Personal injury claims are quite common nowadays, with people constantly getting injured in different types of accidents. Whether it’s a car accident, slip and fall accident, or medical malpractice, people tend to seek compensation for their physical, emotional, and financial losses.
When someone file a personal injury claim, typically, it goes through an investigation process by the insurance company. In this article, we will discuss the steps and methods that insurance companies use to investigate personal injury claims.
Table of Contents
The Investigation Process
The investigation process for personal injury claims by insurance companies involves the following steps:
Step 1: Gathering Information
The first step for an insurance company is to gather as much information as possible about the incident and the claimant. This includes obtaining police reports, medical records, eyewitness statements, and any other relevant details. This information is crucial for the insurance adjusters to assess the authenticity of the claim.
Step 2: Reviewing Documents
Once the insurance company has gathered all the necessary information, the next step is the review process. The adjusters review all documents and statements to ensure everything is in order and authentic. They thoroughly analyze the medical records to determine the extent of the claimant’s injuries and look for any pre-existing conditions.
Step 3: Statements and Interviews
The insurance adjuster may contact the claimant and other individuals involved in the incident to get their statements. They may ask questions related to the incident, such as how it happened, the extent of the injuries, and any other relevant details. Also, they may contact the claimant’s employer, physician, or any other relevant entity to gather additional information.
Step 4: Inspection and Photography
To assess the extent of damages and injuries of the claimant, the insurance company may conduct an inspection of the accident site, or the property damage location. Also, they may take photographs of the damages to have visual evidence. This visual evidence is necessary for the adjusters to determine the damages and injuries.
Step 5: Conducting Medical Examination
When dealing with personal injury claims, the insurance company may require an independent medical examination. This examination is conducted by a medical professional who is not affiliated with the claimant’s physician. This examination helps to provide an unbiased diagnosis to determine if the claimant’s injury was caused by the accident.
Investigative Techniques Used by Insurance Companies
The investigation process is just the initial step. Insurance companies also use several investigative techniques to investigate personal injury claims. Some of the methods include:
Social Media Investigation
The use of social media platforms has become common when investigating personal injury claims. Insurance adjusters may check the claimant’s social media accounts to see if there is any discrepancy with their claim. For example, if a claimant stated that they were injured and unable to walk, but social media shows them hiking or jogging, the adjusters may have cause to question the legitimacy of the claim.
Surveillance
Insurance companies may use surveillance as a way to determine the extent of the claimant’s injuries. They may monitor the claimant’s daily activities through video or photographic evidence. This investigative technique can help determine if the claimant is exaggerating their injury or if their activity level is consistent with their claimed injury.
Background Investigation
Insurance companies may also conduct background investigations on the claimant. This involves obtaining information on the claimant’s past, including criminal records, medical history, and employment records. This investigative technique can be used to determine if the claimant has a history of filing fraudulent insurance claims.
Conclusion
In conclusion, the insurance company’s investigative process is essential for regulating personal injury claims. It helps protect insurers from fraudulent claims while also ensuring that claimants receive fair compensation. Understanding the investigation process and techniques used by insurance companies can help claimants navigate the claims process.