Claims Investigations

Posted May 2, 2016

After a policyholder submits a claim for benefits under his or her insurance policy, the insurance company will undertake an investigation of the accident. Many insurers treat policyholders fairly and conduct thorough and careful investigations of claims. Unfortunately, some insurance companies do not adhere to the standards of honesty and fair dealing owed to clients and instead review policyholders’ claims in bad faith. This often leads to unfair denials, which can be devastating for victims and their families who faithfully paid insurance premiums for years.

The Investigative Approach

Claim investigators attempt to recreate the loss. This requires noting the details about the accident, including:

• Date;
• Time; and
• Location.

Investigators then conduct an interview where claimants are given the opportunity to make a statement, either verbally or in writing. The information obtained is subsequently entered into the investigation report. In most cases, claim investigators also compile any documentary evidence related to a claim. This may require a claimant’s submission of a variety of documents, including:

• Police reports;
• Invoices;
• Receipts;
• Shipping and inventory records;
• Titles and deeds;
• Photographs;
• Maps and diagrams;
• Bills of sale;
• Appraisals; and
• Proof of ownership.

Thorough insurers may also request additional physical evidence to help them weed out any unlawful substitutions or fabrications. An investigator may request one or all of the following pieces of evidence:

• Damaged property;
• Computer hard drives;
• Fingerprints; and
• DNA.

Witness statements are another important tool that insurers use to fact check the other evidence. Any discrepancies may lead to additional investigations and the eventual possibility of the denial of a claim.

Official Report

Once the information has been compiled, an investigator creates a report, usually within a certain time frame, that highlights the most important facts of the case as well as the most convincing evidence. While the report does not usually contain an opinion on the validity of the claim in question, it is an important tool for unearthing disputed facts or overlooked evidence. Based on the report, which includes witness statements, physical evidence, and documentary evidence, as well as the claimant’s version of events, an insurer will go on to make a determination of whether the claim is justified or should be denied.

Insurers are required to adhere to certain ethical standards when determining the validity of an insurance claim. Failing to adhere to these standards may constitute bad faith, so if you sustained property damage or were injured in an accident and your insurer unfairly denied you coverage, it is important to obtain the help of an experienced bad faith insurance attorney who can ensure that your interests are protected. Please contact or call a member of our legal team at the Bennett Law Firm at 405-272-0303 for a free consultation.