Filed Under:Carrier Innovations, Technology Solutions

Social Networking and the Claims Investigation

Back when many of us began our careers investigating claims, we did it the old fashioned way. There was no Internet, cell phones were the size of suitcases, and email had yet to replace inter-office memos. Somehow, we managed to get by using the relatively scarce resources available at the time.

The key to success was a combination of intuition, tact, and perseverance, where significant time was spent knocking on doors, canvassing witnesses, and searching for the truth. If it was suspected that a claim was a fraud, there was no such thing as link analysis technology to validate the hypothesis. Rather, clues had to be gathered and put together like a jigsaw puzzle.

People are the most crucial element in any successful endeavor. As a result, they must have the training and skills necessary to properly execute basic fundamentals. Technology should be considered nothing more than a tool to make them better at what they do.

Technology, in particular social networking, can also be a distraction to those not properly trained and monitored on utilization. Certainly seeing the injured party with “significant limitations related to the accident” on YouTube in some type of contradictive behavior can add significantly to an investigation. That said, employees chatting on Facebook about plans for the weekend doesn’t serve to improve organizational quality.

Two cars collide at an intersection. The insured readily admits fault, saying he didn’t see the stop sign. The occupants of the claimant vehicle retain the services of an attorney and get medical treatment from a local chiropractor. The marginal adjuster may confirm the accident facts with both parties, pay estimates on both cars and move along to the next claim. The great adjuster will recognize that there may be more than meets the eye.

Great adjusters will leverage the Internet to dig deep. They will not only ask questions of the parties to the claim, but also they will look for discrepancies. They will inquire about not only their medical treatment, but get physical descriptions of their clinics and providers. The good adjuster will ask for directions from home to the chiropractor’s office. They will measure the damages and look for metal striations and paint transfers. The list of what the great adjuster will do goes on and on and at the end of the day may show that this ordinary claim was actually a staged accident.

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