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  • Writer's pictureDan Fleming

Claims Investigations Procedures

The purpose of any investigation is to gather information which is either:

  1. Obviously relative to the claim

  2. Potentially relative to the claim


"An investigator must have a curious nature and an open mind when conducting interviews. Do not be afraid to follow your instincts when asking questions".

Good results depend on good case preparation. Know the history of the case and the issues to be resolved. Most importantly know as much as possible about your subject before you begin the investigation. You need to know as much as possible about your subject before you begin the investigation. You need to know the injury, body part involved, current medical condition or diagnosis, physical limitations or restrictions (use of cane/crutches, etc.), and have a good physical description of the worker. Additionally, know the coverage and limitations of the insured's policy.


Compensability is the initial step in the processing of any worker's compensation claim. It is the step that will lay the foundation for a claim's legitimacy-or its denial. What is called compensability in the insurance and investigative industry is the gathering of information about the claimant, the circumstances, and the nature of the claim. A compensability statement that is properly and completely done should, in the event of a fraudulent claim, provide all of the necessary information needed to deny and perhaps even prosecute the offender.
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