Information for Claimants

If your insurance claim is under investigation, learn more about the process, your rights and responsibilities

Have you suffered an injury? You may be eligible to claim on an insurance policy. For example, a workers compensation claim if you were injured at work, or a general insurance claim if you were injured or suffered property damage because of fire or theft. However, not all insurance claims are straightforward. If your claim is investigated, it helps to understand what’s happening.

Why are you investigating my claim? Have I done something wrong?

Insurers can often quickly assess and process claims. However, from time to time, a claim may present difficulties, and an insurer will choose to investigate. It isn’t an indication that the insurer will reject the claim. Instead, it’s a sign that the insurer is seeking more information to decide how to proceed. And there are many reasons why an insurer may investigate. For example, perhaps:

The cause of the injury is unclear
There is limited evidence
The full extent of the injuries isn’t yet known
There are concerns about whether the claim is genuine

Why do I have to participate in the investigation?

As the claimant, you are likely to have valuable, relevant information and be able to contribute more details than anyone else. We can’t force you to participate. However, without your input, the insurer may not be able to assess your claim, or it will decide your claim without further reference to you.

How can I trust that the investigation will be unbiased?

Insurers use our investigation services specifically because we’re independent investigators. Our job is to locate as much information as possible about the claim and its circumstances. We don’t make any conclusions about whether the insurer should accept the claim.

What is the investigation process?

If the insurer engages us to investigate your claim, it will usually advise you that we’ll be getting in touch.

We will contact you to inform you of the investigation and what to expect. We’ll also let you know about your privacy rights and how we treat your confidential information.

Depending on the type of claim, we may ask you to attend an interview with us, either in person, by phone, or by video conferencing. We will use this time to take a statement from you detailing the circumstances of your claim. We may also seek other information. For example, when investigating workers compensation claims, we may ask you questions about your personal circumstances including:

Income
Education
Employment history
Employment tasks
Training
Health
Home life
Leisure activities
Any pre-existing injuries

If you have any other documents, such as emails or letters, that are relevant to your claim, we may ask you to provide them (if you haven’t already done so).

After our interview with you, we may follow up by:

Locating any further documents
Speaking to other witnesses
Assessing the accident scene or worksite

Once we have all the information, we send it to the insurer to assess and determine your claim.

How long will it take you to investigate my claim?

We aim to conduct our investigations as quickly as possible. However, we can’t predict how long an investigation will take. It often depends on what further issues arise during the investigation process and how long it takes to find relevant documents and speak to the witnesses.

The time that the insurer takes to decide will depend on how quickly we can complete our investigation and the complexity of the issues. If you’re concerned, you can speak with your insurer about the best way to get updates about the progress of your claim.

What else do I need to know?

You must understand:

Our investigations are unbiased – we don’t make any decisions about your claim. Instead, we pass the information to the insurer
Our discussions with you are confidential
It’s your choice to provide as much or as little information as you like
We will give you information about how we handle your personal information
If relevant, we will tell you how you can access a copy of your statement
You can have a support person with you during your interview, for example, a union representative, a family member or a friend
If you need an interpreter, you or your support person can ask us to make the arrangements in advance of the interview
We can’t force you to participate in the investigation, but you need to understand that if you don’t, it may affect the insurer’s ability to assess your claim fairly
Lying or deliberately omitting information during our interview may lead to the insurer taking legal action against you
In the days after the interview, you can call or email us to amend your statement or, if appropriate, make a supplementary statement

You can ask your insurer for more information about the claim investigation process.