“The Tools for the Job: What You Need for a Thorough and Ethical Investigation in First-Party Claims"
In the May 2021 issue of CLM Magazine, Rebecca Strickland and Christine H. L. Russell authored an article offering practical guidance and insight on tools for conducting a thorough and ethical investigation into first-party claims.
The claim file is a history of every move the insurer made, the facts it gathered and the basis for its claim decision. Strickland and Lee offer a list of do's and don'ts when considering what to place in a claim file:
- Do consider how the claim file would look if it were an exhibit to the claimant’s complaint in a lawsuit or displayed in closing argument at trial. The tone and substance of the entry should be appropriate.
- Do document facts relevant to the claim, including what happened and why. The insurer will use this information to defend its claim decision.
- Do make sure that the claim file is sufficiently detailed so you can explain your thought process in a claim years later based upon your notes.
- Don’t try to influence experts’ opinions. If an expert is hired in order to evaluate the claim pre-suit, the expert should remain unbiased and provide an objective view of the claim.
- Do document the basis of the conclusion ultimately reached by the insurer.
- Do diary the claim. This will ensure that anyone touching the file will know what needs to happen next.
- Do maintain objectivity in notes.
- Don’t include subjective comments about the insured, claimant’s counsel or vendors.
- Don’t make conclusory statements prematurely.
- Don’t ignore claim handling procedures.
- Don’t express claim notes as “us v. them.”
- Do involve an attorney early if you believe there is a need to protect the file.
Additionally the article explores the various tools a claims professional has at their disposal for a thorough review of a matter to add to the claim file. These include collecting statements of the insured, statements from witnesses and photographs and videos (including from surveillance or doorbell cameras). Additionally, relevant experts to evaluate the cause of loss or the value of a claim are important resources. Other tools to dig deeper in an investigation include financial authorization to review the insured’s finances, review of publicly available social media content and cellular data.
For the full article, please click here.