What is claim investigation?

I've been told my insurance claim is being investigated. What does this mean? Am I under investigation for fraud? Not necessarily.

When you have had a loss, be it a car accident or a break-in to your home there are procedures that are followed. You report the claim to your insurance company, often by notifying your agent or broker who file a report on your behalf.

The insurance company has a team of people that can be used for any claim. The first one will be the adjuster who will check the policy wordings to be sure that your claim "triggers" coverage. Yes, if you have auto insurance then you do have coverage for liability but now it needs to be confirmed which physical damage you chose to buy.

The adjuster wants to be sure that your damaged property is restored to how it was just before the loss occurred. The adjuster also has to consider if you will be held legally liable for any damage or injury. Some claims are very clear-cut and do not require any follow up investigations. The ones that do need investigation are not done just because someone suspects fraud.

Sometimes forensic engineering is required to help determine the circumstances and possible fault in a claim. This is done by the process of deducing what actually happened with the vehicles and the conditions at that time. This investigation will examine how a loss occurs and hopefully provide an explanation as to how a a loss could have been prevented and who was responsible.

Car accidents can involve injury. The technical side of the forensic engineering can show whether or not it was likely that a physical injury could have resulted from the force involved in the car crash. There can be follow up investigations when a person files a disability claim. Be careful what you post on Facebook!

Fire investigations are done to help determine what caused the fire. If it is a result of faulty wiring or a mechanical failure then the insurance company knows who to address for subrogation. So it is a bit like CSI on the television but actually goes further looking at the areas of possible causes of losses beyond the human factor.

Claim investigation will bring out the truth of the circumstances. You will find out how things actually happened and what might have been done to prevent, avoid or reduce the loss. It is done without bias. The investigators do not look to favour one party or another. The truth will be found and the results will determine how insurance is paid out.

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