How do car insurance companies investigate accident claims? Once you submit your auto accident insurance claim, your insurance company assigns an adjuster to oversee the investigation. The company might also hire a private investigator to assist with the investigation. The adjuster obtains copies of the police report and doctor’s notes to make accurate and fair deductions on your claim. Then, the adjuster combs through your records and interviews witnesses to verify the credibility of your claim.
The adjuster or insurance investigator visits the accident scene to collect physical evidence. The adjuster monitors and reviews your social media activities. The insurance claim investigation team also interviews you and anyone who might have witnessed the accident. The team also gathers pertinent information, such as the insurance details of the involved parties, the time, date, and location where the accident occurred, a copy of the auto accident report, and names and police badge numbers of the responding officers. The team then compares the documentary evidence provided by you to its own findings.
After completing the investigations, the investigation team submits its findings to the insurer. The report includes the sequence of events leading to the accident, the party (or parties) responsible for the accident, and recommendations on the due settlement payable to the victims.
Why Your Claim Is Investigated by the Insurance Company
The insurer conducts car accident claim investigations for several reasons, including:
Preventing Potential Insurance Fraud
Insurance companies have noted the rising cases of auto insurance fraud. As such, your insurer investigates your claim to protect itself from possible insurance fraud. The investigation helps verify the validity of the reported injuries and property damages.
Determining the Extent of Injuries or Damages Suffered
Investigations are instrumental in determining the actual extent of your injuries. The insurance company gathers the necessary evidence to help estimate the seriousness of your injuries and the amounts of losses or damages incurred.
Determining the Value of Your Claim
On top of verifying your claim and determining the extent of your injuries and damages suffered, investigations also help establish how much your claim is worth. The adjuster or investigator works to protect the best interest of the insurance company, not you. Consequently, the settlement package recommended by these professionals is usually on the lower side.
The investigation helps identify the liable party for the accident. Adjusters or investigators collect as many details about the accident as possible. They might also bring an accident reconstruction team on board if necessary. This process removes any doubt or confusion on who is responsible and to what extent.
How Long Does an Investigation Take?
An accident claim investigation can take a few weeks to a few years. The type of auto insurance claim and inconsistencies in your claim affect how long the investigation takes. The investigation span also depends on the extent of the resulting injuries and damages.
For example, a car accident insurance claim involving minor injuries or property damages might get resolved within a couple of days. With such small claims, the insurance company might instruct you to take your damaged vehicle to a specific auto repair shop and pay the repair fees once the vehicle gets repaired. Alternatively, the insurer simply sends you the repair costs directly.
You have the option to take your damaged vehicle to your preferred auto repair shop. Remind your mechanic to use authentic spare parts from the manufacturer to avoid voiding your claim. Go over your policy to learn more about the types of replacement parts you are allowed to use.
Auto accidents resulting in permanent injuries, fatalities, and major property damages usually take significantly longer to resolve. Such serious cases involve potentially massive payouts. Because of that, the insurer needs to do a thorough investigation to confirm the claim and avoid losing money. Any discrepancies in the documented evidence need to get investigated further. That only prolongs the case.
How Do Insurance Companies Investigate Car Accident Claims?
Collecting and Verifying Personal Identifiable Information
The adjuster calls to ask for your full name, birthday, home address, and health insurance information, among other personal details. That information gets entered into the national database to show your past insurance claims, insurance coverage, and if you sustained injuries in prior accidents. The information you provide needs to match what is in this national database. Any contradicting information can be an excuse to deny the claim.
The adjuster often gathers evidence from police, medical reports, deeds, videos, appraisals, inventory records, and witness statements from other parties. The adjuster might work closely with a private investigator to spy on you at home or the hospital. That monitoring helps confirm that you are truthful about the nature and severity of your injuries and other losses.
The adjuster needs time to collect evidence and go over the police report and your documentation. That investigation allows the adjusters to figure out how the auto accident occurred, who was to blame, and to what extent.
Additionally, the investigation confirms your injuries by examining the doctor’s notes and receipts. The process also allows the adjuster to assess the resulting property damages.
The insurance adjuster or investigator might ask you to authorize access to your medical records. This authorization allows the investigation team to obtain medical records and reports from your treating doctor or medical facility. The team then reviews the medical documentation to confirm the type and severity of your injuries, the treatment provided, and the medications administered.
Inconsistencies in the medical records or reports can be grounds for claim dismissal. These inconsistencies can also lead to further investigations that only delay the compensation.
Other routine investigations carried out by the adjusters include the following:
- Going through your phone records
- Conducting a background check
- Reviewing your social media activity
- Inspecting the accident scene
As the investigation proceeds, you will have access to a rental car provided by your insurer if your coverage has a transportation expense clause. Call the insurance company to confirm whether the company will reimburse your rental car expenses and for how long.
