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Dawson and Rosenthal
Dawson and Rosenthal

How Do Insurance Companies Investigate Claims?

If you or somebody you care about has been injured due to the careless or negligent actions of another individual, you are likely entitled to some sort of compensation. However, securing compensation can be challenging. The vast majority of personal injury claims are resolved through a settlement with insurance carriers, so it is important that you understand how insurance carriers investigate claims. It is strongly recommended that you seek assistance from a skilled personal injury lawyer who can handle every aspect of your case, from the initial investigation through to any possible trial.

Collecting evidence and reviewing documents

During the insurance claims investigation, the insurance carrier will gather all evidence and documents that are available pertaining to the incident. This can include a variety of items, such as the following:

  • Hospital or doctor’s office records
  • Medical release forms
  • Prescription medication records
  • Workers’ compensation claims forms
  • Workplace accident reports
  • Car accident police reports
  • Property damage assessments
  • Eyewitness contact information
  • Police reports
  • Photo or video surveillance of the incident

Taking statements and interviewing witnesses

Insurance claims adjusters will speak to every person involved in the incident. They will likely begin with the injury victim as well as the person who allegedly caused the incident. If you have been injured due to the negligence actions of somebody else, it is crucial that you say as little as possible to the insurance claims adjuster. They will use anything you say against you, particularly if you accidentally say something that could jeopardize your claim.

Additionally, the insurance claims adjuster will contact any eyewitnesses to the incident. The claims adjuster may request a recorded or written statement from those involved. It is important to understand that you are not required to give a recorded statement to an insurance carrier at any time.

Surveying the area and the injury victim

Insurance claims adjusters may actually visit the scene of the incident to gain a thorough understanding of what happened. At the very least, they will use any photo or video surveillance of the incident to gain an understanding of the sequence of events. Insurance claims adjusters are known for visiting work accident scenes, car accident scenes, or any other area that an accident occurred in the days or weeks following the incident.

Additionally, an insurance carrier may actually conduct surveillance on the person making the injury claim. For example, if a car accident victim has made a claim that they are unable to work due to excruciating back and neck pain, but they are then seen going to play a pickup basketball game, this will certainly jeopardize their claim.

Obtaining additional information

Insurance claims adjusters are intelligent, and they are certainly technologically literate. This means that they may use other information sources to gain an understanding of the entire situation. This includes the claimant’s social media accounts. Just about everybody has an Internet presence, and this could jeopardize a claim. Anytime a claimant posts information about the accident or their injuries, they are leaving more evidence that could hinder the overall claim. This includes posts to Facebooks, Instagram, TikTok, YouTube, and more. If you suspect foul play during an insurance claim investigation caused your claim’s denial, contact a San Diego bad faith insurance lawyer for help.