Information for Insured Parties

Find out what to expect if an insurance claim is made against a policy held by you or your organisation

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:

Workers compensation insurance
Public liability insurance
Compulsory third party (CTP) insurance
General insurance

Why would an insurer ask ISG to investigate?

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:

The claim is fraudulent
A witness hasn’t provided accurate information
There’s more evidence to be located
There are more witnesses to interview

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.

What is the investigation process?

Our investigation process will vary depending on:

The type of claim
The complexity of the circumstances
Whether it’s a legal claim (for example, a public liability claim or WID)
Other issues

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.

What information do you need from me?

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:

The worker’s employment contract, enterprise bargaining agreement or any other instrument of employment
The worker’s job description
Any relevant workplace policies or procedures
Any relevant induction, training or qualification records
Any relevant records of disciplinary action, performance reviews or similar
Any relevant risk assessments for work duties
Any relevant incident reports or notification of injury
Pay and leave records
Medical reports and certificates

For CTP insurance investigations, we may seek information about:

Your driving history and experience
Whether you consumed alcohol or drugs before the accident
Information about the accident scene
Driving and weather conditions
Information about the other driver
Where the vehicle is usually garaged or parked
Who is the owner of the vehicle
Whether the car was loaned to another driver
Where the keys are located,
Whether the driver had been drinking or consuming drugs before driving

At the commencement of the investigation, we may write to you about the type of information that we will seek.

What happens when the investigation is finished?

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.

What else do I need to know?

Key points about our investigations

As independent investigators, we’re unbiased
Our discussions with you are confidential
We can’t force you to participate in the investigation. However, if you don’t participate, the insurer may not be able to determine your claim, or will make a decision without your input
It’s important to be truthful and to provide as much information as possible
You can contact us with any questions or any other relevant information