Why Would an Insurance Company Investigate a Claim? (2024)

Why Would an Insurance Company Investigate a Claim? The prospect of an investigator hired by the insurance company following you around and looking into your life is not a myth, nor is it a scare tactic used by lawyers to get you to hire them. Insurance companies do investigate claimants. Doing or saying the wrong thing really can cost you money. Insurance companies commonly use surveillance. Prepare for them to use it in your case, especially if you allege severe injuries.

Insurance Companies Devote Time and Resources to Surveillance

Insurance companies will spend thousands of dollars to tail claimants for as long as a week. This surveillance can be around-the-clock, just like in the movies. Cars can be parked outside your home out of view or follow you as soon as you leave your home. These investigators are good at what they do, so you will probably not outwit them. Insurance companies can follow you at any point during your claim. If your case drags on for a year or two, their investigators may watch you at any time. Although they will not follow you the whole time, you should always act as if they are watching you because they can follow you at any time.

Insurance Companies May Use Surveillance in Personal Injury Claims

Most often, insurance companies will order surveillance in disability claims when the basis of your case is that you can no longer work. However, a personal injury claim can pay you for your inability to work. If you are early in your career or have a high-paying job, these damages can be the bulk of your claim. The insurance company investigators are not amateurs by any means. They are private investigators with experience who know what they are doing. These people have expensive and sophisticated spy gear that they are using on you. Again, it is entirely legal for insurance companies to surveil you. How far they can go depends on state law.

Tactics that Insurance Companies Use to Get Information

Insurance investigators will watch you. They will look through whatever parts of your social media that they can access to get an idea of the life that you are living when you file the claim. They are not beneath hiring someone to physically follow you during your claim to see what you are doing. Their only limit is that they cannot enter or look into your home. Other than that, everything else is fair game. These investigators will undoubtedly perform a Google search on you. They can see the publicly available information that anyone can view, including news articles and comments that you may leave in chat groups and forums like Reddit. While there are rules about what these investigators can and cannot do, you should not expect that they will follow them. Some unscrupulous investigators have used shady and dishonest tactics to discredit your claim, seeking to impress their insurance company bosses. No matter how they obtained the information, you can count on the insurance company being more than happy to use it against you if it can save them money. Even if a state limits insurance company surveillance under anti-stalking laws, there are still plenty of things that investigators can do to find information. Following you is just one of the many things that insurance companies can do.

Insurance Companies Can Use Surveillance to Undercut Your Damages

Once you have proven your entitlement to damages, you will begin trying to negotiate a settlement agreement. When you file a claim, you have also outlined the damages you have suffered in the hopes that you will obtain compensation for them. Before they write you a check, the insurance company wants to ensure that you have suffered these damages. They may be looking for nuggets that they can use against you, especially if your case goes to court. Insurance companies are more likely to investigate you when you file a large claim. Any large check that they write comes out of their profits. Therefore, they are looking for any way to escape paying for the damages their policyholder caused.

How Insurance Companies Use Information that They Gathered Against You

The insurance company wants to disprove:

• Lost wages
• Pain and suffering

Your lost wages depend on showing that you are either unable to work or can do less work than you did in the past. In a hypothetical case, when someone claims that they cannot perform the physical duties of their job, it does not look good when there is evidence of them out riding a bike or doing something physical in public. The insurance company is trying to prove that you can do your job or take another position to pay you some money. Even if an insurance company does not have enough to physically disprove your claim, they may get something that strengthens their bargaining position. Settlement negotiation is very similar to any other type of negotiation - information is power, and those who have it are in a stronger position. In the insurance company's estimation, they can scare you by claiming to have some evidence that they can use if your case goes further. When you seek pain and suffering, you claim that your life has changed for the worse since the accident. One central element of pain and suffering is the loss of enjoyment of life. You seek compensation because you cannot do things you did before the accident. Your pain and suffering claim may also say that you deal with intense physical or emotional pain. Pain and suffering are often the most significant parts of your damages. The insurance company wants to do anything possible to undercut this part of your claim, trying to find something inconsistent with what you have put on paper. If they can show that you are in better shape than you claim, the insurance company can reduce your damages.

Insurance Companies Take Snippets of Information Out of Context

All it takes is one glimmer or piece of information for the insurance company to cherry-pick for them to reduce your settlement offer. Although they do not have the final say over the amount of money you get, they can present this evidence in court if you file a lawsuit. Inconsistent information can undercut your credibility, and the insurance company will not hesitate to use it as leverage against you. While insurance investigators are usually more common in other cases (such as long-term disability insurance claims), do not assume that the insurance company will not investigate your claim. In fact, you should act like the insurance company is watching you while your claim or lawsuit is pending, even if they are not. The last thing that you want to do is give them ammunition to deny your claim or try to reduce your damages.

Be Very Careful When You File a Claim

With that in mind:

• Set all your social media accounts to private to keep those who are not your friends from seeing your posts (if that is possible)
• Do not post anything about your physical condition.
• Do not post any pictures that show you performing any physical activity.
• Be very careful about what you do outside your home.
• Do not speak to anyone about your accident, especially those who you do not know.

You Can Dispute the Information They are Using Against You

Even if the insurance company obtains the information that can undercut your claim, you still have the right to tell your side of the story to the court. Insurance companies are known for cherry-picking favorable evidence and taking small snippets out of context to make you look bad. You can tell the court the entire story and show why the small slice that the insurance company has played does not accurately capture reality. In addition, you can present medical evidence that reinforces what you have alleged in your personal injury claim. A jury will decide how much compensation you are due if you cannot agree on a settlement with the insurance company. While the insurance company may present evidence, they do not get the final word over your financial compensation. Personal injury claimants may have good days and bad days, and the insurance company will try to argue that the good days are your entire life. However, never give the insurance company reason to make your life more difficult when seeking financial compensation from them. Whenever you deal with an insurance company, exercise a healthy degree of caution, knowing their motivations. You are not being paranoid if you act like an investigator is following you. You are simply being smart. Assuming that everything you have included in your claim is true and correct, you should have nothing to worry about. Nevertheless, do not make your life any harder when filing a claim and seeking compensation.

Always Get Legal Help When You File an Insurance Claim

You should always hire a personal injury lawyer for your claim. They will advise you about what you should and should not do while your claim is pending. If the insurance company is trying to strong-arm you with some information that they claim to have, your attorney will know how to deal with them. While you can try to negotiate with the insurance company on your own, it is always a bad idea. Your attorney has the benefit of experience dealing with the insurance company. Your lawyer may also challenge the evidence that the insurance company has gathered if your case goes to court when the insurance company’s investigator has gone too far. Some of these investigators break the rules through their overzealousness and their attempts to please the insurance company that pays them. In that case, you can try to have the evidence thrown out if your case goes to court. In the end, insurance companies chase figurative waterfalls most of the time, as most of their surveillance efforts fail to discover anything that they can use against a claimant. Many claimants have become aware that an investigator may follow them, and they are cautious while their claim is pending. However, when the insurance company does turn up damaging evidence, it helps them pay for all the surveillance because they can cut financial compensation if they successfully use what they find.