If you’re reading this, it’s likely that you or someone you know has recently had a vehicle damaged. One of the first things you probably did in the following days was notify your car insurance company and file a claim.
This, unfortunately, was likely the easiest part of this entire process.
By filing an insurance claim, you are hoping to get enough money back to pay for the costs of the damage. But as you’ll see below, the insurance company has a vested interest in paying you as little as possible on this claim.
After you File An Insurance Claim
After filing a claim with the insurance company, a representative from the company will typically contact you and ask for other potential witnesses and more detailed information about the accident. In most cases, it will be a claims or insurance adjuster, and this person will investigate your claim on behalf of the carrier itself.
The insurance adjuster will also review your policy and determine what type of coverage you have available.
Next, the auto insurance adjuster may ask you to clarify the initial information you gave and probe deeper to gain a fuller understanding of what happened with the car accident.
Why is your Car Insurance Claim Being Investigated?
Because insurance companies have a financial incentive for pushing back against the claims of their own policyholders, the process of negotiating with an adjuster and the resulting investigation can quickly become confusing and even downright frustrating.
Insurance companies are motivated by their own profitability, which is why it benefits them to pay out as little as possible to a person who makes a claim. Many of the country’s largest and most profitable insurance companies boost their bottom line by simply denying legitimate claims. These are claims that should be paid, but where the insurance company comes up with a bogus reason to deny it.
Examples include blaming the incident on a fault-free party and asserting policy exclusions that either don’t exist or don’t apply. These companies often utilize incentive programs to reward their employees for successfully denying a claim even if the claim should be paid. In some cases, companies have been found guilty of engaging in outright fraud to avoid paying legitimate claims.
In situations where a person has suffered a high level of damages as a result of an accident, the push back from the insurance company can sometimes be too complicated to pursue alone. Consulting with a personal injury attorney could benefit victims who are experiencing this kind of push back from an insurance adjuster, and a lawyer may actually also be able to add value to the claim.
- READ: Insurance Adjustor Negotiation Tactics
- READ: 9 Simple Tips for Dealing with the Insurance Adjuster (2018)
How do Insurance Companies Investigate Claims?
Most insurance companies employ insurance investigators whose sole job is to detect and deter insurance fraud. At GEICO, this division is known as the Special Investigations Unit (SIU) and is composed mainly of individuals who have law enforcement experience as well as insurance knowledge.
These investigators are combat fraud a number of different ways. They will look to “reconstruct” the accident, and do so in a systematic way.
They’ll investigate suspicious claims closely and check for evidence of fraud. These investigators will also cooperate with law enforcement to help put fraud perpetrators out of business.
And finally, these investigators will look for “red flags” on insurance claims that signify fraud. This means staying up to date on fraud schemes.
What do Insurance Investigators Look For?
The insurance investigator will start by getting a short summary of the incident, including date, type, time, location and a brief description.
As part of the process, the insurance investigator may and likely will ask for any of the following pieces of information:
- Contact information that you obtained for the other driver at the accident scene
- Images or photos of your car
- To inspect your car for damages
- A visit to the accident scene to determine all potential contributing factors and circumstances
- Statements from witnesses or other passengers in your car
- Medical bills
- Physical evidence (fingerprints, damaged property, hard drives, etc.)
- Request you send a copy of the police report for review
It is helpful to be prepared with any of these things to help the investigator with your case. These pieces of information can make it much easier for the investigator and adjuster to determine what happened and who is at fault.
No matter what, the adjuster will review your policy and make sure your claim is covered and see if the possible expenses exceed your coverage limits.
What Questions will the Insurance Investigator Ask?
When an insurance investigator is looking into your claim, they may ask to conduct an interview with you to sort out some of the details. In this situation, you have the opportunity to control the conversation and answer confidently and clearly.
Few people know that you are allowed to request that the interview be held at a neutral location. You can also make it clear that you only have a certain amount of time for the interview.
Some other tips:
- Do not guess for an answer. If you truly don’t know, say, “I don’t remember” or “I don’t know.” Answer questions as best you can, but don’t make anything up.
