Investigative Techniques: 6 Key Questions for Claims

When it comes to insurance claims, especially the complex ones, the truth isn’t always obvious. It’s buried beneath layers of documentation, conflicting accounts, and sometimes intentional misdirection. For claims adjusters, the ability to ask the right questions isn’t just a skill—it’s a necessity.

While we capitalize fully on technology advancements to supplement our investigations, that doesn’t mean we skip over the basics. Asking these standard questions and inspecting the responses helps cut through the information overload, both for the claimants and our investigators.

Uncovering Claims with the Classics

Every claim tells a story. To uncover it, adjusters should lean on the classic investigative framework: the “Who, What, Why, When, Where, How” Framework.

• Who was involved? Who witnessed the event? Who benefits from the claim?
• What exactly happened? What was damaged or lost?
• Why did it happen? Why is the claim being filed now?
• When did the incident occur? When was it reported?
• Where did it happen? Where are the supporting documents?
• How did the damage occur? How was it discovered?

This methodical approach helps adjusters move beyond surface-level details and identify inconsistencies or red flags.

Real-World Red Flags: Details That Change Outcomes & Costs

Sometimes, the truth hinges on a single overlooked detail. Consider these examples:

Property Sales: A claim for storm damage might seem valid—until records show the property was sold before the storm hit.

Ghost AOBs (Assignment of Benefits): Fraudulent contractors may file claims without the homeowner’s knowledge. Verifying the legitimacy of AOBs is crucial.

Social Media Research: A claimant reporting a debilitating injury might post conflicting physical activities online. Public digital footprints can be powerful tools in validating or challenging claims.

These scenarios underscore the importance of digging deeper and verifying every aspect of a claim.

Independent Adjusters & Experts: Your Allies in Investigation

Independent adjusters and forensic experts bring specialized knowledge and objectivity to complex cases. Their insights can reveal structural issues, validate timelines, and uncover fraudulent patterns. Collaborating with these professionals ensures a more thorough and defensible investigation.

How Davies Supports Smarter Claim Investigations

Our team has an average of 18 years of experience and specializes in the following areas:

• Special Investigations Unit (SIU)
• Surveillance (Traditional & Remote)
• Field Investigations
• Social Media Investigations, Preservation & Monitoring
• Background Intelligence Investigations
• Medical Canvass
• Database Investigations

By partnering with Davies, claims professionals gain the tools and support needed to ask better questions—and get better answers.