Claims Explained What does it mean when an investigator is appointed

Claims Explained: Why is an investigator involved?

Being told your claim has been referred to an investigator could make you feel a little nervous.

If your insurer appoints an investigator to review your claim, does this mean they think you’re committing fraud?

Not necessarily. The fact that your insurer has appointed an investigator is not necessarily any cause for concern.

Travel insurance claims can be complex or require more extensive investigation than can be done by internal claims handlers.  This means that sometimes insurance companies refer claims to a team of in-house investigators or to an independent investigation company.  Often investigative enquiries can be made directly with you but sometimes it is necessary that we also engage the services of an investigator in the locality of where the loss has occurred.

If your claim is referred for investigation, this does not automatically mean that your insurer believes you are attempting to commit fraud.   As part of our claim handling methodology, claims are regularly selected at random for investigation.  Other times, there may be anomalies in the claim which trigger further investigation.  It is also the case that claims are referred for investigation when fraud is suspected.

Most Australian insurance companies believe in fair, transparent and honest claims handling.  Many also comply with the general insurance Code of Practice which sets down requirements for claims handling and the appointment of investigators.

In accordance with the Code, if your claim is referred for investigation, your insurer will advise you of this fact within 5 business days of this having occurred.  You will be advised at that time if the claim is being investigated by an internal investigator or an external service provider.  You will be provided with the name of the investigator who will be contacting you in relation to the investigation.

The process which will be followed by the investigator depends on the type of claim you have lodged and the queries they need to make to substantiate the claim.  For example;

  • Telephone interview/s of the claimant (and any other relevant persons)
  • Face-to-face interview/s of the claimant (and any other relevant persons)
  • Enquiries of individuals and entities who have issued documentation in support of the claim
  • Attendance at the situation of loss
  • Collection of witness statements
  • Review of CCTV footage, hand writing analysis and forgery detection
  • Requests for the claimant to provide further supporting material
  • Referral for medical examination (if applicable)

This is not an exhaustive list as claims are generally considered on a case-by-case basis.  The investigator will be able to advise you further in relation to their requirements.  Once their enquiries are complete, the investigator will provide a report to the insurance company so that it can make a determination regarding policy response.  In order for the investigation process to occur as quickly as possible, your insurance company will ask for your cooperation.

If you have any queries about our policy on claim investigation and how it may affect you, please don’t hesitate to contact us on 1300 819 888 or send an email to info@goinsurance.com.au

 

 


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