What Does an Insurance Investigator Do and How Do They Work

An insurance investigator's main goal is to uncover the truth behind a claim, which involves conducting thorough investigations to verify the legitimacy of the claim.

They often start by reviewing the claimant's file and gathering information from various sources, such as medical records, police reports, and witness statements.

Insurance investigators work closely with law enforcement and other experts to gather evidence and piece together the facts of the case.

Their findings can have a significant impact on the outcome of the claim, which is why they must be meticulous and thorough in their work.

An insurance investigator is a professional who investigates and gathers facts to determine the validity of insurance claims. They are often hired by insurance companies to help resolve disputes and ensure that claims are legitimate.

Their primary goal is to determine the cause of a loss or damage and whether it is covered under the policy. This involves reviewing policy documents, interviewing witnesses and claimants, and analyzing evidence.

Insurance investigators use various techniques, including surveillance and undercover work, to gather information. They may also work with experts, such as engineers and medical professionals, to help determine the cause of a loss or damage.

Their findings are then used to make a decision on the claim, which may involve denying the claim, settling the claim, or investigating further. Insurance investigators must remain impartial and objective in their work to ensure that claims are handled fairly and efficiently.

Insurance investigators use various techniques to determine the extent of an insurance company's liability in a claim. They are willing to go to extreme lengths to disprove or reduce a claim.

Investigation is a key part of an insurance adjuster's job, as it involves gathering information about the claim. This can include talking to the person making the claim, as well as their neighbors.

Assessment is also a crucial part of the process, as it involves evaluating the information gathered during the investigation to determine the extent of the insurance company's liability. Verification is another important step, as it involves checking the facts to ensure they are accurate.

Negotiation is the final step, where the insurance adjuster will work with the person making the claim to reach a settlement.

Insurance fraud is a growing concern in wealthy nations, with many governments running public awareness campaigns to deter potential fraudsters and encourage people to report suspicious claims.

Insurance companies employ various methods to investigate potential fraud, including surveillance to verify the authenticity of claims.

Exaggeration of injuries is a common form of insurance fraud, where claimants may exaggerate the severity of their injuries to receive higher compensation.

Private investigators are often used by insurance companies to gather evidence and monitor claimants' movements, which can be invasive and intimidating for those trying to recover from an accident.

Insurance companies may study medical reports and history to eliminate the possibility of pre-existing injuries being claimed for after an accident.

Valuable assets, such as property or art, can be deliberately destroyed or stolen to claim insurance compensation, making it essential for policyholders to be honest about their possessions and their condition.

Private investigators may follow claimants in public or sit outside their homes to gather evidence, which can be used to dispute their injuries and jeopardize their claim.

Insurance companies will do whatever it takes to dispute a claim and deny compensation, even if the claimant has been honest about their injuries.

It's essential to be cautious after an accident in case an insurance company has hired a private investigator, and to be aware of unfamiliar cars or individuals following you.

Insurance companies often hire private investigators to gather evidence that might contradict a claimant's reported injuries or the severity of their condition. Private investigators may follow you in public or even sit outside your home to monitor your movements and gather evidence.

They might stake out your home or workplace by hiding in a vehicle and recording your movements, or track you following you as you go about your day. A private investigator must not breach your property, but it is not illegal for them to follow you to take photographs from the street.

Insurance companies employ a range of surveillance tactics, which can be physical or digital, and might be carried out by a private investigator or an adjuster employed directly by the insurer. These methods can be intimidating and invasive for accident victims who are trying to prioritize their recovery and recover some sense of normalcy after their accident.

Here are some reasons why an insurer might hire a private investigator:

A Bachelor's degree from an accredited college or university in Insurance, Business, or related fields is required for a career in private investigation.

Four years of experience in the property and casualty insurance industry as an investigator, adjuster, underwriter, or agent may be substituted for the education requirement, or three years of experience working within a state's insurance regulatory agency in a property and casualty capacity.

One year of experience in the property and casualty industry as an investigator, adjuster, underwriter, or agent is a good starting point for a private investigator.

A J.D. degree may substitute for the minimum qualifications, or possession of a J.D. degree and one year of experience in the property and casualty industry may be enough to get started.

Two years of experience in the property and casualty industry as an investigator, adjuster, underwriter, or agent can also satisfy the education requirement, or four years of experience in the same field may be substituted for a degree.

Commercial underwriting and rating experience is preferred in the field of private investigation.

Having a working knowledge of insurance laws is crucial, as it can often intersect with investigative work. This includes understanding the Annotated Code of Maryland, Insurance Article and the Code of Maryland Regulations ("COMAR").

Excellent customer service, communication (written and verbal) and organizational skills are a must for any private investigator.

Insurance companies often employ private investigators to gather evidence that might contradict a claimant's reported injuries or the severity of their condition. These investigators may follow you in public, take pictures, or even track your social media profiles.

Private investigators have the right to follow you at a distance in public places, take pictures of you in public areas, look at your social media profiles, and examine your public records. However, it's not always a straightforward process, as insurance companies may switch cars or investigators to avoid detection.

Insurance companies may say they hire private investigators to prevent fraudulent claims and protect their bottom line. However, the reality is that they also use surveillance to try and find a way to avoid paying out on legitimate claims.

A private investigator can uncover a lot of information about you, including your online activities, social media posts, and even your medical records. This information can be used to discredit your injuries and how they affect your life.

Insurance companies might also monitor your online activities, such as forum posts, blog comments, or reviews. A claimant discussing their recent gym workouts on a fitness forum might raise eyebrows if they've claimed severe physical injuries.

Here are some common insurance company surveillance tactics:

Keep in mind that these tactics are not always obvious, and insurance companies may switch cars or investigators to avoid detection. If you suspect you're being followed, it's essential to take precautions to protect yourself and your potential case.

Insurance companies might contact witnesses to cast doubt on your version of events and weaken your claim. They might ask witnesses to question what they saw, making it seem like you're partly or fully at fault for the accident.

Witnesses might be asked if they saw you wearing a seatbelt, if your head was down, or if you looked distracted. This is an attempt to dispute your client's liability.

Insurance adjusters often contact witnesses to ask about your injuries and whether you seemed hurt immediately after the accident. Not all injuries appear straight away, and adrenaline can often mask pain.

Witnesses might be asked about your condition after the accident, but many injuries are hard to identify by sight alone, especially if you put on a brave face.

Following doctor's orders is crucial when it comes to private investigation. If you've been advised to use crutches to walk but are spotted walking without them, it could jeopardize your claim.

Your medical professional's advice is a documented recommendation that can be referred to in your claim. Always adhere to medical advice and ensure all visits and recommendations are well-documented.

Ignoring doctor's orders can lead to complications and undermine your case. It's essential to take your medical advice seriously and follow it to the letter.