Understanding CLAIMS INVESTIGATIONS

May 30, 2014

Do not get nervous, it's standard procedure to be investigated if you make a claim.

Even with help and representation this can be one of the most overwhelming times if your life. There is a lot of red tape, and it can get quite confusing. Here we will try to break it down a bit, and if you have questions still there are always professionals standing by to help you through.

Understanding claims investigations regarding disability and income protection, for most, can mean having or getting a legal degree. Legalize has never been easy for the layman. For those of us without a legal degree and no plans on getting one, we need to rely on trusted sources that cam help with our claims.

The claims investigations process – Do you have disability and income protection?

If you have disability and income protection and are making a claim you need to know the process. Typically the process calls for a claims reviewer to investigate a long term temporary or permanent disability. You should know upfront that claims investigations are common.

A claims representative will:

  1. Give you a call to ask questions. Don't be nervous, just tell the truth to the best of your knowledge.
  2. Request medical records. This is customary. Without substantiating medical records you won't be able to prove a claim.
  3. Background investigations will likely be performed.
  4. Background interviews may also be done by:
    • Interviewing your friends, family and even your neighbors.
    • Obtaining substantiating employment records.

The claims investigator will need to know all the details of regarding your claims investigation.

There's really nothing you can do if you are the one filing a claim to keep from being investigated. This type of disability income protection is expensive. The more claims filed, the more expensive it is on employers.

No doubt the employer or the insurance carrier will fight with all their might, to keep from paying out claims. Some policies even state that investigations are mandatory.

If you are somehow required to have a medical examination then by all means cooperate. You can request an audio recording be done during any examinations. This way you also have records from the claims investigation that could help your case. If the doctor or examiner refuses this stipulation have them put it in writing. However, in most cases the claimant cannot refuse. Yes I know, it seems like a double standard to me too, unfortunate but reality nevertheless.

You may never meet the examiner in person but you can be assured you will be speaking. Again, if you have questions regarding a claims investigation do not hesitate to ask. We are always here to help.

Seca Investigations:
Phone 61 3 9544 6865 / 61 3 9544 8279
Fax 61 3 9558 8980

Optimized by NetwizardSEO.com.au

facebook