Unraveling The Investigation Process: A Deep Dive Into Auto Insurance Claims Assessment

After an accident, the process of filing an insurance claim can be confusing and stressful. The insurance company will investigate your claim to protect itself from fraud and correctly assess the situation. This process can take anywhere from a few weeks to several months, depending on the complexity of the case and the severity of the accident. The investigation will include examining evidence from the accident scene, reviewing records and documents, and interviewing witnesses and those involved. The adjuster, or investigator, will also visit the accident scene, review social media activity, and collect pertinent information such as insurance details, time, date, location, and police reports. It is important to cooperate with the investigation and provide honest and accurate information to ensure a successful claim.

Adjuster interviews

Once a claim is submitted, an insurance adjuster is assigned to oversee the investigation. The adjuster will contact the claimant to ask for more information, including a summary of how the accident occurred, and may ask follow-up questions. The adjuster may also request additional information, such as:

• The police accident investigation report
• Photos taken at the scene
• Medical records and bills
• Vehicle information

The adjuster may also want to inspect the claimant's vehicle and visit the accident scene, especially if fault isn't apparent or it was a severe accident.

The adjuster will also interview witnesses and other drivers involved in the case to verify the claimant's version of the accident. They will ask for details such as the time, date, and location of the accident, and gather information such as insurance details of the involved parties and the names and badge numbers of responding officers.

In addition to interviews, adjusters may also review documentary evidence such as police reports, medical records, and social media activity. They may also take recorded statements, request cellphone records, conduct background checks, and obtain medical authorizations.

The adjuster's role is to gather as much information as possible to verify the credibility of the claim, determine the validity of the reported injuries and property damage, and assess the value of the claim.

Evidence collection

Police and Medical Reports

The insurance adjuster or investigator will typically obtain copies of official reports related to the accident. This includes the police report, which details the investigating officer's findings, statements from those involved, and any citations issued. Additionally, medical reports and doctor's notes are collected to verify the extent and nature of the claimant's injuries. These reports play a crucial role in determining the validity and severity of the claim.

Physical Evidence

Physical evidence from the accident scene is also crucial. This may include photographs or videos of the scene, skid marks on the road, lighting or visibility conditions, and any physical debris left at the scene. The adjuster or investigator may visit the accident location to collect this evidence themselves or work with a private investigator to do so.

Witness Statements

Witness statements carry significant weight in insurance investigations. The adjuster will interview witnesses, including those listed in the police report and any additional individuals identified during the investigation. Obtaining recorded audio or video statements from witnesses can provide valuable insights into the circumstances of the accident.

Vehicle Inspection

In cases involving vehicle accidents, the insurance company may request to inspect the vehicles involved. This inspection allows them to verify the damage, its extent, and any previous conditions or factors that may have contributed to the accident.

Cellphone Records

Cellphone records are becoming increasingly important in insurance investigations, especially when determining fault. By reviewing these records, adjusters can determine if cellphone usage or distraction played a role in the accident.

Social Media Activity

Insurance adjusters may also review the social media presence of the claimant. This is done to identify any inconsistencies in the claimed injuries or losses. For example, if the claimant states they cannot walk after the accident but posts photos on social media showing them engaging in physical activities, it could raise doubts about the validity of their claim.

Background Checks and Previous Claims

Background checks are another tool used by insurance adjusters. They may investigate the claimant's past, including previous insurance claims, accidents, and medical records, to identify any discrepancies or pre-existing conditions that could impact the current claim.

Other Investigative Techniques

In some cases, insurance adjusters may employ additional techniques, such as conducting a recorded statement with the claimant, reviewing GPS or navigational data from the vehicle, or obtaining video and photo evidence from those involved or nearby sources.

The evidence collection process is comprehensive and aims to gather as much relevant information as possible to make an informed decision regarding the validity and value of the insurance claim.

Witness statements

Types of Witnesses

There are two main types of witnesses: first-party and third-party. First-party witnesses are directly involved in the accident and have a stake in the outcome of the case. For example, the drivers involved in a collision are first-party witnesses. Third-party witnesses, on the other hand, have no personal connection to the people involved in the accident and no financial interest in the case. Examples include drivers and passengers in uninvolved vehicles, or people in nearby houses or businesses.

Witness Credibility

The credibility of a witness is an important factor. Third-party witnesses are often considered the most credible by insurance adjusters, judges, and jurors because they are neutral and may have seen or heard things from a different perspective. However, all witnesses are human, and their recall of an accident may not be perfect. Events during a car accident happen very quickly, and people may only catch a glimpse of what happened. Additionally, the stress and trauma of an accident can affect a person's memory and attention.

