Today there are many fraud cases due to which the insurance company comes in loss. Some client make false claim to recover money from the insurance company. So that about to all insurance company uses to investigate the event or accident, when ever a claim is made by their clients. The insurance fraud affects the agency by getting direct injury to insurance company’s property and they are forced to increase premium because of fraud. Due to these frauds they lose competitive advantage in market competition. If the insurance agencies don’t investigate through the fraud, they make unbearable burden in the long run. Insurance claim creates a number of complexities according to the varieties of cases.

There are separate characteristic for each separate case that make the case distinctive from other cases. There may be various similarities between different kinds of cases. The similarities may have some basic concepts like: when, where, who, why, what object, what matter etc. The policy claim fraud investigation is conducted to

achieve some unknown information with investigative skills, approaches and means. Many companies conforms their investigations in the form of photograph and video film evidence together with a comprehensive and detailed report. These companies also provide a facility of witness statement allowing the customers to facilitate disclosure. Some of the fast growing company centralizes claims adjustment in a claims center, where they determine the cost for repair and a check is issued immediately. When there may be a more complex case then it is dealt with the senior adjusters.

These senior adjusters works for different purposes and they became specialist of that related field. Some are homeowner claims specialist, business losses specialist, automotive damage specialist, or workers’ compensation specialist.

Types of claim investigations:

• Field Investigation
• Contestable investigation
• Field Activity Check
• Verification
• Permanent Disability and Beneficiary Field Reviews
• Medial and public record research and retrieval
• Surveillance
• Telephone Investigation
• CPA Audit

There are several verities in the case of life insurance policy. If there caught a death case then the investigator reviews on the cause of the death. Some of the insurance agency doesn’t pay the insurer family if the case is of an accident. The investigator also may ask new questions for life insurance to make sure that the client was not seriously ill. If it is not determine the company reaches to a high risk to insure. If there is found any clue that shows the insurer was seriously ill, the company disqualifies them from obtaining insurance. When the insurance agency found any fraud in compensation injury, automobile accident, or other liability, the client has the primary responsibility for payment of medical claims related to the injury.

Insurance claim investigations are initially handled through the policy agency’s appeal in many cases. This essentially means that another person of the policy agency will conduct a policy claim investigation to determine whether or not to uphold the real denial of claims or to pay benefits to the client. Once the agency’s internal regulation department has conducted a policy claim investigation, the client may then have the option of seeking legal remedy for the bad faith.