Scenario 1: Insured is operating an owned vehicle not listed on the insurance policy

Investigation activities:

Review prior policy endorsements.
Obtain and review bill of sale or purchase agreement.
Statement from the named insured.
Statement from the insured's agent or broker.

Scenario 2: A water leak at the insured's home

Investigation activities:

Review of prior claim history.
Complete an inspection of the property and damage.
Engage a cause and origin expert.
Statement from the named insured.

There are other factors for the adjuster to contemplate that could influence how coverage is applied to the facts:

Policy contract language ― How did the completed investigation assist them with applying the language to the merits?
State statutes/insurance codes ― Are there any statutes or codes that apply to the facts?
State case law/public policy ― Have the state courts provided any opinions when interpreting the application of any "on-point" statues, codes or policy language?

Fundamental #2: Documenting the investigation activities

The adjuster should clearly document the specific nature of the coverage issue along with the investigation activities he will be completing to "find" coverage. It is equally important for the adjuster to think about and indicate how he believes each activity will assist with the investigation.

Special Reports /

3 fundamentals of closing insurance claims

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