Collecting Witness Statements

It is important to act quickly when collecting witness statements, as witnesses may not stay at the scene for long. Get names and contact information for each potential witness, and ask them to record a video or voice memo on your phone describing the accident in detail. Alternatively, they can write a signed and dated statement. It is important to tread lightly when asking for these statements, as witnesses should not feel pressured or coerced.

Witness Rights

Witnesses have the right to decide whether or not to speak to the insurance company. They are not legally obligated to do so unless there is a court order, such as a subpoena. Witnesses can also control the terms of the interview, such as choosing to be interviewed by phone or refusing to have the interview recorded.

Witness Cooperation

While witnesses have the right to decide whether to cooperate, it is important to note that their refusal to speak to the insurance company may affect the value of their statement. The insurance company may suspect that the witness is trying to conceal facts or that there is no witness at all. Therefore, it is generally advisable for witnesses to provide their statement to the insurance adjuster.

Social media activity

Insurance adjusters or investigators will review your social media presence to gather information and evidence related to the accident and your claimed losses. They will look for any discrepancies or inconsistencies between your social media activity and the details of your claim. For example, if you claim to have sustained a back injury from a car accident but then post pictures of yourself dancing at a wedding, the insurance company may use this as evidence that your injuries are not as severe as claimed.

Additionally, insurance companies may use social media to verify your personal information, such as your name, birthday, address, and health insurance details. They will also look for any evidence of previous accidents or insurance claims that may be relevant to your current claim.

It is important to note that insurance companies cannot directly access your private social media accounts without proper authorization. However, they may request access to this information during the claims process, and individuals sometimes voluntarily provide access or share relevant content. Therefore, it is crucial to be cautious about what you post on social media and to review your privacy settings to ensure maximum confidentiality.

Furthermore, even if your own social media profiles are set to private, your friends' profiles may not be. This means that information about you, such as photos or posts that mention you, could still be accessible to insurance companies.

In summary, social media activity plays a significant role in auto insurance investigations, and it is essential to be mindful of your online presence when filing an insurance claim.

Claimant's records

Claimants' records are an essential aspect of auto insurance investigations, and companies will scrutinise these documents to verify the legitimacy of a claim. The process involves collecting and reviewing various types of information, including official records, financial records, and other relevant documentation. Here is an overview of how auto insurance companies investigate claimants' records:

Official Records

Official records play a crucial role in the investigation process. In the case of a personal injury claim, insurance companies will seek medical records such as medical release forms, prescription records, doctors' notes, and any other documents that can confirm the legitimacy and severity of the claimant's injuries. Similarly, for workers' compensation claims, investigators will collect medical records as well as the OSHA form detailing the incident.

Financial Records

Financial records are also subject to examination during auto insurance investigations. This includes bank statements, credit card statements, loan statements, lines of credit, and mortgage documents. By analysing these records, insurance companies can gain insight into the financial situation of the claimant, which may be relevant to the claim.

Police and Accident Reports

Police reports are standard documents requested by insurance companies during investigations. These reports provide valuable information about the circumstances surrounding the accident, including details of the incident, the parties involved, and any witnesses present. Accident reports, generated by the insurance company or a third party, also play a similar role in the investigation process.

Photographs and Videos

Visual evidence, such as photographs and videos taken at the scene of the accident, can provide valuable context to support or contradict claims. These visual records can help insurance adjusters understand the extent of the damage to vehicles and other property and may also capture important details about the incident.

Social Media Activity

In today's digital age, social media activity has become an increasingly important aspect of insurance investigations. Insurance companies may monitor and review claimants' social media posts and activities to verify the information provided in their claims. For example, recent posts about financial struggles or negative sentiments towards work may raise suspicion about the validity of a claim.

Cellphone Records

Cellphone records are another piece of the puzzle in auto insurance investigations. With the increasing role of electronic devices in accidents, insurance companies may request access to cellphone records to determine if the use of a device contributed to the accident. These records can confirm or disprove device usage around the time of the incident.

Background Checks

Background checks are also a standard component of insurance investigations. This involves reviewing the claimant's personal information, including their full name, birthday, home address, and health insurance information. This information is cross-referenced with a national database to identify any inconsistencies that may impact the claim.

In summary, auto insurance companies conduct thorough investigations into claimants' records to protect themselves from fraud and accurately assess the validity and value of a claim. By examining a range of official documents, financial records, and other relevant information, insurance companies can make informed decisions about the appropriate course of action regarding the claim.

Frequently asked questions