If someone claims against your insurance policy or your organisation’s policy, there may be an investigation if the claim is difficult to determine. Investigations may be necessary for various types of insurance, including:
As independent, third-party investigators, insurers often engage us to investigate when it’s not clear how to determine the claim. For example, consider public liability, workers compensation or work injury damages (WID) claims. Investigations may help unearth relevant evidence and information. In a CTP or general insurance claim, an investigation may help the insurer clarify what to do about a property damage claim or an injury claim.
Also, an investigation may be appropriate if the insurer is concerned that:
With high caseloads, insurance case managers must be able to count on our independent services to keep the matter moving. Our job is to locate the evidence and present it to the insurer. The insurer then decides what to do about the claim.
Our investigation process will vary depending on:
Insurance investigations are usually factual investigations, meaning that our focus is on gathering as much evidence as possible (including witness statements).
The insurer may notify you in writing that the claim is to be investigated by ISG. Then, we’ll contact you to arrange a time to interview you for a witness statement or to collect documents or other evidence, or both.
Depending on what’s raised in your interview or the information in the documents, we may need to speak to other people or locate evidence elsewhere. We will keep going through this process until we’re satisfied that we’ve gathered all the information the insurer will need to determine the claim.
For CTP claims, we usually go to the accident scene to take photographs and measurements so we can corroborate any witness accounts. For workers compensation or WID claims, we may go to a workplace to assess the claimant’s work environment and tasks.
Depending on the circumstances and COVID-19 restrictions, we may seek to interview you in person, by phone, or via video conferencing.
The information we will ask you to provide depends on the type of claim. For example, for workers compensation claims we may ask the insured representative (the employer) to provide:
For CTP insurance investigations, we may seek information about:
At the commencement of the investigation, we may write to you about the type of information that we will seek.
Once we’ve completed our investigation, we prepare a report for the insurer. The information in the report usually includes your statement, other witness statements, documentary and other evidence, our analysis, and any findings. It does not include any recommendations to the insurer about how to determine the claim.
When the insurer has all the necessary information, it will asses the claim.
Key points about our investigations
Independent investigations to clear the air and move on