Ensure you cooperate with the insurance adjuster or investigator during the investigation. Do not disclose any information that might hurt your chances of getting compensated for your injuries or losses. Instead, provide only the information the adjuster needs to ascertain the credibility of your claim. Alternatively, politely ask the adjuster or investigator to contact your lawyer for any questions about the accident and your injuries.
In return for your cooperation, the insurance company must keep you aware of the investigations at all the times. The law requires that insurers open investigations into the filed claims as soon as possible. Otherwise, you might have grounds for bad faith insurance suit against your insurance company if the company delays investigating your claim with no justifiable reason.
Questions Asked by Insurance Investigators
If you are considering filing an auto accident claim or have already done so, you might ask, “what questions do the insurance investigators ask?” The investigators ask for your account of events preceding and after the auto accident. They also ask you to provide accident details like the time, date, and crash location.
Investigators usually ask questions that will help them gather as much information about your claim as possible. They then review the information to determine the validity of your claim. They also leverage that information and other evidence collected to determine the value of your claim, especially if you have a valid claim.
Compulsory Medical Exams
Compulsory medical exams or independent medical exams are mandatory physical and oral medical tests performed by doctors hired by insurers. Even though doctors must remain objective, these professionals are on the insurers’ payroll. As such, the medical practitioner can easily get swayed to favor the interests of his or her employer.
Some insurers give the doctors specific words or actions to note during these medical examinations. These actions or utterances can lead to reduced compensation later.
Work with a car accident lawyer to better prepare for these crucial medical exams. Your lawyer helps you prepare for the medical exam by taking you through the questions the doctor might ask. Most importantly, you get coached on the correct replies to the medical practitioner’s questions. Inaccurate or ambiguous responses during the compulsory medical exam can significantly hurt your car accident claim.
What Happens During a Compulsory Medical Examination?
This compulsory medical examination usually takes place after the deposition. The examination is a two-stage procedure. First, the doctor subjects you to a thorough oral exam. Before the exam begins, the physician observes your demeanor in the waiting room and when getting on the examining table. This observation helps the examiner form a professional opinion of your health state.
The examining doctor asks about the resulting injuries and their impacts. The doctor may also ask you to recount the crash to learn how the injuries occurred. As mentioned earlier, a car accident lawyer can help you understand what to expect during the medical examination and prepare for the same. Your lawyer can also advise on when and where you can invoke the right to remain silent and refuse to answer.
The other part of the compulsory medical examination is the physical exam. Here, the doctor examines you for pain, neurological impairment, and disrupted range of motion related to your reported injuries. The examiner compares his or her findings with your answers to verify if the injuries are factual.
The doctor seeks to establish if your reported injuries are exaggerated. Or, if the injuries arose from pre-existing conditions. The insurer wins when the doctor proves the injuries are below the legal threshold for compensation.
The medical report and subsequent testimony determine the case outcomes. The insurer gives the doctor complete access to your medical history and other case-related material that can be used to dilute or nullify the claim. That doctor gets called in as an expert witness for the defense in the trial.
Fortunately, however, your lawyer can set you up for a medical examination with another doctor to provide an alternative medical opinion. That strategy helps to counter any biased reports by the physician.
In some examinations, the doctor gets joined by other parties with vested interests. A court reporter and an insurance representative may be present in the examination room to record the procedure.
Having all these strangers around during the examination can be overwhelming and uncomfortable. Do not leave matters to chance. Collaborate with a qualified car accident attorney to breeze through these medical examinations.
Speaking With a Medical Examiner
Your responses should always be short and clear. Simple answers prevent you from uttering potentially self-incriminating statements. There is no need to elaborate on your answers. Answer the questions politely and truthfully.
Do not exaggerate the symptoms. Do not include other unrelated complaints or pains while describing the accident injuries. Your answers need to match your responses during the deposition stage.
Why You Should Let a Lawyer Handle All Communications With the Adjuster or Investigator
An insurance adjuster prefers working with you directly, rather than dealing with your lawyer. The reason is that the adjuster knows that you might not be familiar with specific aspects of your accident, available legal options, and statutes relevant to your case. The adjuster leverages his or her understanding of the situation to reduce your potential recoverable damages.
A lawyer with a proven record of closing settlement deals with insurance companies knows the common strategies insurance adjusters employ to devalue or deny claims. The lawyer knows what to do to counter these strategies.
Your lawyer also considers aspects of your case that you might ignore if you work alone. The lawyer, for instance, reviews your medical records and doctor’s note to determine if your injuries will need ongoing medical care. The lawyer also carefully examines any settlement offer from the insurer to determine if it covers all your losses, expenses, and damages.
Chicago personal injury and workers’ compensation attorney Howard Ankin has a passion for justice and a relentless commitment to defending injured victims throughout the Chicagoland area. With decades of experience achieving justice on behalf of the people of Chicago, Howard has earned a reputation as a proven leader in and out of the courtroom. Respected by peers and clients alike, Howard’s multifaceted approach to the law and empathetic nature have secured him a spot as an influential figure in the Illinois legal system.