Becoming An Insurance Private Investigator: A Step-By-Step Guide

Insurance fraud is a widespread problem, costing American consumers at least $80 billion every year. As a result, insurance investigators are in high demand. These professionals are responsible for uncovering evidence of insurance fraud, which can take many forms, including false claims, lying on forms, and exaggerating injuries. To become an insurance investigator, you'll typically need a high school education, a bachelor's degree (ideally in a relevant field), a license, relevant certifications, and related experience. Strong communication and active listening skills are also a must, as the role involves interviewing claimants and witnesses.

Surveillance techniques

Blending In

An important aspect of surveillance is discretion. No matter the sophistication of your information-gathering methods, if you are too obvious, you will not only fail to gather the evidence but also risk a conflict-filled day. So, blend in with the general population by wearing inconspicuous clothes and driving an unremarkable car. If you need to embody a character to get closer to your subject, ensure you have a backstory to avoid raising suspicion. For example, if you are posing as a neighbourhood dog walker, be prepared to answer questions about your work.

Familiarity with the Area

It is crucial to quickly familiarise yourself with local roads and landmarks. Knowing your way around allows you to tail subjects without getting lost and provides a quick escape route if things get tricky.

Knowing Your Subject

To effectively track someone, you need to know their habits, schedule, and tendencies. Start with a background check to learn about their history and potential violent tendencies. Then, gather additional information by talking to sources. An informed investigation is often a successful one.

Working with a Partner

Sometimes, loitering in an area for too long will draw suspicion, regardless of your appearance. To counter this, consider working with a partner, preferably of the opposite sex, as it will make your presence more acceptable to onlookers.

Quality Recording Equipment

Invest in good recording equipment, such as a DSLR camera with a telephoto lens, to capture high-quality evidence.

Social Media Tracking

Create social media accounts and follow your subjects on platforms like Facebook, Twitter, and Instagram. People often reveal a lot about themselves through their social media activity.

Trash Inspection

In many states, once someone puts their garbage out, it is no longer considered their property. Going through someone's trash can reveal a lot of information, but do this quietly and late at night to avoid confrontation.

Remember, always operate within the confines of the law, as running into legal trouble can undermine your investigation. Stay discreet, become an expert on the area, embody your role, and be creative in your information-gathering methods as long as they are legal.

Research and document review

As a private investigator, you will be tasked with reviewing and investigating insurance claims to determine their validity. This will involve a lot of research and document review.

Firstly, you will need to understand the type of insurance claim being made. There are several types of insurance investigations, including personal injury, slip and fall, product liability, workers' compensation, disability insurance, and healthcare fraud investigations. Each type of claim will have different documentation and evidence that you will need to review. For example, a personal injury claim may involve reviewing photographs of the injury or accident, while a workers' compensation claim may involve reviewing medical records and employment documents.

You will also need to be able to identify red flags or discrepancies in the documentation. For instance, in a property damage claim, you may need to review receipts for property purchases or repair bills. You would cross-reference these with other evidence, such as police reports or witness statements, to ensure consistency. You may also need to review insurance documents for any signs of forgery or tampering, which could indicate a fraudulent claim.

In addition to reviewing documents, conducting background research on the claimant is crucial. This can help you identify any motives or patterns of behaviour that may indicate insurance fraud. For example, you may discover that the claimant has a history of filing questionable claims or has been convicted of fraud in the past. Financial records can also reveal financial stressors that may motivate someone to commit insurance fraud, such as outstanding bills or home foreclosure.

Throughout your research and document review, it is important to maintain a high level of attention to detail and critical thinking skills. You must be able to identify inconsistencies, discrepancies, or suspicious patterns in the information you review. Additionally, staying organized and maintaining thorough records of your findings is essential for building a case and providing clear reports to your clients.

Background checks

A background check can help identify whether the person making the insurance claim has a history of filing claims and whether they have been convicted of crimes such as fraud. A background check can also reveal personal or financial information about the claimant, such as whether they are going through a divorce, have fallen behind on bills, or have their home in foreclosure. These factors may influence the claimant to commit insurance fraud.

For example, a claimant may have a history of filing fraudulent insurance claims, which can be uncovered through a background check. This information can be crucial in determining the validity of the current claim.

In addition to background checks, insurance investigators may also employ other techniques such as surveillance, research, and document review to uncover insurance fraud. They gather information from various sources, including insurance adjusters, law enforcement, claimants, and witnesses, to develop a comprehensive understanding of the case.

The goal of an insurance investigator is to gather sufficient evidence to pursue monetary damages and/or a civil or criminal conviction against those committing insurance fraud. By conducting thorough background checks and employing other investigative techniques, insurance investigators play a crucial role in ensuring fairness in the insurance claims process and protecting the interests of insurance companies and their customers.

