Page 270 - IC38 GENERAL INSURANCE

 Close proximity claims (claim within a short time of start of insurance)
 High weekly benefit amount with longer period of disability
 Discrepancy in the claim documents
 Multiple claims by same insured
 Indication of alcohol
 Suspected suicide
 Late night Road Traffic Accident while vehicle was being driven by

insured
 Snake bite
 Drowning
 Fall from height
 Suspected sickness related cases
 Poisoning
 Murder
 Bullet injury
 Frost bite disappearance
 Homicide etc.

The main objectives of investigation are:

a) Examine the cause of loss.

b) Ascertain the extent and nature of loss.

c) Collection of evidence and information.

d) To ascertain if there is element of fraud or exaggeration of claim
amount.

Please note: the objective of investigation is to verify the facts of the case and
gather necessary evidence.

It is important that Claims examiner guides the investigator as to the focus of
investigation.

Example

Example of case guideline:

Road traffic accident

i. When did the incident take place – exact time and date place? Date and
time

ii. Was the insured a pedestrian, traveling as passenger/pillion rider or
driving the vehicle involved in accident?

iii. Description on the accident, how did it take place?

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