- If you are unsure, tell the investigator exactly that.
- If you are giving an estimate, make that clear to the investigator. Otherwise they may take it as a hard fact.
- Try to remain calm.
- Take your time with your answers.
- Ask for a break if you need one.
- Ask for a recording of the interview afterwards.
- If you are unsure about doing the interview, consider consulting with an attorney beforehand.
- Do not sign anything unless you are 100 percent sure.
Here’s some possible interview questions to expect from the insurance investigator:
- Could you please state your full name?
- Do you understand that this interview is being recorded?
- Is it being recorded with your permission?
- If I need to share the information with another adjuster, may I do so?
- What type of damage was done to your vehicle?
- Do you know what type of damage was done to the other vehicles?
- Was there any type of evasive action that was able to be taken to avoid the accident?
- Was there any ringing in your ears or popping in your jaw?
- Did you have any deep cuts or lacerations?
- Was there any emergency treatment performed at the scene?
- What treatment have you received since the accident?
- If you can rate the pain that you feel now, 10 being the worst, 1 being the least, how would you rate your pain?
- Did you have any prior injuries that could have resurfaced because of the accident?
- Is there anything in reference to the accident that you would like to add that we have not discussed that we should know about?
- Have you understood all these questions?
How Long Does an Insurance Investigation Take?
If you have not hired an attorney to represent you in an accident case, insurance companies may try to “play” you and drag their feet on the investigation.
Insurance companies assume that if you don’t have a lawyer, you may get frustrated, miss a statute of limitations, or otherwise lose interest in the claim. Conducting a lengthy investigation is a common strategy insurance companies use to indirectly get out of paying claims.
Hiring a lawyer is a clear sign that you are taking things seriously. This will speed up the process significantly.
A complex case may require a truly extensive investigation. For cases such as these, a month may be required to sort all the different pieces out. Have patience, but if you believe you are being taken advantage of, consulting with an attorney may be not only smart, but necessary.
Withdrawing from a Claim Under Investigation
If your claim is bogus or fraudulent, you should withdraw from it immediately. The penalties for insurance fraud are serious.
For whatever reason if you’d like to withdraw from a claim, this can be done at any time. If you have made a claim against your own insurance policy — under the “collision” or “uninsured motorist” portions — you should be able to cancel.
But again, if fraud is involved the insurance company will not stop the investigation.
How do you Evaluate Damages from a Car Accident?
Depending on the accident, the insurance adjuster may request you take your car to one of its approved body shops for an estimate or ask of you to go to a shop of your choice and obtain some quotes.
It is important to keep in mind that you have the freedom to perform the repairs at any shop of your choice, but you may have to pay the difference between the shop’s estimate and the amount the insurer feels is a reasonable price.
After evaluating all the appropriate information, the adjuster determines if you have a valid claim and how much the insurer is willing to pay out.
Specifically, your claim could go one of two ways:
1. If your claim only involves property damage and you’re going to have the repairs completed at an insurer-approved auto repair shop, then the repair shop will typically bill the insurance company. In most cases, your policy will include a deductible that you must pay, while the insurance company will cover the difference.
2. If your accident resulted in you suffering some form of personal physical injury, the insurance adjuster will also negotiate an appropriate settlement with you in order to reimburse you for the losses you suffered as a result of the car accident. In these cases, the insurance adjuster is more likely to push back on your attempts to negotiate fair settlement offer.
Request A Free Legal Consultation & Get Our Free Report
Attorney Chris Davis of Davis Law Group, P.S., has authored a number of free downloadable PDF reports. You can download your free copy of our report, "Unsurance: The Ugly Truth about Unethical Business Practices in the U.S. Insurance Industry," right now to learn more about the insurance claims process and how to protect yourself.
The award-winning attorneys at Davis Law Group are also here to help you better understand your legal rights and whether hiring an attorney for your personal injury case might be in your best interests. Call our office in Seattle at (206) 727-4000 or use the confidential contact form on this page to have your case personally reviewed by our legal team.
If we believe we can add value to your case and increase the chances of a favorable outcome, our lawyers will meet with you for a free case evaluation at your convenience.