Insurance Companies Investigation of You: What are they looking for? Why do they inquire?

Insurance Companies Investigation of You: What are they looking for? Why do they inquire?

 Posted by:    Jul 31, 2015  


personal injury private investigatorWhen you call the insurance company to submit your claim for a car crash, workers compensation claim, your wife's missing wedding ring, or even to start the process for disability insurance, you can be sure that the insurance company is going to investigate your claim thoroughly. That means they will begin an investigation of you. The investigation methods for insurance companies vary.  The scope and detail of the investigation also varies.  But, in terms of what they are looking for, it’s always the same.

When an insurance company investigates you, they are seeking to confirm that your claim is legitimate. But even when they deem your claim to be meritorious, they often continue to investigate you. Why? Insurance companies want to make sure that the scope of your claim for loss (damages) is not an effort by you to overreach. In short, they are looking to rule out fraud.

In the industry, insurance fraud is broken down into types. Hard fraud involves conspiracies to make a fictitious claim for profit. Insurance companies know these claims are statistically infrequent. Their own internal studies show that hard fraud occurs on their consumer line of products far less than 1% of the time. The other kind of fraud is called soft fraud. Soft fraud involves people with real claims attempting to inflate their claim's value. A garden variety soft fraud is where a fender bender with no physical injuries gets reported as an injury claim. Soft fraud, while more prevalent, statistically still only occurs in a small percentage of insurance claims. The insurance industries own data places soft fraud at between 3 and 10% of all claims filed.

So when the insurance company questions you, researches your history, questions your friends and neighbors, and takes video surveillance of you walking in store parking lots, all of these efforts are to discover soft fraud.

Their investigation of you will not end until they are satisfied that your claim and the extent of your loss is bonafide.  However, you should relax and think of this process like the security checks you endure at the airport. In fact, since 9/11, most efforts to board an airplane are considerably more burdensome than the typical insurance investigation. After all, an insurance company won’t require you to remove your shoes.

Here are some tips to getting through the process reasonably unscathed:

1) STAY COOL (BE CHILL):
Remember, insurance claim adjusters are no different than anyone else you know, except that they were hired to work for the insurance industry. If you react aggressively to their inquires, common sense suggests that you have something to hide. Remember, acting like a jerk at the airport ticket counter has never resulted in anyone getting on the plane quicker. Chill out.  You did nothing wrong, and the insurance adjusters are just doing their job.

2) BE FORTHRIGHT:
Because you know they are looking for soft fraud, be particularly forthright when discussing your claim with adjusters during their investigation. If you had a pretty serious prior injury that got aggravated a little by this car crash--make sure they know that. Don't just answer questions along this line if they ask, be proactive and volunteer information that you know they should know. umpireIf you don't, and they later discover this information, they could evaluate every part of your claim with bias against you. This is a time to build credibility with the insurance company, not destroy it.

3) CALL BALLS AND STRIKES:
I'm a little league coach. During baseball season, I find it difficult to explain much of anything without bringing it back to baseball. However, this phrase fits with what I want you to understand.

When talking with insurance companies, try to remember that they are specifically looking for soft fraud. Don't describe every ache or pain you have suffered since the motor vehicle crash as profoundly extraordinary. Some injuries really hurt. Others are just a temporary and slight annoyance. If you are able to minimize at least some of your more minor issues, you will build credibility with the insurance adjuster.  If you can't, I suggest you see a neurologist (you could have something much more serious to worry about than your insurance claim).

4) KNOW WHEN TO SAY WHEN:
While our first three tips center around you being okay with a typical insurance investigation of you, and building credibility through candor, at some point, this process could start feeling like a proctology exam. If the investigation seems to be excessive, inordinately intrusive, or prolonged, retaining a lawyer to even the playing field and to get to the bottom of the excessive investigation might be in order.

At Anderson, Hemmat & McQuinn, we believe that when you are making an insurance claim, you should be honest, cooperative, and forthright. Even when you do so, the insurance company may not treat you fairly.  If you have been injured in a car accident, and you feel like the insurance company is not treating you fairly, please contact one of our attorneys today for a free consultation.









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