The Claims Investigator may be an in-house appointment or may be hired on a contract basis for individual claims. The role has grown from that of a Claims Inspector who typically worked with an Insurance Company. There are many aspects to the Claims Inspector role. At one time it was common for them to be the main manager of individual motor and liability claims. They would go to the policy holder’s premises, meet with and contact witnesses, make relevant enquiries and decide on policy cover issues with the underwriters. They might have been the person to put an estimate or reserve on the claim and they would often be the one to attend at court when the case was in for hearing or settlement meetings.
Most Investigators have a professional qualification but as well as this they have significant “on the job” training. Training for this role in the companies involved a period as something of an apprentice. The importance of gathering the right information preferably during the first visit is hard learned. The need to again take to the Irish back roads in winter to get the missing statement or photograph tended to be a stern lesson!
It is perhaps in the court arena that the real experiences that forge an investigator are learned. As the insurance company representative at court the individual often had control over the payment of a large amount of money. The alternative to payment was often an expensive fight in court with the possibility of a poor outcome. A major case will often involve a plethora of experts. It would not be unusual to have two barristers, a solicitor, an engineer, a motor assessor, and a number of doctors depending on the injuries. As well as this there may be several witnesses all with their own bias and interests. The final decision about what to do in a case often rested with the Insurance Company Representative (Claims Inspector). They would need to take all of the advice offered and consider it in the light of the facts and past experience. Different weights would also be attached to that advice depending on who it is from. It is also sometimes the case that there is a need to fight a case for a social or business reason that is outside the normal legal considerations. this needs to be understood and held in context by the Inspector.
It is very useful if a Claims Investigator has been through all of this. It is then possible to sort the vital information from the remainder at the earliest stages and to see how different pieces of information will be seen by the courts. How will a witness stand up to examination and indeed cross examination? Are there legal obligations that have not been attended to that would hurt any chance to have the case defended.
In a typical case an Investigator will attempt to:
It will be seen that the Investigator needs a very varied set of skills. These must be allied to a suitable personality and strong presentational skills. Clients vary in their desire for information with some needing chapter and verse with others sighing if they get more than a few bullet points. These and every requirement in between must be accomodated. It would be common for the investigator to discuss the case with the handler at some stage to help decide on strategy and to explain further any difficult issues. Often more information will have been collected than is presented in the Investigators Report. Sometimes such information only becomes relevant because new allegations are made and it is useful to check back with the investigator to see if they are aware of any relevant facts or if it changes their view.
Because Investigators are usually Qualified with a Professional body they are governed by a Code of Ethics and are expected to conduct themselves in an appropriate way. Dress is usually conservative and quite formal especially during corporate visits. Certain individuals may be easier to approach in a less formal way and this would be a call for the individual investigator.
It is not possible for a Claims Investigator to go into a place of work and question policies regarding safety equipment or processes unless clear attention is paid by the investigator. All safety equipment that might be needed is carried at all times including
Other more specialist equipment will usually be provided by the host company and this might include:
Building Sites in Ireland often require a “Safe Pass” card from all entrants. Even though it may not be strictly necessary under the relevant legislation, it is better for an investigator doing this kind of work to have it.
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