work on. Think of how a juror, judge or arbiter would react to a third-party assessment that was done early on in the life cycle of the case. This can strengthen an argument to file a claim for personal injury. We have built a reputation on reporting facts that have been uncovered on all different types of cases in New York and I am proud of my team for curating so many case files over the years with thorough work.
In my opinion this is the only way to curb this concerning behavior of fraudulent claims being thrown out at many of the bigger personal injury firms in New York City. Investigate the case early and establish liability. Get this case over the threshold or use a thorough investigation to disengage on a matter that just doesn’t feel right. A good investigator will follow a template on how to establish whether or not the claim meets certain standards. Think of all the money a firm has spent to build a caseload and that firm’s reputation. It is scary to think how a baseless accusation can cost a firm millions of dollars in revenue. Please feel free to contact my firm to have us come in and review any of your case files from a third-party investigative perspective. The best way to shorten the life cycle of a good personal injury claim is to investigate and then litigate. God Bless F Lee and his ability to make sentences into poetry.
