Liability Insurance Claims, encompasses many facets and roles: As an investigator, and insurance contract expert, and a person of empathy. Both the adjuster and investigator have an obligation to fulfill the promise made in the policy to defend and indemnify the insured.
In doing so, they also protect the assets of the insurer so that only the claims owed are paid. The adjustment of a liability claim commences with the loss notice. When an insured incurs a loss, the policy requires that notice be given to the insurer.
Your investigation should determine whether an individual’s level of activity is, or is not consistent with their claimed condition and restrictions. The goal of an Activity Check is to know more about the worker when you finish than you did when you started.
Good results depend on good case preparation. Know the history of the case and the issues to be resolved. Most importantly, know you’r subject before you go out.
Perhaps the first step in investigating a suspicious claim or any claim for that matter-is to obtain the preliminary statement of the insured or third-party claimant. The purpose of this statement is to get a brief sketch of the facts and circumstances surrounding the loss.
The insured or claimant should be asked for the facts about how the loss occurred. Background questions should also be asked, as well as basic questions about the insured’s financial condition where appropriate.
Experience has shown us that some injured workers will prolong their return to work by malingering or exaggerating their disabilities.
Surveillance investigations should be initiated when you have good reason to believe the worker is misrepresenting his / her disability, and when visual evidence can be utilized or be of benefit in closing or managing the claim.
In those instances, conducting covert surveillance and gathering video evidence of the injured workers’ disability and activity level is necessary to manage the claim effectively and avoid paying undeserved benefits.
Based on a visual inspection condition of your property, surrounding property, general utilities and infrastructure, Perimeter Assessment Report (PAR) serves to identify critical physical and other vulnerabilities with common mitigation solutions for consideration.
The primary focus of this report is on physical security and crime prevention through environmental design.
Remember that no matter what type of property you manage or own you should have a proactive, and reactive security measures in place.
In our dedicated support to you as claims examiners we have developed a product named the “Guide To Investigations”. This web based product is designed to assist claims professional in the investigative process. It provides direction, consistency and clarity as you investigate. This resource is a must for all Claims Examiners, Third Party Administrators (TPA), Private Investigators and other claims professionals.
Welcome to a new and effective way to reduce the paid costs on claims, Eliminate high reserves, and increase leverage for settlements. The current trend to subjectively review each claim for fraud leads to inconsistent results.