Study 8: Fundamental Elements of Investigation - Summary

Question 1

Stationary investigation

Answer 1

• Completed in the office
• Desk adjusters review and analyze claim and policy details to determine the type and scope of investigation required
• Investigations conducted using Internet and web resources
• Investigation produces report that outlines findings and recommendations regarding claim

Question 2

Field investigation

Answer 2

• Completed outside the office
• Travelling to meet with insureds, witnesses, or claimants to obtain a statement; visiting businesses to gather information or surveillance footage; conducting scene examinations
• Purpose is to collect evidence relating to concerns that have been identified
• Can also involve a stationary component (i.e. social media searches)

Question 3

Analytics

Answer 3

• Equally important in both stationary and field investigations
• Review gathered data and look for commonalities or patterns in behaviour
• Helps identify collusion between interested parties or vendors

Question 4

The four types of investigations

Answer 4

1. Individual
2. Collusion
3. Network
4. Concealed

Question 5

Individual

(Investigation type)

Answer 5

• Involves one party, typically the insured, an unlisted driver, or a passenger in the vehicle
• Vary in terms of claims (ex. vehicle loss, property loss), risk (ex. unlisted driver, misrepresentation), and internal resource (ex. intermediary, appraiser)

Question 6

Collusion

(Investigation type)

Answer 6

• Agreement between two or more parties to limit competition by deceiving, misleading, or defrauding others of their legal rights
• Can involve agreements among firms or individuals to divide markets, set prices, limit production, etc.
• May involve unions, kickbacks, wage fixing

Question 7

Collusion investigations typically focus on the following parties

Answer 7

• Adjusters
• Appraisers
• Intermediaries
• Collision repair shops
• Rental facilities
• Tow operators
• Trade unions
• Firms

Question 8

Network

(Investigation type)

Answer 8

• Group of interconnected individuals or suppliers
• Ex. towing company linked to a body shop, linked with a rental car company, linked to a health-care clinic, linked to a paralegal - provides parties with opportunity to strategically profit from a motor vehicle accident

Question 9

Concealed

(Investigation type)

Answer 9

• Concealed investigations are kept secret or hidden to ensure it proceeds with the highest level of discretion
• May involve an insurer’s employee, or an internal investigation where only the investigator and involved individuals know what it’s about
• Parties involved typically sign an NDA

Question 10

Importance of written documentation in an investigation

Answer 10

• Keeping clear and concise documentation just as important as investigation itself
• Ensures if another individual reviews the file, they will know precisely what the concerns are, why the investigation was initiated, what has been done, and what is still outstanding
• New information should be added to file as quickly as possible
• When writing notes, investigators should remain as objective (factual) as possible

Question 11

Use of social media in investigations

Answer 11

• Social media platforms are invaluable tools in investigations - people share details of their lives willingly
• Can be used to verify or refute information, or provide insights into patterns of behaviour
• Information gathered from social media must be publicly available and not obtained through deceit or impersonation (can pose a risk to the lawsuit if so)

Question 12

Use of statements in an investigation

Answer 12

• Purpose is to obtain more information from an insured, witness, or claimant regarding the reported loss
• Active listening is very important when conducting a statement (focus on what speaker is saying, understanding what is being said, and acknowledging what the speaker is saying)

Question 13

Remote statements

Answer 13

• Taken when parties involved are not at the same location
• Can be taken over the phone or an online video call
• Advantage: can collect them at any time without having to travel
• Disadvantage: cannot observe facial expressions, body language, or reactions over the phone

Question 14

Participating in giving a statement

Answer 14

• Insureds, witnesses, or claimants who participate do so voluntarily and cannot be coerced
• However, if a named insured refuses to participate in a statement, they can be held in non-compliance - claim will not be processed until the insurer is able to gain insured’s cooperation

Question 15

Audio and video recordings of remote statements

Answer 15

• Phone statements should be recorded for accuracy purposes
• Recording statements avoids misinterpretations down the road
• Interviewer should record their name, date, time, and who they are calling at the start, and get the subject’s consent to record

Question 16

Signs of deception in a statement can include the following

Answer 16

• Using words like “always” or “never” to support a point of view
• Being very defensive
• Repeating the question to buy time to formulate a response
• Changing speech patterns
• Covering the mouth or face
• Repeatedly touching the face
• Excessive fidgeting

Question 17

Sworn declarations

Answer 17

An official statement declared by the named insured and notarized and signed by a Commissioner of Oath relating to a reported claim

Question 18

In-person statements

Answer 18

• Preferred method as people are more willing to speak face to face, more opportunity to build rapport
• Ask baseline behaviour questions (i.e. “What’s your name? Age? Date of birth?”), no reason to lie about these, can observe behaviour to identify deceptions in other questions
• Active listening, as well as paying attention to body language and facial expressions, are important

Question 19

Expert witnesses

Answer 19

• Relied on to view insurance losses through the lens of their professional opinion
• Anyone who has met qualifications in their professional field - doctor, lawyer, architect, hairstylist, chef, etc.
• Can determine causes of loss, and prove or disprove an insured’s statement of events

Question 20

Four types of evidence

Answer 20

1. Real evidence—This is physical evidence and can include things such as DNA samples taken from an airbag and samples from an accident scene.
2. Demonstrative evidence—This type of evidence can help illustrate the testimony of a witness; for example, photographs that help explain what a witness may have seen.
3. Documentary evidence—This evidence may include a contract, such as a purchase agreement. It is essential that all documents are authentic and from reliable sources.
4. Witness testimony—This evidence comes from witnesses who testify under oath in court and describe what they saw and heard.

Question 21

Chain of custody

Answer 21

Order and documentation that establishes a record of the control, transfer, and disposition of evidence

Question 22

Four uses for digital evidence (i.e. search history & social media)

Answer 22

Used to obtain basic information to

• determine the degree of an injury;
• locate or obtain details on an insured, witness, or claimant;
• confirm or refute information otherwise obtained during a claim; and
• provide avenues for further investigation.