What does an Insurance Investigator do?

An insurance investigator’s job is to ensure that all submitted insurance claims are valid and relevant. Some insurance investigations are carried out as part of routine audits to ensure that fraud isn’t widespread. At other times, the investigator is on the lookout for a specific target, whom the company believes has not submitted a valid claim. Hundreds of thousands of people work as investigators.

Insurance investigators can be private investigators or insurance company employees. An insurance company employee typically has the security of a full-time job, which includes a guaranteed salary and benefits. This scenario provides the most security. A private investigator is a contract agent who works for an insurance company on a case-by-case basis, rather than a full-time employee. As time and business permit, an insurance investigator in private practice may also investigate other types of situations.

An insurance investigator is frequently called in to look into disability claims. Medical science may not be able to detect some disabilities. Others may have been misrepresented the claimant as being worse than they are. People frequently try to take advantage of the ambiguity falsely claiming to be disabled. In such cases, the investigator will observe the individual in secret to see if the problem is as severe as claimed.

A case of auto insurance fraud is another scenario that an insurance investigator might look into. False reports of stolen vehicles are the most common type of auto insurance fraud. An experienced investigator should be able to follow a paper trail through public records to determine whether the car was truly stolen or if the owner sold it and then reported it stolen. If a fraudulent claim is made, the insurance company can either deny payment or pursue civil or criminal remedies. In such cases, the insurance investigator will almost certainly be called to testify and provide evidence in court.

Although fraud investigations are an important part of an insurance investigator’s job, they may also be assigned other tasks. For example, some investigators may specialize in car accidents, attempting to determine fault and obtaining compensation from the responsible party. Though the insurance company will often simply accept a report filed local law enforcement, there are times when it will conduct its own investigation, particularly if there is reason to doubt the report provided law enforcement or if law enforcement was not present at the scene.