Interviewing skills

To enhance your interviewing skills, consider the following strategies:

Prepare in Advance:

Before conducting an interview, ensure you have a clear understanding of the case's specifics. Review relevant documents, such as insurance forms, medical records, police reports, or repair bills. Identify the key questions that need to be answered, and prepare a list of specific inquiries to guide the interview. This preparation will help you focus on pertinent information and adapt your line of questioning as needed during the interview.

Establish Rapport:

Building a rapport with the interviewee is crucial for creating a comfortable environment that encourages open and honest dialogue. Begin the interview by introducing yourself and explaining your role in a friendly and professional manner. Establish a connection by showing empathy and respect for the interviewee's situation. Maintain eye contact, use appropriate body language, and actively listen to build trust and encourage cooperation.

Ask Open-Ended Questions:

Frame your questions in a way that invites detailed responses. Ask open-ended questions that cannot be answered with a simple "yes" or "no." For example, instead of asking, "Did you witness the accident?" consider asking, "What did you see or hear at the time of the incident?" This approach encourages the interviewee to provide more information, allowing you to gather a broader range of details.

Listen Actively:

Active listening is essential during interviews. Pay close attention to the interviewee's responses, non-verbal cues, and tone of voice. Focus on understanding their perspective and experiences. Show that you are engaged by maintaining eye contact, nodding occasionally, and using small verbal affirmations like "I see" or "go on." Paraphrasing what the interviewee has said and asking clarifying questions can also demonstrate your attentiveness and help ensure you have a clear understanding of their statements.

Probe for Specifics:

Encourage the interviewee to provide specific details by asking follow-up questions. For example, if they mention a particular incident, ask them to describe it in more detail or provide specific dates, times, or locations. Probing for specifics can help you assess the accuracy and consistency of their statements and identify any potential discrepancies or areas that require further investigation.

Maintain Objectivity:

As an insurance investigator, it is important to remain objective and non-judgmental during interviews. Avoid jumping to conclusions or allowing personal biases to influence your line of questioning. Maintain a neutral tone and body language, and refrain from expressing opinions or making assumptions about the interviewee's statements. Your role is to gather facts and information, so approach each interview with an open mind and let the evidence guide your conclusions.

Developing strong interviewing skills will enhance your effectiveness as an insurance investigator. These skills will enable you to build trust, gather critical information, and make informed assessments to support your investigations.

Understanding insurance law

Insurance law is a complex area, but understanding it is essential for anyone considering a career as an insurance investigator. At its core, insurance is a legal contract between the insurer and the insured. The insured agrees to pay premiums, usually monthly, and the insurer agrees to cover their losses or shield them from personal liability within certain limits. This is a simplified view, however, as insurance law is subject to extensive regulation at both the state and federal levels, and the specific terms of insurance policies can be highly nuanced.

Insurable Interest

To take out an insurance policy, an individual must have what is known as an "insurable interest". This means that the item or person being insured must provide some kind of benefit to the insured. For example, you cannot take out insurance on a house that you do not own, as you have no direct stake in it. Most items with a tangible benefit to the insured can be insured, and the value of the insurance policy will depend on the worth of the item and the likelihood of it becoming lost or damaged.

Premiums, Deductibles, and Copays

The monthly payments made to an insurer are called premiums. In addition to these, there may also be deductibles and copays. A deductible is an amount of money that must be paid out-of-pocket by the insured before they can receive insurance benefits. This can be a set amount or a percentage of the claim. Copays are similar, but they are smaller payments made when accessing specific services, such as visiting a doctor or emergency room.

Types of Insurance

There are many different types of insurance, each with its own nuances and complexities. Some common types include:

• Automobile insurance
• Homeowners insurance
• Health insurance
• Life insurance
• Pet insurance
• Renters insurance

Insurance Fraud

Insurance fraud is a pervasive problem, with incidents stealing at least $80 billion every year from American consumers. It can take many forms, including submitting false claims, lying on forms, exaggerating injuries, and staging accidents or break-ins. Due to the prevalence of insurance fraud, insurance investigators are in high demand. These professionals are responsible for uncovering evidence of fraud that can be used in a court of law. They may be employed by insurance companies, private consulting firms, or state/federal agencies.

Becoming an Insurance Investigator

To become an insurance investigator, a strong understanding of insurance law is essential. A bachelor's degree in criminal justice or a related field is often required, and industry knowledge is highly valued. Investigators must also possess strong communication and active listening skills, as well as the ability to organize and communicate information effectively through writing.

In addition to educational and skill requirements, most states have licensing requirements for insurance investigators, which may include passing a written exam. Professional certification, such as the Certified Insurance Fraud Investigator (CIFI) program, can also enhance an investigator's credentials and lead to better career opportunities.

Frequently asked questions