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If Your Company Isn't Using Insurance Claims Investigation Services, You Are Overpaying Claims
Organizations are willing to take financial responsibilities for their actions, but that doesn't mean a liability claim is a blank check. Insurers or other liability carriers use insurance claims investigation and forensic accounting services to ensure claims are fair and accurate measures of their legal responsibility.
Don't Pay Unreasonable Losses
Sometimes liability costs are simple. An accident causes damage which costs $50,000 to repair, so it is reasonable for the responsible party to pay $50,000. However, many cases are more complicated, and the parties involved struggle to quantify just how much loss was incurred.
For example, assume a new apartment complex opens six months late due to mistakes made by the construction company. The apartment owner wants the construction company to pay the six months of lost rental revenue as compensation but calculates reimbursement based on 100% occupancy. That's an unreasonable figure since apartments in the area rarely run at 100% occupancy, and new apartments tend to have lower occupancy than established complexes.
Liability calculations grow even more complicated when dealing with nebulous concepts like "pain and suffering."
Forensic accounting services help a company calculate loss. This financial specialty focuses on risk, exposure and loss. It takes imprecise aspects of loss and turns them into concrete figures. These services provide an objective method of calculating fair value.
Forensic accounting services are capable of more detailed and accurate analysis than most claimants are. A typical liability claim is derived from a superficial examination of the loss, such as the apartment scenario above. Experienced risk management professionals bring more information into the equation so they can provide realistic and fair calculations of actual losses incurred and owed. Carriers who don't perform insurance claims investigations end up overpaying claims submitted by claimants who can be generous in their estimations of loss.
Uncovering Fraud
Most cases of overestimated liability are honest mistakes. Claimants overvalue assets, misunderstand policy limitations, or neglect to consider other insurance policies when calculating true loss. Insurance claims investigations clear up these simple matters, but also may reveal deliberate attempts to mislead the liability carrier. Careful and objective analysis is necessary to ensure the carrier can build a strong case against a claimant committing fraud.
If the case ends up in court, the carrier will need expert litigation support to strengthen the case. Insurance claims investigation and forensic accounting services carried out by disinterested third parties have more credibility than the same services performed by the carrier itself. Third party services often have more experience with these specialized areas and can perform the tasks more quickly, accurately and efficiently.
Liability carriers must have a program of insurance claims investigation and forensic accounting services to ensure that they are paying fair losses on their policies. This not only protects the carrier from unreasonable expenses, but also allows them to keep their clients' premiums down.
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