A structured methodology improves the quality and defensibility of insurance claims investigations. It ensures that enquiries are evidence-led and proportionate.
The first step is to understand the claim, policy context, reported facts, timeline and documents submitted. The investigator should identify what needs verification.
Document review may include claim forms, invoices, photographs, police reports, medical records, repair estimates, communications and witness information.
Version analysis is important. Differences between the insured’s version, witnesses, documents and physical evidence may indicate areas requiring further enquiry.
Background enquiries, OSINT, lifestyle indicators and prior claim patterns may provide context, but should not replace direct evidence.
The investigation report should clearly set out facts, inconsistencies, evidence reviewed, enquiries conducted and limitations.
The objective is to support a fair and defensible claims decision, not to force a predetermined outcome.
Author: Adrian van Straaten, CFE | IAFCI