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Insurance Investigation Techniques - Casualty (From Criminal and Civil Investigation Handbook, P 7-3 to 7-14, 1981, Joseph J Grau and Ben Jacobson, ed. - See NCJ-84274)

NCJ Number
J P Cicale
Date Published
12 pages
Techniques of investigation are described for automobile insurance claims, public liability claims, and worker's compensation claims.
All investigations of automobile casualty claims and suits have the same format and differ only in intensity, expense, and priority. The three categories of automobile investigation are coverage, liability, and damages. Coverage investigation involves establishing the existence of the policy, including such components as the policy number, effective dates, policy limits, and identification of the insured vehicle. Liability investigation includes obtaining (1) a statement by the adverse driver, (2) photograph of the locus of the accident or of the vehicles involved in the collision, (3) statements of witnesses, (4) official reports, and (5) information from a canvass of the neighborhood where the accident occurred. Damages investigation involves injury verification, the identification of exaggerated claims, a review of the patient's hospital record, and observation to determine if the injured party's activities are consistent with the injuries claimed. In public liability investigation, more than in automobile liability investigation, situations are encountered that justify a cause of action against another wrongdoer. The claims representative must obtain evidence to show that someone other than the insured is the primary negligent party. The investigation must also include the review of safety standards and statutes. Investigation into worker's compensation claims primarily involves determining if the injury was work related. The investigator is also interested in ensuring that the insurance payments are directed toward treatment and rehabilitation that will return the claimant to work as soon as possible.


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