Auto Insurance Investigations: What They Mean For You

If your auto insurance company is investigating you, it doesn't necessarily mean that you did something wrong. Insurance companies investigate claims to find out who is responsible for an accident and to protect themselves from fraud. When auto insurance claims are filed, the insurance company assigns a representative, called an adjuster, to the case. The adjuster contacts you to ask for more information and to verify the credibility of your claim. They will ask for a summary of how the accident occurred and may request additional information, such as a police report, photos taken at the scene, and medical records. The adjuster may also contact other drivers and witnesses involved in the case to gather their accounts of the accident. While the investigation process can be stressful, it is important to cooperate with the insurance company to ensure your claim is processed fairly and efficiently.

To prevent insurance fraud

Insurance fraud is a crime that costs consumers millions of dollars in the form of increased premiums and higher prices for goods and services. According to the FBI, insurance fraud costs drivers between $400 and $700 per year in raised premiums. Auto insurance fraud happens when drivers, mechanics, or scammers lie to an insurance company to get an inflated payout or cheaper insurance rates.

Be an Informed Consumer

Know that insurance premiums are based on your individual claims history and the degree of risk involved. Generally, the greater the risk, the higher the premium. For example, the theft premium for a luxury car will be far higher than that of an economy car because more luxury cars are stolen each year.

Know Your Agent or Broker

Deal only with licensed agents and brokers. Ask to see proof of their license. Consumers can sometimes be victimized by unscrupulous agents or brokers and only discover after they file a claim that they are without coverage.

Get a Copy of Your Policy

You should receive a copy of any type of insurance policy, including endorsements and declarations specifically outlining your coverage and limitations, within a reasonable time after your purchase. If you do not receive it, question your insurer, agent, or broker. If there is no satisfactory explanation for the delay, contact your local department of financial services.

Pay Only for Services You Have Received

If you have received medical or dental treatment that is covered by a health care provider, you will receive an "Explanation of Benefits" statement listing the services for which benefits have been paid. Review it to ensure you have not been billed for services that were not rendered or for dates on which you were not treated. Contact your insurer immediately if you suspect fraud.

Be Wary of Common Insurance Scams

Be cautious of common insurance scams, such as a vehicle filled with people stopping suddenly in front of you to set you up as the cause of a rear-end collision. Doctors and lawyers who are participants in the scheme then handle the subsequent medical claims and lawsuits. Be on the lookout for "runners" at the accident scene who solicit the injured parties and direct them to medical facilities involved in the scam.

Report Suspected Fraud

If you suspect insurance fraud, report it to your local department of financial services or insurance fraud hotline. The matter will be kept confidential.

To determine the extent of injuries or damages

An insurance company will investigate a car accident claim to determine the facts of the case and assess the extent of injuries and damages. The process can be stressful and time-consuming, but it is necessary to ensure fair compensation. The investigation will involve gathering evidence, including medical records, police reports, witness statements, and photographs, to confirm the nature and extent of injuries and vehicle damage.

The insurance adjuster, or investigator, will play a crucial role in this process. They will contact you to obtain a summary of the accident and request additional information, such as medical reports and bills, as well as details of any property damage. The adjuster will also likely speak to other drivers and witnesses to gather their accounts of the incident and determine fault.

If your claim involves significant injuries, the investigation will be more thorough. The adjuster will need to confirm the extent of your injuries and the resulting medical treatment. This may involve requesting access to your medical records and obtaining an independent medical examination by a doctor chosen by the insurance company. They may also take a recorded statement, review your cellphone records, and even check your social media presence to verify the details of your claim.

The investigation aims to gather as much information as possible to accurately assess your claim. While it may feel intrusive, it is important to cooperate with the insurance company's investigation to ensure your claim is processed efficiently and fairly. Providing complete and accurate information will help support your case and prevent any delays or denials of your claim.

To establish the value of a claim

Insurance companies use a variety of methods to determine a car's value, including referencing established valuation guides or employing proprietary formulas. They consider factors such as the car's make, model, year, mileage, condition, location, market demand, regional pricing, optional features, and any previous damage or repairs.

When a car is damaged in an accident, the insurance company sends an adjuster to assess the damage and decide if the vehicle is a total loss. If the car is totaled, the adjuster conducts an appraisal and assigns a value to the vehicle, excluding any damage from the accident. The insurance company then enlists a third-party appraiser to provide an additional estimate. The company considers both appraisals when making an offer to the policyholder.

Policyholders have the right to appeal the insurance company's valuation and negotiate a higher amount. They can provide supporting evidence, such as recent sales data of similar vehicles, independent appraisals, or documentation of any unique features or modifications that add value to the car.

It's important to note that insurance companies are not solely reliant on resources like Kelley Blue Book (KBB) or the National Automobile Dealers Association (NADA) guides. They also consider other factors like local market trends and internal claims data, which may result in differences between the insurance value and the KBB or NADA values.

To identify the liable party

An insurance company will investigate a car accident claim to determine who is responsible and to protect themselves from fraud. The investigation process begins when you make a claim by contacting your insurance company. They will then assign an adjuster to your case who will ask you for more information, such as how the accident occurred and for any relevant documentation. The adjuster may also want to inspect your vehicle and may ask you to undergo a medical examination. They will also likely contact the other driver and any witnesses to get their version of events.

If the insurance company suspects fraud, they will seek information on possible motivations and evidence that the claim might be bogus. For example, they will check to see if you are in financial trouble or if there is anything on your social media that contradicts your account of events.

If the other driver refuses to provide insurance information, you can still report the accident and file a claim. By working with an attorney, the state, and your car insurance company, you might be able to identify the driver and secure their insurance information.

To confirm the validity of the claim

An insurance company will investigate a car accident claim to confirm the validity of the claim. This is a necessary step in the car insurance claim process. The investigation process begins when you make a claim by contacting your insurance company, and they assign an adjuster to your case. The adjuster will then ask you for information about the accident, including a summary of what happened, and any relevant reports, photos, or other documentation. They will also want to know about any losses you're claiming, such as damage to your vehicle or other property, or personal injuries.

The adjuster may also contact other drivers and witnesses involved in the accident to gather their accounts of what happened. They may even visit the accident scene to help answer questions about how the accident occurred and create a clear picture of the case. In some cases, the adjuster may request a medical evaluation with a doctor of their choosing to assess your injuries.

The purpose of this investigation is to gather evidence and evaluate your situation to determine if your claim is valid and if you are owed a payout. The adjuster will make a preliminary determination of fault and payment based on the information gathered during the investigation. If your claim is valid, the insurance company is contractually obligated to pay it.

It's important to note that while you are not legally obligated to provide the information requested by the insurance company, failing to cooperate with the investigation may result in your claim being denied.

Frequently asked questions