What’s the incentive for insurance company employees to investigate car accident claims thoroughly?

What's the incentive for insurance company employees to investigate car accident claims thoroughly?

Craig answers......

I often tell new investigators that our job, as an investigator, is to deliver on our promises.  At its most basic an insurance policy is nothing but a promise; the insured promises to pay a premium (there are some other promises in there) and the insurer promises to indemnify them for certain types of loss or damage.  The investigator is the person in the insurance company that delivers on that promise.

In order to deliver on the promise of indemnity we also have to fulfill another implicit promise; to ensure that we (the insurer) protect the indemnity pool so that the money is there to deliver on the indemnity promise.  Both of these promises require a thorough investigation of all claims. 

For the first promise, indemnity, we need to investigate to ensure that we can accurately quantify the damages payable.  Determining the damage to a vehicle is pretty easy but requires some investigation, determining the damage to a human is much more difficult and requires a great deal more investigation.  Without an investigation we cannot determine how much we should pay.

For the second promise, protecting the indemnity pool, we need to investigate coverage, whether or not the peril is insured, whether or not the damaged property is insured, liability, etc.  If we did not investigate coverage then we would not be able to determine whether or not we need to pay.

Our investigations are about fulfilling both promises as completely as possible.  If we were to pay claims that are not covered then we would be neglecting our promise to all our other insureds, if we were to pay too much, we would be neglecting our promise to all of our other insureds, if we were to pay too little we would be neglecting our promise to the claiming insured.  These two promises have to be balanced, doing so means we need to ensure that we pay exactly what we contracted to pay for losses that we contracted to indemnify for; no more, no less. Finding that balance requires a thorough investigation.

 

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