How Do Insurance Companies Investigate Personal Injury Claims?

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If you are involved in an accident that might have occurred due to someone else’s negligence, a critical step following an accident is notifying your insurance company, or the at-fault party’s insurance company.

An investigation commences after you file a claim with the insurance company. Typically, the role of the insurer is to evaluate your claim through an adjuster and decide whether you claimed a fair amount of damage. While this might seem straightforward, there are a lot of complications involved that may impact your claim.

We’ll provide a breakdown of what you need to know about the personal injury claim process, the role of the insurance company in the investigation process, and how our lawyers at AttorneyJeff can help you.

Why Do Insurance Companies Investigate Injury Claims?

The insurance company undertakes a rigorous process of investigating your claim in order to determine whether it is valid.

An insurance company will investigate claims in order to:

Avoid insurance fraud

Insurance fraud is one of the main challenges facing insurance companies as it tends to affect the smooth operation of the insurance company as a business. Insurance companies work hard to ensure they detect insurance fraud from the onset.

Insurance fraud involving personal injury claims is committed in two ways:

  • Soft insurance fraud: This happens when the victim of a personal injury claim inflates a claim. For example, a victim of a car accident who suffered minor injury claims to have sustained a severe injury. Although they have a right to seek compensation for the injuries sustained, they will have committed fraud by inflating the claim.
  • Hard insurance fraud: This is a serious type of fraud that occurs when a person invents a scenario as the basis of a claim for compensation. For example, a person may intentionally fall in a grocery store and claim that the accident occurred due to a wet floor. As a result, they commit insurance fraud when they attempt to recover compensation from the insurance company.

Gather evidence to reduce or invalidate your settlement

Quite frankly, insurance companies don’t have your best interests at heart. They will do whatever it takes to ensure they minimize the amount of compensation that you may be entitled to receive.

To minimize payout, they will look for compelling evidence to dispute your claim or counter the eligibility of your claim. Some of the common strategies used to dispute your claim or minimize payout include:

  • Transferring blame by providing evidence that more than one party is to blame for the accident. For example, a third-party insurer may offer evidence alleging that mechanical challenges led to the accident. This may bring about the issue of the manufacturer’s liability instead of their insured.
  • Offering evidence that proves that you had a pre-existing medical condition that could have contributed significantly to your injuries, as opposed to being the consequence of the at-fault party’s negligence.

The bottom line is that the insurance company will work hard to minimize the payout. For this reason, it is imperative to ensure that you are not affected by the actions or strategies invoked by the insurance company. You will need to speak to a personal injury attorney to help handle the claim process on your behalf.

What Is the Insurance Company Looking for When Investigating Injury Claims?

Following an accident, the insurance adjusters will need all the necessary information that may assist them in evaluating your claim.

Some of the pertinent information taken into consideration by the adjusters include:

  • Medical records: These provide vital information regarding the severity of the harm or injuries sustained. They provide evidence for treatment in the claim process. If the adjusters can’t find sufficient proof about the extent of your injuries, they can request it or deny your claim.
  • Witnesses: Witnesses are also vital in the evaluation process. The adjusters gather witnesses who will help determine if your story matches theirs.
  • Documentations: Pictures and other relevant documents of the scene of the accident are also critical in the evaluation process. The insurance adjusters will want to gather this information in order to reconstruct the scene of the accident and determine the validity of your claim.

Moreover, the insurance adjusters will want to speak to you. Their communication is to learn about the incident and the extent of your injuries.

Although talking to the adjusters is part of the claim process, having a personal injury attorney communicate on your behalf with the insurance company is vital. An attorney helps level the playing field and ensures that your rights and interests are safeguarded throughout the claim process.

How Does the Insurance Claim Investigation Process Work?

The following is the process undertaken by the insurance company in the investigation process:

  • Assigning insurance adjusters
  • Communicating with the claimant
  • Conducting a thorough evaluation of the scene of the accident
  • Talking to witnesses
  • Requesting medical records
  • Evaluating the claim

It is imperative to note that the timeline for the investigation process is not definite. Although the insurance company may prefer to settle the claims as soon as possible, the investigations can take months.

Some of the factors which affect the duration of an investigation include:

  • Severity of injuries
  • Number of parties involved
  • The complexity of the evidence

We can help manage the investigation process and work hard to ensure there is a timely payout for you.

What Should You Do During an Insurance Investigation?

Often, the insurance adjusters capitalize on the confusion you may feel about the claim process. Typically during investigations, they want you to admit fault or provide any other information that may harm your claim.

Some tips on what you should and shouldn’t do during an insurance investigation include:

  • Don’t provide unnecessary information.
  • Stick to the basic facts.
  • Don’t admit fault.
  • Communicate to the insurance through a personal injury attorney.

Contact AttorneyJeff to Safeguard Your Rights During an Insurance Investigation

The insurance investigation may help or harm your claim, depending on the facts and the information it uncovers. To ensure your claim is successful, you need a competent and qualified personal injury attorney.

At AttorneyJeff, we have experience handling personal injury claims and will work to ensure that your rights and interests are safeguarded throughout the insurance investigation process. Contact us today for a free case evaluation.

Insurance Investigation Frequently Asked Questions

Do insurance companies use private investigators?

Yes, the insurance companies can use private investigators who conduct surveillance of the injured party and obtain conclusive evidence about the extent of an injury.

Will insurance companies look at my social media?

Yes! Avoid oversharing on social media following an accident. Even by privating your accounts, social media platforms may be asked to share your recent activity if they suspect you’re behaving like life is continuing as normal.

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