The importance of a timely insurance claim investigation

Early examination of a claim helps avoid problems later on in the process.

Accessing a claim early in the process can help avoid issues like lost interviews and critical documentation. (Photo: Shutterstock)

Arriving first usually ensures the best chance of success. True in life, and of even greater importance perhaps in the claims world.

The “early bird” adjuster is assigned a new notice of loss, where the information is brand new and readily available. In stark comparison is the claim reassignment. Being the second or third owner of a case puts you at a major disadvantage.

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Missing statements with witnesses that are long gone, photos that have magically disappeared from the file and the insured’s blurred view of prior events are just a few of the common struggles. The advice to “treat the file like your own” is immaterial because if it were indeed your own, you would have attempted to call the insured within the first two weeks to mitigate the flood of complaint calls.

Getting started ASAP

Make the appropriate phone calls and follow-up attempts. Each carrier has its own requirements, whether it’s two hours or two days for contact. A recorded statement may take more effort up front but is a transfer adjuster’s dream, assisting in potential arbitration or litigation work.

Request the police or incident report. Use your phone call with the insured to obtain the case number or further details to make it a more accurate request with fewer delays.

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Preserving the evidence right away is equally important. If the incident was recorded on CCTV, make sure the insured knows to preserve the tape. Our “DIY” society may encourage insureds to undertake their own repairs after a pipe break loss if an adjuster is not timely. Instead of trying to piece together what happened weeks after a repair through photos, a non-itemized plumber’s invoice and some old parts; assign an engineer to arrive on the scene as soon as possible. The cost of the expert will save money in the long run, result in great customer service and a much happier subrogation team.

For a notice only claim we tend to subscribe to the theory that the best idea is to not contact anyone to avoid inviting a claim. Frequently, however, the decision has already been made whether to pursue one so wouldn’t it be better from a customer service standpoint to reach out for a statement, show compassion and get an idea of an exposure now? An immediate investigation avoids surprises, allows the setting of accurate reserves and likely leads to lower expenses in the end.

Avoiding investigative tardiness

If you have too many claims, voicemails and emails to return, you need to prioritize them. Re-organize your day and move on the fly. Do you really need to completely work all your new claims today or can you focus on the initial contacts and get them out of the way?

Typically, one can predict when the wave of new losses will arrive and you can try to schedule your calendar ahead for a lighter day. It may also be a day that your teammates are out of office. If you are hit unexpectedly with new claims, re-prioritize your diaries and make sure to avoid distractions. Perhaps a teammate is willing to assist with an after-hours contact? Brainstorm with your manager for ideas on how to stay ahead of your contacts. Can you dig deeper into ISO searches for additional contact options?

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Working a file early definitely pays off. Whether we need to comply with state laws, preserve the available evidence at the scene, or speak to our insureds while the events are still fresh in their minds, all claims benefit from a timely and thorough investigation up front.

Chris Casaleggio (ccasaleggio@h2m.com) is a former liability claims adjuster and currently serves as department manager of forensics/insurance for H2M architects + engineers.