Accident Details Collection:

The insurer gathers detailed information about the accident from multiple sources to ensure the accident's authenticity and to assess the scope of coverage. The investigator might:

Interview the Claimant:

The claimant may be asked to provide a detailed account of the accident, including how, where, and when it happened.

Witness Statements:

If there were any witnesses to the accident, the insurer may contact them to obtain statements or testimonies.

Police Report:

For certain types of accidents (e.g., road traffic accidents), the insurer may request the official police report, which provides details about the accident, cause, and any involved parties.

Site Investigation:

In certain cases, especially if the circumstances of the accident are unclear or disputed, an investigator might visit the accident scene to verify the conditions that led to the incident.

Medical Assessment and Verification

Medical Records Review:

The insurer will review the claimant's medical records to confirm that the injuries sustained are consistent with the reported accident. The insurer may contact hospitals or healthcare providers for further clarification.

Independent Medical Examination (IME):

If necessary, the insurer may ask the claimant to undergo an independent medical examination (IME) by a doctor or specialist selected by the insurance company to assess the severity of the injuries, determine if they were caused by the reported accident, and evaluate the long-term effects of the injuries (especially for disability claims).

Verification of the Nature and Extent of Injuries

Assessment of Permanent Injury/Disability:

If the claim involves permanent disability or death, the insurer will assess the extent of the disability or the cause of death (whether it was directly linked to the accident). For example:

If the claim is for temporary disability, the insurer will examine whether the claimant is unable to work for a certain period as a result of the injuries.

For permanent disability claims, the insurer may evaluate the level of impairment (e.g., using the percentage of disability chart or other guidelines).

In death claims, the insurer will ensure that the cause of death was indeed the result of an accident and not a pre-existing medical condition or natural causes.