Who is an Insurance Claims Investigator


A Claims investigator examines the facts of a claim to determine if the claim is valid. They decide the extent and validity of a claim, and in so doing, they prevent fraudulent claims by determining the claim’s authenticity.

The kind of insurance claims that require investigations include;-

  1. Fraud cases
  2. Third party bodily injury claims to confirm whether the accidents actually took place, where the insurer needs to establish the net worth of a third party whom they wish to recover from.

The criteria claims appointing claims investigators in insurance will always vary from one insurance firm to the other. Below is a sample from one of the leading insurance form in Kenya.  The investigator can be;-  

  1. An Ex-police officers
  2. An EX-Military Intelligence Officers. 
  3. An Ex-CID officers
  4. People with at least 3 years’ experience of investigative insurance work.

 Above everything else, the insurance company requires that the investigators should be people whose credibility is not questionable. More important is related work experience, usually in law enforcement, law or insurance.

The fee structure.

The fee for each investigation should be agreed on in advance depending on the extent of their involvement. The insurer is normally specific when giving instructions and its normally done in writing and that the insurer will only pay for the scope of work agreed on at the time of appointment.

The claimant will be notified depending on whether the claimant’s involvement will assist in achieving the objective of the investigation.


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