Insurance Investigator and Legal Sanity

Professionals who specialize in investigating insurance frauds are knowns as Insurance Investigators. They render their services by evaluating the suspected fraud / triggered claims, ensuring fairness, and give feedback / opinion to the Insurance companies. By the nature of their work, Insurance Investigators are perceived as people with magnifying eyes and critical think tanks, who help insurance companies make wise decisions. They are an integral part of the fraud prevention and loss mitigation eco system of every insurer!

Investigators inspect claims, verify facts, and conduct research, to ensure no fraud claims are honoured. Aligned to develop a better understanding of the claim and the surrounding facts, an Insurance investigator gathers information from the insurance surveyor, law enforcement bodies, claimants, witnesses, and other related parties to exam the veracity of the claim. They begin the process by collecting and reviewing documents, interviewing the victim, witnesses, and related parties, recording their statements, forensic reconstruction, background & financial verification. They often visit the spot, assess the facts with surveillance and social media tracking to justify the claim. After the investigation is complete, they write a report confirming their findings and evidences. If the situation demands they might be called to testify the findings in the court of law.

For becoming a successful insurance investigator, one must possess strong communication skills, active listening skills, critical thinking, strong decision making, persuasion, negotiation, integrity & smartness. It is pivotal to add that for a subject as vast as Insurance that investigators also look to specialize in Motor (OD, TP & Theft), Health including personal accident, Non-Motor (Fire, Engineering, Marine, All risk, etc), Life, Workmen compensation, etc. Hence knowledge of insurance, relative products and the legal aspects are rudiments.

Insurance Surveyors derive their legal existence from Insurance Act, 1938 duly licensed by IRDA. Regulation 12 of the IRDA (Insurance Surveyors and Loss Assessors) Regulation 2015 mandates the appointment of Surveyors and Loss Assessors. Further, the required qualification to become Surveyor is also laid down in Annexure-1 of Schedule-1 of above said Regulation. Any Surveyor shall access losses for the type of claims for which they are qualified and is specified in their license. In all the developed insurance markets minimum education, degree, license and certification, experience, and Infrastructure are basic requirements to be an ‘Insurance Investigator’. However, it is important to highlight that in India- IRDA or relevant laws and regulations have not assigned any education, license, or certification for insurance law & regulations for being an ‘Insurance Investigator’.

Insurance Institute of India (III) has initiated, “Certified insurance Anti-fraud professional” course, for the enhancement of the professional but not being a mandatory qualification, it will not raise the bar for the investigators. I believe it's high time to induct more qualified professionals in the insurance investigation field and to equip such professionals with the requisite set of tools and on ground training with case studies on business realities and possible frauds that happen.

An insurance investigator plays a pivotal role in protecting the insurers and industry at large. They ensure that miscreants don’t bypass the law by filing fraudulent claims. They work towards making the industry fraud-free, ?resilient and bringing about a great deal of transparency for all stakeholders.