The Challenge

The Fraud Division currently employs 17 experienced investigators, but Mr. Griffiths expects that number to grow to about 24 over time. In addition to investigating all types of consumer and commercial insurance fraud – including cases involving automotive, property and casualty, life, fire and disability coverage – the division recently took over responsibility for investigating suspected cases of fraud in West Virginia’s workers’ compensation system.

In the past, suspected cases of insurance fraud in West Virginia were typically handed over to state or local police for investigation. Provided there was enough evidence to warrant charges, the case would then be referred to a prosecutor. The task of logging and managing all of those cases “was basically just done with a paper filing system and human memory,” Mr. Griffith says.

After taking charge of the newly created Fraud Unit, Mr. Griffith began to look for investigation management software that would enable his team to electronically record every case and every step of their investigations. One of the people he consulted was a former West Virginia senior state trooper who now works at the National White Collar Crime Center in Richmond, VA. “He told me there were a lot of case management systems out there, but the ones he’d seen all had drawbacks of one kind or another,” Mr. Griffith says. “Some are really just case tracking systems. I wanted something a lot more intelligent, something that would give me the ability to look at a case in real-time and make sure nothing gets left behind.”

The Solution

Eventually, another former colleague recommended that Mr. Griffith take a look at the case management system that was already in use at the West Virginia Workers’ Compensation Commission, whose investigative responsibilities were about to be transferred over to the Fraud Unit. That system used Case IQ fraud investigation software. “I arranged for a demo of [Case IQ] and I could see right away that it did a lot of the things I needed,” he says. Better yet, Mr. Griffith learned that the Case IQ system was fully configurable, so it could easily be modified to meet the Fraud Unit’s exact requirements.

It didn’t take long for him to decide that Case IQ fraud investigation software was the solution he had been looking for. Within weeks, the development team at Case IQ produced a customized version of Case IQ, and field trials got underway. After further refinement, the completed system went live on September 1, 2005.

From Mr. Griffith’s standpoint, the Case IQ software offers a number of key benefits. For one thing, the software is remotely hosted by Case IQ, so maintenance is not a concern. The fact that it is web-based means that users can access the system securely from the office, at home or on the road; the only requirement is a computer and an Internet connection (dialup or better). And Case IQ fraud investigation software is simple to use, so training time for staff members is minimal.

“Some of our cases might involve three or four investigators in different parts of the state,” Mr. Griffith says. “With [Case IQ], they can each enter their own information separately in the case file and it will all be logged in chronological order. I or any other manager can go in and see the status of a particular case, offer suggestions and direction, see how much time our people have spent working on a particular case, and have everything documented in real-time.”

Accuracy is another important consideration. “In the past, the lead investigator or somebody else would have had to sit down and manually go through all of the information in a file in order to write up a summary. It was very, very time-consuming, which meant that people often got frustrated and took shortcuts. With [Case IQ], you just press a button and the system spits out a complete written report. It saves a lot of man-hours and eliminates duplication of effort. And the final result is more accurate.”

At Mr. Griffith’s request, the Case IQ software was configured to send him automatic alerts based on specified triggers, such as when there has been no activity on a case for 30 days. “That’s important because it means I can take a look at the case and make sure there are no problems that are getting in the way of our investigative work. It gives me much greater supervisory capability. I can see the whole case at once instead of just bits and pieces.”

Using Case IQ’s built-in reporting capabilities, Mr. Griffith and his team can also analyze the Fraud Unit’s caseload to detect patterns of insurance abuse and plan their strategies accordingly. Over time, he says, that should allow them to become much more proactive in dealing with fraudulent behaviour.

“I’d been looking for investigation management software that offered all of these features, and [Case IQ] does exactly what we need,” Mr. Griffith adds. “I am sure that anyone who manages a large volume of cases would be interested in a system like this.”