What Are Insurance Investigations?

A part of each insurance adjuster’s job calls for performance of those efforts that produce facts that can contribute to an insurance investigation, typically one that relates to one of the adjuster’s assigned cases.

The 2 types of insurance investigations

Claim: This is used to prevent or question the presentation of an inflated claim.

Coverage: This determines whether or not a given policyholder’s policy covers a certain accident.

Details on each type

The principal question in the minds of adjusters that must conduct a claim investigation is this one: Who was at-fault? That question highlights the approach often taken by someone that has come forward with an inflated or false claim. That same person likes to suggest that someone else caused the property damage that had actually resulted from the policyholder’s own actions.

Adjusters use 3 different methods for answering that principal question. Those methods include collecting relevant evidence, conducting interviews and seeking out specific records.

The principal question in the minds of adjusters that need to conduct a coverage investigation is this one: Does this policyholder’s policy cover the incident to which I have been assigned? Insurance companies launch such an investigation in order to protect the company, and not to protect an injured claimant, as per an accident lawyer in Cambridge.

Questions asked by an Adjuster

Here are some of the questions that might be asked, after an adjuster was

asked to investigate the coverage for the losses that had been suffered in an auto accident:
• Was the damaged vehicle being towed?
• Was the driver at the wheel of the vehicle that was named on the car insurance policy?
• Was the driver at the wheel of a rented automobile?
• Had the vehicle’s owner paid the annual premium?
• Was the driver one of the individuals that had been named on the car insurance policy?
• Had the car’s owner agreed to give the driver the keys to the automobile that later became involved in a car accident?

When conducting a coverage investigation, an adjuster must pay close attention to the wording in the policy held by the person being investigated. Ideally, those words would spell out in no uncertain terms what could be covered, who could be covered and what reported situation managed to match with one of the situations that had been named in the car insurance policy.

Admittedly, no policy covers all possible situations and every potential source of damage. Still, no policyholder wants to pay for some sort of elusive coverage, in other words, an undependable assertion that any anticipated losses should get covered.

Those two facts underscore the challenges faced by adjusters that have been asked to undertake a coverage investigation. An experienced adjuster has learned how to face and deal with those sorts of challenges.