An Insurance Investigator is a blanket term for an Investigator that specializes in investigating insurance fraud. The term Fraud Investigator can also be used in place of Insurance Investigator. The majority of Private Investigators get most of their business from insurance companies by investigating their suspected fraudulent claims. So, a PI could be referred to as an Insurance Investigator or Fraud Investigator. More often, the term Insurance Investigator is referring to an employee of the insurance company whose role it is to investigate possible insurance fraud. The terms Insurance Investigator and Fraud Investigator can also refer to a government investigator. This is the case when the government has a monopoly on the local insurance industry and does not allow private competition. Even though the Insurance Investigator can be employed by the insurance company or a private contractor, the nature of the insurance investigation is often similar.
The most common insurance fraud investigation is an auto collision insurance claim. However, there can be many other common insurance investigations. These insurance fraud cases can also involve arson, theft, property damage, fatality, and a wide variety of other types of insurance fraud.
An employee of an insurance agency that is an Investigator will typically work in a department called Special Investigations Unit or SIU for short. An SIU Fraud Investigator that is employed by an insurance company, government or private, will typically be tasked with vetting insurance claims. This can also be done with the assistance of a computer algorithm that can detect fraudulent behavior. For some insurance employees, this is as far as the Investigator will go before contracting out the investigation to a PI agency. Other insurance employees will go further and complete a cyber investigation on the insurance claimant before handing out the case to a contractor. An SIU Investigator performing any type of field work is very rare.
The majority of insurance fraud work will be completed by a Private Investigator who receives a contract from an insurance agency regarding a suspected fraudulent insurance claim. Sometimes the SIU Investigator will include an in-house cyber investigation report with the contract. However, it is common for PI agencies to be tasked with completing a cyber investigation report on the subject of the insurance investigation. The field work involved with insurance fraud will often be surveillance. As mentioned before, insurance employees will almost never perform field work. This is left to the Private Investigator. After successfully performing an investigation on the subject, the PI agency will give their evidence and report to the SIU to further their investigation.
About the Author
Peter Sandru is an Instructor & Co-Founder of Novel Data Investigative Learning with over 13 years as an Investigator. Peter Sandru has spent more than a decade conducting investigations and security operations throughout the world, primarily for corporations, law firms, and government agencies. Peter has assisted in the creation of numerous investigative & security training programs in various capacities. Peter has conducted many insurance investigations throughout his 13 year career.