When does the claim investigation happen? Ideally, it will happen soon after the loss. This is when the event is most fresh in everyone minds, and evidence of what happened is available. The loss must be mitigated, in other words, it must be stopped from continuing. For example, a fire must be put out and in doing so, evidence for what happened is often lost. It is the investigation that will eventually provide details to confirm if coverage is triggered under your insurance policy.
The investigation is not a test; it is a careful review of all available information. Once the information is reviewed, the next step is to apply that information to your policy. The examination is typically completed by an experienced claims examiner who is knowledgeable about how your policy applies to the circumstances of the loss. In some cases, an independent adjuster is assigned to make a site visit and meet with you in person to obtain the details and report back to the insurance company. Their role is to gather all the evidence and facts surrounding the loss and submit it to the insurance company.
It can be tough to wait for an answer from your insurance company. This article will highlight some of the steps involved in a claim investigation, helping you to understand exactly how thorough it will be, ensuring your claim gets complete consideration.
Examine a Claim
What are the documents needed to fully examine a claim? The first four items in this list are essential. The next few items depend on the type of claim and how severe it was.
Items to Examine a Claim
- Details of the claim including the cause of loss and any related circumstances
- Photos or videos of the loss
- Insurance policy with applicable wordings in effect on the date of the loss
- Any other insurance policies which may apply
- Any official statements from the policyholder or third-parties
- Expert opinion or investigation e.g. fire expert or engineer’s evaluation
- Police investigation number and details (if applicable)
Timeframe for an Answer
The time it takes to examine a claim varies, as does each unique loss situation. What can impact the timeline when examining a claim?
Complexity
The elements that make up a loss can be straightforward or complex.
Example 1 – A home theft where all of the electronics in the house are stolen is usually a straightforward examination. The examination confirms the police number, items lost, and value of items.
Example 2 – A house fire with an undetermined cause of loss and major damage to the dwelling is a very complex examination.
Evidence
The claims examiner will review all evidence available to determine if the property or liability claim is covered under the terms of the policy. Reviewing the evidence is an important step because it identifies if any exclusions, conditions, warranties, or limits of insurance apply. A review can also determine if any other party is responsible for the damage and if the opportunity to subrogate against that party is available.
Scope of Damages
The full scope of damages must be evaluated by the claims examiner. It paints a clear picture of what needs to be replaced or repaired so that you are fully indemnified (returned to the same financial position you were before the loss).
Participation
This is your part in the claim. One way to help your claim move forward is by quickly providing documents and signing forms as requested by your insurance company. In this way, we can respond promptly!
Summary
Supporting you through a claim is what insurance companies are built to do—it may take some time, but each step in the process is necessary to investigate a claim. The process ensures policyholders receive a fair and accurate review.
If you have any questions, always reach out to your claims examiner who can provide guidance to you and to the independent adjuster as to what is available to you under your policy.
