Key points of investigation in non-auto insurance loss adjustment cases

After I retired from a certain joint venture, I was hired by a certain adjustment company after being recommended. I have been involved in many property insurance and machine damage insurance scenes. He has led and guided many surveyors. Below are the key points of investigation of non-auto insurance loss adjustment cases that I bring to you. Welcome to read.

1. The importance of on-site investigation in handling cases:

On-site investigation is the first and most important step in handling cases. The first step that the public accounting company will do after receiving the entrustment is on-site inspection. In an insurance case, the core issues are two: insurance liability and the size of the loss. As long as the case handlers grasp these two points and work around these two points, they can find a breakthrough.

Only through careful investigation can we obtain first-hand information about the case: the crime scene contains the most authentic original information about the case. This information often contains the nature of the case, insurance liability and the size of the loss. Whether or not this important information can be fixed determines whether and how much compensation should be paid. In a sense, the on-site investigation determines the direction of the case. Therefore, investigators carefully investigate and capture key information, which is the basis of the case.

The original scenes of most cases are undisguised and therefore are real (except for intentional bail fraud). Therefore, careful and in-depth on-site investigation is of vital significance to future work. Once the scene is lost, the case may become unsolved, causing major trouble to the client and even triggering litigation. It also has a negative impact on the credibility of the accounting company.

The ultimate goal of on-site inspection: A high-quality investigator, after conducting on-site inspection of a case, can finally draw the following conclusions: whether the subject property is the insured property; whether the subject property is within the insurance period ;The cause of the loss is not covered by insurance liability.

Only the size of the loss is difficult to determine on site. In other words, after investigation of the case, most of the conclusions have actually been drawn. What is missing is just an adjustment of the loss and the writing of an adjustment report.

2. Preparation before entering the site:

The importance and purpose of the survey have been clarified, and all preparations before entering the site are carried out around the above purposes.

Mental preparation: The fixed thinking of the mind is generated when accepting the commission. For example: If a client of our economic company (a certain factory, a certain company, etc.) is in danger, the survey personnel may be more relaxed. If it is a small company in a county town, we may have the idea of ????defrauding insurance or exaggerating losses, and we will find faults, find evidence, and do everything possible to reduce losses. These ideas are contrary to the fair, fair, objective and true work philosophy of the public adjuster. Therefore, before the survey, our surveyors should not have any subjective concepts and should not have any preconceived personal prejudices before the survey.

Before entering the site, it is best for the survey personnel to seize the time to familiarize themselves with the policy and the content of the entrustment, try to make an impression in their minds on the types of insurance, validity period, and the list of insured properties, and try to avoid checking the policy repeatedly at the survey site. Give the other person the impression that your work is unprofessional.

Various documents: Depending on the type of insurance, the contents of the documents required to be filled out and provided by the insured are also different. The surveyor must be familiar with the various evidentiary materials necessary for different types of insurance. These original evidences must be carefully examined, and the seals, signatures, fingerprints, etc. must not be ignored. Because we can only access some on-site evidence once, our omissions may have irreparable consequences.

Material preparation: The survey package should be checked frequently to prevent low-level errors such as the camera being out of battery and incomplete forms when setting off. Be sure to bring all the various forms that will be used during the inspection, including the list of evidence provided by the insurance company, white paper, pencils, and measuring tapes.

3. Taking photos and drawings:

Surveyors should be familiar with their own cameras, understand the functions of different camera settings, and practice taking clearer photos in low light conditions. Technology, the technique of photographing close objects. You can't just shoot in "auto" mode.

Photos that must be taken during the survey: the brand of the insured's company, footage of the surveyor working on site, a panoramic view of the damaged object, the model of the equipment, the nameplate of the equipment, and replaced parts or components , damaged buildings, indoor conditions, etc. You don’t have to worry about too many photos, so you can use different parameters to shoot the same scene and pick out better photos.

When the loss site is relatively large or the house is damaged, it is necessary for the surveyor to draw a floor plan on site to explain the accident situation. When drawing, pay attention to the size of the graphics to match the proportions as much as possible to avoid causing difficulties in subsequent work. The floor plan drawn must have the signature, fingerprint or official seal of the insured.

