How Do Insurance Investigations Work? | O’Connor and Partners, PLLC

After suffering an injury caused by another’s negligence, you may be facing high medical bills, pain and suffering, and time away from work you and your family cannot afford. In cases of personal injury, it is important to know your rights and understand the legal process and how an insurance investigation impacts your case.

While the specific nature of insurance investigations can vary depending on the individual claim, insurance adjusters typically follow a common series of investigative steps. A personal injury lawyer can help you navigate the complexities of insurance investigations and negotiations.

The experienced personal injury attorneys at O’Connor & Partners, PLLC know how insurance companies operate and the tactics they use to delay, diminish, or deny valid claims. We have a proven history of success in a wide range of personal injury cases, and we know how to pursue the maximum compensation you deserve for your physical, emotional, and financial losses.

What Is the Claims Investigation Process?

The process for investigating insurance claims is similar to other types of investigations. It involves a series of steps to gather documentation, interview witnesses, take statements, inspect the accident scene, and conduct surveillance.

During the claims inspection process, an insurance company will:

1. Open a File

After learning about a potential personal injury claim, the first thing an insurer will do is open a file. The claim may be reported to the insurance company by either the injured person or the insured. Once a file has been opened, it will be assigned to a claims adjuster. This is the person who will investigate the accident and negotiate the settlement.

2. Contact the Claimant

Once a claims adjuster has been assigned, he or she will reach out to the claimant – the insured person – to discuss the incident. As an injured motorist, it is your prerogative whether or not to speak with the claims adjuster. In order to protect your rights and avoid missteps, it is in your best interest to hire a personal injury lawyer to handle all communications and negotiations with the claims adjuster on your behalf. 

The call from the claims adjuster could come as soon as the same day the accident is reported. When speaking with a claims adjuster, stick to the facts. Keep your answers brief and to the point. Do not speculate and do not admit any fault for the accident. Do not offer any information the adjuster does not request. Do not give the adjuster permission to record a statement.

3. Request for Records

The insurance adjuster will try to procure any official records that may be available. In the case of a car accident, the adjuster will request the police report as well as the drivers’ accident reports that are filed with the state department of motor vehicles. During this process, the adjuster may request access to your medical records. If this happens, do not give permission and do not sign any medical authorization forms. Adjusters commonly access the full medical history of injured parties rather than the documents that are relevant to their claims. This is done in an effort to find pre-existing conditions to justify denying the claims.

4. Investigate the Injured Party

If you’ve been hurt in an accident, the insurance adjuster wants to find any negative information about you that could potentially diminish the value of your claim. They will comb through your history to look for any previous property damage or personal injury claims. They will review your social media accounts to learn everything they can about you.

5. Physical Evaluation

Insurance adjusters commonly make trips to assess property damage in person, especially in car accident claims. During this step of the investigation, the adjuster inspects the damaged vehicle, takes official photographs of the damage, and compares this against what is listed in the original claim. This information, combined with reports from the auto shop, is used to estimate the value of the claim.

6. Determination of the Claim Value

After gathering as much information as possible, the insurance adjuster will submit a full assessment to the insurance company, including his or her recommendation to deny or accept the claim. If the adjuster recommends approving the claim, he or she will provide an estimate of its value. The insurance company will review the recommendation, make its own determination, and notify you about its decision. 

7. Settlement Negotiations

Once a settlement has been offered, you or your personal injury lawyer can begin settlement negotiations. The initial settlement is typically not enough to adequately cover damages. The insurance company expects you or your lawyer to negotiate for a higher amount.

Negotiations are not easy. While this may be your first time negotiating a settlement amount, insurers have been trained in negotiations and have substantial experience in settling for as little as possible. A seasoned personal injury lawyer can level the field. Your attorney can negotiate on your behalf and take your case to trial if a fair settlement cannot be reached.

Contact a Kingston Personal Injury Lawyer Today

If you’ve been injured because of the careless or reckless actions of someone else, the insurance company may already be building a case against your claim. You need someone on your side to explain your rights and fight on your behalf for the full and fair compensation to which you may be entitled under the law.

The accomplished personal injury attorneys at O’Connor & Partners, PLLC have extensive experience in a broad range of personal injury matters and are committed to helping you recover from your injuries. 

Don’t face your injuries alone. Call O’Connor & Partners, PLLC today at (845) 303-8777 for a free case evaluation. Our personal injury lawyers serve clients in Kingston, Newburgh, Poughkeepsie, and other New York areas.

by O'Connor & Partners, PLLC
Last updated on - Originally published on

Posted in: Personal Injuries