Investigating Claims

A recent article in the Post Magazine suggested that complying with the law and upholding professional standards would put those investigating potentially fraudulent claimaints on ‘the side of the angels’. Was it implying that such investigators tend to operate well below such standards?

The article was further marred by its case study having nothing to do with the use of illegal or unprofessional investigation techniques, being instead about a properly investigated and convicted fraudulent claimant.

While it was probably the magazine’s editors who chose the article’s title, it does shine a light on difficulties the sector (or at least those reporting the sector) seems to have in reflecting upon its own behaviours and the ease with which it moves the focus onto the behaviours of claimants. The latter obviously costs it a lot more money, but that doesn’t obviate the sector’s responsibilities to get its own act in order.

Private investigating is an unregulated activity with no overarching professional body to set and enforce standards. So when insurers and adjusters hire a private investigator, they have to rely on their own standards and procedures to ensure that the claimant under investigation is treated fairly (most claimants are customers of the insurer and so continue to fall within the FSA’s expectations of fair treatment). It is surprising, and more than a little worrying, to hear reports that the sector has yet to establish standards for how such private investigators are managed.

It all begins to take on shades of the News of the World scandal – big company allows an ‘let’s go get them’ culture to develop and along the way fails to control how some of the information is obtained. All it will take is for a particularly sensitive case to be come along and insurers will find themselves in the court of public opinion with less than a leg to stand on.

Perhaps this is overstating it a bit, but there is a real risk here that the considerable energy being put behind the sector’s very justified initiative to tackle fraudulent claims will create a blindspot to its own ethical responsibilities around how those cases are investigated. News International presents a near perfect example of where insurers don’t want to end up.

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