House burglary investigation sequence

[Bugz]

Hi all
Can someone please explain to me the sequence of a house burglary insurance claim, and at what stage, or why, an or how, an investigator will be utilised. This is what I know/think so far. House gets burgled. Insured calls police, who attend and make a police report, including list of stolen items and/or any damage. Insured then notifies insurer, and gets asked to fill in a claim form. Claim form goes in, and insured gets paid out-if all is well and good.

Obviously if something is not right, it will need to be investigated, and I imagine there are a whole host of red flags that can make this happen. But under what circumstances does an sub-contract investigator get called in to do it as opposed to, or additionally to, an insurance company employee, such as an assessor?

If someone could fill in the details I would appreciate it. I have only been on the receiving  end years ago when my house was burgled, and I can only remember putting in a claim form, waiting ages, then getting paid out. Nobody came to the house. However, my last two MVA's I had assessors out from the other parties insurance company, and I know for a fact the second one was an employee of the insurance company. They took pics of the damage and condition of the car, and that was it.

If someone could enlighten me, I would appreciate it. I may have extra questions, but that would depend on the answers given.

Cheers

[BigGeorge]

Hello Bugz

You've described the sequence quite right up until the point where the insurance company pays the claim.

Most insurers investigate most burglary claims, or rather, they "assess" the claims and the investigator is essentially an insurance assessor, but his objectives are two-fold. Most insurers have assessors in-house, but not usually for house claims or content claims because some  independence is needed in the assessment. Most insurers have a red flagging system the details of which are too tedious to discuss here.

The investigator, who usually introduces himself to the insured as an insurance assessor, attends the house and does a walk around with the insured to find out what was where. He examines the point of entry, but not forensically, takes measurements and pics and draws a diagram. Sits down with insured and interviews him and takes statement, covering typical things such as are covered in stolen car claims. And then gets to a detailed discussion about each and every item taken - proof of purchase, source, ownership, cost/value, valuations, precise position in house, etc etc.

These interviews can take hours and must be meticulously detailed. The objective is to compare with the list supplied to police, assess viz sum insured, insurable interest, compliance re security/policy, etc. No negotiation takes place.

Insured signs statement and supplies documents. Investigator then consults with regular suppliers/wholesalers of all kinds of goods. I regularly would call Harvey Norman, supply a list of items/models and they'd come back to me with costs. This allowed me to set out the loss and analyse it and work out a final total loss for the insurer. Adjustments are then made for dubious items and excessive or insufficient insurance cover. Report is submitted to insurer covering the loss assessment and any other issue that may allude to fraudulent matters including misrepresentation. Insurer decides claim and OKs wholesaler to supply the goods to insured.

Something along these lines is typical. Same approach is taken with house claims, say house burnt out or car drives into house, etc. You assess and you investigate. You look for policy compliance and potential recovery.

Claims are not often knocked back on evidence of criminality (because it's not so common to get the proof), but on evidence of breach of contract, misrepresentation, over/under insurance, bad security and such.

Other investigators may not take the same approach I did.

BG

[Bugz]

Hi BG

Thank you very much for your detailed response. It has answered all my questions, and then some.

I was not entirely sure just how much was done by the insurance company as opposed to a sub-contract investigator, but now I see it is more than what I initially thought. It also has me leaning more toward wanting to work in factual.  

Once again, thank you.