Overview
Effective claim investigation is fundamental to fair, accurate and professional insurance claims handling. This course provides insurance professionals with the knowledge and practical techniques required to investigate property and casualty claims, establish relevant facts, verify insurance coverage and gather reliable evidence to support informed claims decisions.
The programme examines the key stages of claim investigation, including reviewing policy provisions, obtaining information from insureds, claimants and witnesses, evaluating documentary and physical evidence, and identifying inconsistencies that require further investigation. It also explores the investigation of liability claims, including the legal principles relevant to determining responsibility for a loss.
Through practical examples and claims scenarios, learners develop a structured approach to conducting investigations with professionalism, efficiency and due regard for the rights and interests of the parties involved.
Learning Outcomes
Upon successful completion of this course, you will be able to:
- Explain the principles and stages of claim investigation, including the relationship between investigation, evaluation and settlement in the insurance claims process.
- Verify insurance coverage and policy obligations by examining policy terms, conditions, exclusions, limits and other provisions relevant to determining whether a reported loss is covered.
- Apply effective information-gathering techniques when interviewing insureds, claimants and witnesses, obtaining statements and reviewing relevant claims documentation.
- Identify, preserve and evaluate claims evidence, including documentary, physical, direct and circumstantial evidence, while recognising the principles governing its admissibility and reliability.
- Assess legal liability in insurance claims by applying relevant principles of negligence, legal responsibility and available defences to determine potential liability for a loss.
- Apply structured investigation procedures to different types of claims, including motor liability, premises-related accidents, workers’ compensation and fire losses, to support accurate and well-documented claims decisions.
