How Do Insurance Companies Approach Investigation of Submitted Claim?

Insurance companies rely on the investigation of a given claim, in order to determine what took place before and during the reported accident. Insurers do not want to deny a legitimate claim. By the same token, no insurer wants to offer a payout to someone that has submitted fraudulent information.

The investigator helps the adjuster to gather useful evidence, regarding the claimed damages

Investigators visit the location where the reported accident took place. During their visit, significant landmarks, signal lights and road signs become the focus of the investigator’s camera. Sometimes investigators also snap a picture of noteworthy tread marks.

Tasks performed by the adjuster

Visit different social media networks, and check to see if the claimant has posted any statements or photographs on a social media site.

Review the company’s record of past claims, in order to see if the claimant has submitted any previous claims. The presence of a pattern in the nature of the damages could qualify as a “red flag.” Some drivers work with others, in order to stage specific types of accidents.

Perform a background check on the person who submitted the claim. Government authorities warn some drivers with multiple violations that after receiving more than a given number of tickets in a specific year, their license will be suspended. Had the claimant been driving with a suspended or revoked license?

Adjusters check for the existence of any additional “red flags.”

Did the claimant indicate that he or she had suffered severe injuries, even though there had been only minor damage to the involved vehicles?

Had the claimant insisted that the forces created by the collision had aggravated a previous injury, when there was no mention of such an injury in the claimant’s past medical history?

Had the reported damages indicated that the damaged vehicle would need an extensive amount of repair? That could be a “red flag,” if details on the accident had suggested that the level of impact had not been substantial.

Had the claims about the victim’s lost wages not matched with the information that had come from the employer?

Had the claimant’s account of what took place, before the collision not matched with the information that had come from one of the witnesses? For instance, had the claimant’s statement failed to mention that the vehicle’s left turn signal was not working during the moments before the collision?

The adjuster’s tools

A recorded statement: Adjusters often try to obtain such a statement before the victim has been able to hire a personal injury lawyer in Watsonville. What was in the police report: Had the arriving officer issued a citation to any of the involved drivers? Had the victim sought to hide a piece of evidence?

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