Why and How Insurance Companies Investigate Claims

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After a storm damages a home, the owner will want the insurance check as soon as possible. If the insurance company and the restoration experts work with claims management professionals, they should be able to send the insured his or her money fairly quickly.

However, if the insurer suspects abuse or fraud, the company may perform an investigation before finalizing the payment. The adjuster can then decide whether or not to proceed with the claims process. The investigation typically involves the following:

1. Interviews

The investigator will question everyone who was in the home at the time of the loss. The investigator should specifically ask for written or recorded statements. This way, he or she can review the statements later and look for any discrepancies.

2. Location Survey

The investigator should additionally take photos and videos of the loss location. This will help put the witness statements in context. The insurance company may additionally conduct surveillance on the suspect to see if he or she makes incriminating comments.

3. Research

Social media is a great tool for insurance investigators. Facebook posts about financial issues could hint at a possible motive for fraud. The investigations should additionally look at prior claims the suspect made and whether any of those claims were suspicious.

4. Documents

Official records are an important part of any insurance investigation. The company should ask for receipts or other proof of the claimed losses.
Insurers do these investigations in part to help their law-abiding customers. Illegitimate claims cause everyone's insurance bills to increase. In fact, fraudulent claims cost approximately $80 billion annually. Insurance companies also investigate suspicious claims so they can avoid sending large checks to con artists.

An insurance company may investigate a claim, delaying payment until the investigator has performed interviews and studied the records. If fraud has occurred, the suspect could get arrested. Catching these cons benefits both insurers and law-abiding citizens, so investigators should be thorough.

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