4. Things to note when communicating with the person involved in the accident:

After an accident, the parties involved are generally nervous, especially the workers who were on site at the time of the accident. They are direct witnesses and may also be direct operators. Their testimony plays a decisive role in the case. During the inquiry, they are very afraid of saying the wrong thing and causing trouble to the insured. Therefore, you must pay attention to the following points when making inquiries:

More than one person must be present, and other persons of the insured are also allowed to be present.

The attitude should be kind, the tone should be relaxed, and the questions should be concise and accurate. Put the person being questioned on an equal footing. You must declare to the person being questioned in advance that you must seek truth from facts when answering questions, and you will be legally responsible for perjury. Try not to interrupt the other person when answering. Only when the person being asked feels relaxed can the answer be accurate and provide more clues. Other persons of the insured should be allowed to interrupt, but no one should be allowed to induce or threaten the person being questioned. Avoid condescending questions: tell me your identity, name, age, and ID number. Ask questions like this if possible: What is your surname, what is your main job here, and what do you personally think is the cause of this accident.

When explaining the evidence that needs to be provided to the insured, be patient and meticulous. Ask the other party if each item is clear. If the other party does not understand, you must explain it until he understands it.

In addition to general questions such as name, identity, time, location, etc., for specific accidents, you should also ask about the process and circumstances when the accident occurred. As for the cause of the accident and the size of the loss, you should ask the parties’ authoritative experts. Unless there are particularly clear circumstances, other people’s analysis usually does not have high evidential validity.

Pay attention to the contradictions and logical errors that appear when the person being questioned, especially the leader or technical staff of the insured, answers questions. This is often where the breakthrough point in the case lies. Questions should be as accurate and clear as possible. Avoid asking the same question repeatedly, which will arouse the other party's vigilance and have the opposite effect.

Account auditing is a very important part of on-site inspection and must be particularly detailed and cautious. Generally, a legally operating company should have complete accounts and various subpoenas. The main purpose of auditing is to verify whether the damaged property is genuine, whether its value is real, whether it is fully insured, etc. At the first scene, the insured generally does not have time to make false claims. If you are unable to copy the accounts, you must first use a camera to fix the evidence. If the insured cannot provide accounts, or gives excuses such as the accountant's absence, a record must be made and signed and fingerprinted by the parties involved. Inform the parties that the effectiveness of evidence provided after the fact will be greatly reduced. The possibility of a second audit cannot be ruled out.

For inventory, the insured must provide the flow of purchases and shipments. Warehouse entry and exit documents. For a formal company, this is very normal. If it cannot be provided, it must also be recorded in the transcript.

According to the "evidence list", all evidence provided by the insured shall be stamped with the corresponding seal and sealed by the investigator. The insured shall be issued a receipt procedure to prove that he has provided those evidences. Avoid conflicts in the future.

Rescue costs must be strictly controlled. Reasonable rescue fees are insurance liabilities and should be paid. The rescue process must be clearly recorded in the transcript, the rescue items used must be photographed, and items that can be counted (such as fire extinguishers, etc.) must be counted.

5. Prepare an investigation report:

After the investigator brings back all the evidence collected at the scene, he should immediately prepare an "investigation report".

Strictly speaking, the survey report should be handwritten and signed below. The content of the survey report is the translation of the assessment report. The "Description of the property involved in the case" column should indicate whether the property involved in the case is insured property; the "accident course and cause" and "preliminary insurance liability determination" two simplified columns, if not sure, should be discussed and decided within the company.

The above mentioned various requirements for on-site investigation. In a case, after the surveyor's investigation, the following conclusions should be drawn:

What is the damaged property, whether it is insured property, and whether it is within the insurance period.

What is the value of the damaged property, its book value, its useful life, and whether the insured is fully insured.

What is the proximate cause of the accident? Is the process of the accident gradual or sudden? Set the terms and conditions, whether it is insurance liability or not (if you are not sure, you have to have your own opinion).

Whether the photos taken can accurately describe the accident scene. ;