What do insurance investigators do?
Asked by: Mr. Durward Fay PhD | Last update: January 21, 2026Score: 4.3/5 (72 votes)
How does an insurance investigator work?
An insurance investigator is an individual who inspects and researches an insurance claim to ensure no fraud is occurring. They gather information from the insurance adjuster , law enforcement, claimant and witnesses in order to develop a better understanding of the case and decide whether the claim is valid.
What triggers an insurance investigation?
Inconsistencies and delayed claims can trigger alarm bells, leading the insurance company to closely scrutinize the legitimacy of your case. The duration of your recovery is not only critical for calculating the compensation but also for evaluating the credibility of your claim.
Why would an insurance investigator come to my house?
Yes it is common to do home calls when there is concern or other details that need investigation. They are likely gathering details about the claim, the agency that sold the policy or any related businesses (body shops, chiropractors, sometimes even the claims handler themselves).
What questions do insurance investigators ask?
- Questions About the Involved Vehicles. ...
- Questions About How the Car Accident Happened. ...
- Questions About Shared Liability. ...
- Questions About Vehicle Damages. ...
- Questions About Your Injuries. ...
- Insurance Tactics Used to Reduce Your Car Accident Insurance Payout.
Uncovering How Insurance Companies REALLY Investigate Claims | Private Investigator Training Video
Should I talk to an insurance investigator?
Let the facts of the case, such as video and photo surveillance, eyewitness statements, and accident reports, do all of the talking for you. The more you talk about the incident, the more likely the claims adjuster will find inconsistencies in your story to use against you.
Are insurance investigations discoverable?
Consequently, documents prepared in the ordinary course of an insurance company's investigation to determine whether to accept or reject coverage and to evaluate the extent of a claimant's loss are not privileged, and, therefore, discoverable.
How long can insurance take to investigate?
Most insurance companies are typically given between 15 to 90 days to investigate a claim and accept or deny it, depending on the specific state regulations, the type of the claim, and the case's complexity. For instance: Straightforward property damage claims may be resolved more quickly.
Can I refuse a home insurance inspection?
Insurance inspections are often done at the beginning of a homeowners insurance policy or at renewals. As a homeowner, you do have the right to refuse someone from entering your property, including insurance inspectors. However, the result could be a bigger financial burden on you than accepting the inspection.
Is it normal for insurance companies to take pictures of your house?
Having the insurance company come take pictures or inspect your house is a good thing. They are looking for hazards that could cause a claim or even a lawsuit. The purpose is to protect you better and save you hassle & money in the long run.
Why is an insurance investigator calling me?
Clarification: The investigator may simply need more information or clarification about specific aspects of your claim. This can be part of the normal process of claim verification.
What does it mean when an insurance claim is under investigation?
Insurance companies often conduct claims investigations to evaluate the legitimacy of a claim. The investigation process helps the claims adjuster make an educated decision about how to proceed with a claim. Insurance claims investigations are used to combat the prevalence of false or inflated claims.
What is the first thing an insurer must investigate before taking on a claim?
Insurance companies must search for and consider evidence that supports coverage for the claim. Thus, insurance companies cannot close their eyes to evidence that supports coverage and focus solely on the evidence that denies coverage. Too narrow a focus of investigation?
What does an investigator look for?
Private detectives and investigators must properly collect and document evidence so that it may be used in a court of law. Private detectives and investigators gather, analyze, and report information to clients regarding legal or personal matters.
Do insurance investigators look at cameras?
Insurance companies may conduct their own investigation in response to a particularly costly claim. This can include going to the scene of the accident and looking at surveillance footage or any other available evidence. Insurance companies may look at security camera or dashboard camera footage of the car accident.
How long does it take for an insurance adjuster to make a decision?
Typically, insurance companies have 15 days to acknowledge receipt of the claim you submit. That does not mean they have to decide within that time frame. They then have 15 days to investigate the claim. They have 40 days to settle the claim from start to finish.
What is the riskiest part of a home inspection?
Water damage can be the most expensive of all the major issues a home inspection may encounter because it can cause so much damage.
What not to say to a home insurance inspector?
Admitting fault: Using apologetic language is enough for the insurance adjuster to assume you're admitting fault and use that against you. Even if you feel you're at fault, wait for the official investigation to prove what actually happened. Don't say things like “I'm sorry” or “it was my fault.”
Do insurance inspectors come inside?
During a home insurance inspection, your home's exterior and interior are examined to help insurance companies determine the replacement cost of your home. The inspection will also look for any hazards that may make your home riskier to insure.
What is the first step in insurance investigation process?
Once a claim has been reported, the adjuster will begin the second step in the claims process: investigation. The first step in this process completed by the adjuster is to determine whether coverage is applicable to a loss. The methodology they use depends on whether the claim is first-party or third-party in nature.
Can I sue my insurance company for taking too long?
The answer to this question is complex, but California health insurance providers are bound by state law to respond to claims within a specific amount of time. If they fail to do so, you may have the basis for a lawsuit against your insurer due to bad faith.
Can insurance investigators get phone records?
To obtain your phone records, the insurance company must take legal action to do so. That is, while you can certainly provide that information if you would like to, especially if it shows you were not using your phone or otherwise distracted, you may be able to refuse this information initially.
What is the difference between discovery and investigation?
Black's Law Dictionary defines "investigate" THIS WAY: "To inquire into (a matter) systematically . . . ." "Discovery" is defined as "compulsory disclosure, at a party's request, of information that relates to the litigation . . . ." (Black's Law Dict. (7th ed.
What is an insurance investigator?
a person whose job is to carefully examine the damage, etc. relating to a claim (= request for payment) that someone has made to an insurance company: He was an insurance investigator looking into an accident that had occurred on the street some months before.
Do insurance companies do surveillance?
Insurance companies usually begin surveillance soon after you file a claim. They may also conduct additional surveillance if they discover new information about you down the road. This may happen multiple times before your claim is settled or taken to court.