Our Role in Insurance Claims
In order for property and casualty insurance coverage to exist, a carrier must be allowed to examine and verify the information related to an insurance claim. What many people fail to understand is that an insurance company knows little to nothing about a claimant. Once a claim is reported, they will try and speak with the claimant about the loss and their condition, possibly get a report and speak with a witness when available, and frequently that is all that is available to them. Unfortunately that limited information is almost never enough to base a complicated claims decision upon and more independent information is required. It is in those situations where more information is required that a professional investigator is often the only option the insurance company has to get the complete picture and make intelligent decisions.
Those who would condemn an insurance company for hiring an investigator to search for additional information as being “invasive” or “unreasonable” should consider that there are well defined limitations on what a claims investigator can and will do. An investigator, like anyone else, can observe what you are doing when in public. They can obtain public record information about you, again like anyone else can. They can talk with others who may have information of value. These investigative practices have been examined and judged as reasonable many, many times over in courts across the country.
Imagine if all that was required to get whatever amount of money a claimant is seeking is to simply lie about the loss. The insurance industry has little or no choice but to use some independent verification to prevent insurance fraud and abuse from bankrupting the entire industry. Currently, despite the assistance of investigators, the industry still suffers from massive losses on bogus and inflated claims demands every year. Conversely, every time someone’s insurance premiums go up, you can hear nearly endless discussion on the need to fight the fraud and abuse in the industry, but those voices are often quiet when they stand to “make money” on their own casualty claim.
In today’s litigious society, more and more auto, workers compensation and liability claims ending up in the hands of an attorney, who ironically gets paid more if she/he can inflate the value of claim. Some of the time it is necessary to hire an attorney, but all too often a claimant will hire one simply to try and collect a larger settlement, not because it is necessary. In many instances, the presence of an attorney makes the quick and fair handling of a claim impossible and exacerbates problems by restricting the flow of information to the carrier.
As claims investigators we simply document what we see and learn. We do not get paid more or less if someone’s claim is legitimate or not. We do not make the decision on which claims should be paid and which disputed. We simply relay the facts. Integrity and ethics is a cornerstone of what we do each day and we do not compromise them.
As people, we are just like you. We are mothers and fathers, sons and daughters, grand parents, church goers, volunteers, neighbors, drivers, homeowners. We are also things like; youth hockey coaches, Girl Scout troop leaders, instructors at colleges and graduate school students. Many of us have served in law enforcement, served overseas in the military, act in civic leadership roles and we all pay for insurance just like everyone else. Once in a while we even end up filing insurance claims of our own, and when we do, we undergo the same treatment as everyone else. Most importantly we treat people the same way we expect to be treated. We are professionals.
