Insurance Investigator (Specialist)

What is a Specialist Insurance Investigator?

An investigation specialist focuses on a particular field of investigations, whether it is a specific subject area (like commercial-crime investigations) or a particular investigative methodology (like crime-scene investigations).

A specialist is usually a subject-matter expert who has received advanced training in techniques and tactics that are specifically relevant to his or her type of work. He or she may work alone or as a team leader on cases within their area of expertise or as a consultant to other investigators in matters relating to their specialty.

In my case I have specialized in insurance-related investigations. Besides the academic knowledge needed to become a specialist, one needs to have a very solid foundation as a generalist. This is achieved only through practical experience in different aspects of the trade.

Besides my experience as a police detective, I worked for 2 years as a junior investigator (conducting background investigations), one year as a senior investigator (conducting due diligence investigations) and another 2 years as a chief investigator (working with the B-HIVES team). I’m in my 3rd year as a specialist but am studying to become an expert insurance investigator (hopefully by the end of the year. Touch wood. That means you too!)

So what do you do exactly?

The title pretty much sums it up. I’m an insurance investigator, so handle insurance-related investigations either after a claim has been made or before a policy is approved. In most cases, i’m involved only after some incident or event took place and gave rise to an insurance claim. This could be anything from life insurance policies, to medical disability claims, to short-term insurance claims for vehicle theft, hijacking, housebreaking, or motor vehicle accidents.

My job is to gather all the facts surrounding the claim, to uncover the truth about what really happened, and to present that information to my client so that they can make a decision regarding the claim – an important decision being whether to settle or repudiate the claim in the first place.

My clients are insurance companies, brokers, assessors, other insurance investigators and attorneys. Insurance work is big business for us, and its a long-term business arrangement (provided we don’t screw up). For this reason, working in the Insurance Investigation department has many benefits: we work with a larger budget than most other investigators and are able to utilize resources and tools that are too costly for the average client to justify. Insurance claims are generally very high value – a R100,000.00 vehicle claim would swim in the shallow end of the claims pool – so spending R5,000.00, R10,000.00 or even R20,000.00 to ensure that the R100K claim does not get paid means that they’ve saved R80K – R95K.

CAREER CORNER

Interested in a career in this field? Want to know more about the job, training or career prospects? Get honest answers from a subject-matter expert. Add your questions in the comments section below, and we’ll get them answered for you. There is only one rule: be genuine.
insurance investigator - grant fletcher

Howzit. I’m Grant Fletcher, an Insurance Investigator with Intertel in Durban. If you’re interested in a career that is never dull then the investigations industry is worth considering. I’m happy to answer any questions you have. Just ask away in the comments section below.

Do you work in an office or out in the field?

Both, and each day is different. Certain tasks can only be completed at the office, like polygraph testing and all the administrative work that goes with any type of investigation. A large part of my day is usually spent interrogating, interviewing or taking statements from the insured person, others that were directly involved and any witnesses that have come forward or been traced. Sometimes they will come to our offices and other times i’ll need to go out to meet them at their place of business or home.

The remainder of the time I spend at the “scene of the crime” or places of relevance to the claim. I need to inspect the scene to understand what happened. I work a great deal with forensic specialists, scientists and engineers to answer questions about what really happened and whether what I am looking at could have occurred the way the insured claims.

For example, at the scene of an accident a specialist might be called to examine skid marks and make a judgement as to how fast the vehicle was traveling and how long before the impact the brakes were applied.

What’s the most boring part of your job?

I’m not going to BS you, this is a very demanding job, and there really isn’t much time to sit and think, “hey man, this is boring” (high crime rates mean no shortage of insurance claims – and a relatively high number of attempted insurance frauds keeps us busy full-time). 

If i really think about it, i’m probably the most bored when i’m driving to and from the office, but even then its probably more like frustration than boredom because I use the time to plan my next moves or to make calls and that usually gets me amped for the next task which obviously has to wait until my drive is over (yes, yes, I use a handsfree with voice dialing and I don’t text while driving). 

When friends or family ask what I got up to that day I’ve always got something new to tell them.  No two days are the same – ever. Different crooks, different schemes, different challenges.  

I spend a fair amount of time writing reports, and I guess for some this part of the job might be boring.  For me its a chance to showcase the quality of my investigation and the credibility of my findings.  The report is also the hammer that will be used to nail the insured to a criminal prosecution or civil claim (if the commission or attempted commission of a crime or a breach of contract is proven).  Once delivered to the customer there’s no taking it back to correct spelling, grammar or factual errors and omissions.  When a Court (and the opposing attorneys) receive your report they will examine it in microscopic detail. 

If you are not a dedicated professional at all times and if you don’t take pride in producing results of a high standard then you’ll potentially harm the Insurance company’s case and that would hurt the company.  You’d be wise to look elsewhere for employment.

Is the job of an Insurance Investigator dangerous?

I am exposed to a higher level of risk (of death or injury) than someone who never had to leave the office because i’m frequently on the road and occasionally in dodgy areas or with people of questionable morals.  Motor vehicle accidents are probably the biggest threat to my well-being. 

After that, perhaps being the victim of an opportunistic crime like vehicle hijacking or robbery.  I carry a firearm so I can defend myself if the situation warrants it – which it hasn’t ever. 

I’ve been sworn at, insulted, spat on, pushed around, and verbally threatened by a handful of characters over the years.  Nobody is ever happy to have their claim repudiated, but most people accept that they have been caught out fair-and-square.  Many beg and plead for our report to be buried, or for mercy because of this or that reason. There’s usually a lot of tears and sob stories. 

Its important to remember that these are people just like you and I, and regardless of what they’ve done (or are believed to have been involved in) they deserve to be treated with respect and compassion.  If you can do that and you’re being sincere about it then you’ll very seldom be blamed for whatever action the insurance company might take in respect of the claim.  There are always a few irrational people who take it as a personal attack on them and as I’ve said, i’ve been in a few unpleasant situations – but nothing that ever got me worried or concerned for my safety.

What tools/technologies are used by an Insurance Investigator?

This question is quite vague. Its like, “what ingredients do you use when cooking?”.  It depends on what we’re cooking.   I guess I could list the most common tools and technologies we rely on in our investigations.  Some are physical tools, devices or systems (“Hardware”); others are methods and techniques that are vital technologies in breaking a case (“Methods”); and some are skills that one needs to utilize often in this line of work. Here are my top five for each category (in no particular order):

Hardware

  • Polygraph/Voice Stress Analysis
  • Covert video cameras
  • Audio recording devices
  • Video and still cameras
  • Vehicle tracking devices

Methods

  • Physical/Electronic surveillance
  • Interrogation/Interviews
  • Tracing Witnesses/Canvassing
  • Incident/Event Reconstruction
  • Intelligence gathering

Skills

  • Active Listening
  • Incisive Questioning
  • Building Rapport
  • Memorizing Information
  • Managing Time/Tasks

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