How an insurance claims investigation is scoped.

Start with the available account and records

Identify the element of the claim that is in doubt and the information already available to the instructing party. An inconsistency should be treated as a question to investigate, not an automatic finding of fraud.

Agree a focused requirement

The proposed work should relate to that question. Depending on suitability and available support, it may involve relevant background enquiries or observation. A defined scope helps avoid collecting unrelated information.

Interpret observations in context

A record of activity does not, by itself, establish a medical conclusion, someone's intention or the full circumstances of a claim. Findings and interpretation need to be kept distinct, and limitations should be clear.

Decide who will assess the findings

Explain whether the report is intended for a claims team, solicitor or another adviser. Their requirements should be considered before work begins. ASE's role is investigative support, not a guarantee of the eventual claims or legal decision.

Discuss timing rather than assuming it

The proposed timescale depends on the question, locations and available resources. Explain any important deadline during the initial conversation so feasibility can be assessed.

Bringing an enquiry to ASE

Provide a brief, general outline of the unresolved issue. Detailed claim documents and personal information should be exchanged only after the appropriate next steps have been agreed.

When insurers instruct investigators

How insurance companies investigate claims varies, but the work usually starts with the claim file, and much of it is desk-based. External investigators tend to be instructed only where a genuine doubt cannot be resolved from the file.

Whether a claimant's day-to-day activity is consistent with a limitation they have described is one example of a question the file may not answer.

The instruction should be narrow. A well-scoped claims investigation asks a defined question rather than opening a general enquiry into the claimant's life. That focus keeps the work proportionate and relevant to the decision.

What surveillance can and cannot establish

Surveillance records what a person does over a period of time, in places the public can see. Where a claim turns on a stated physical limitation, that record can help test whether the account is consistent with observed activity.

It cannot fairly be judged on a single moment. Someone having a better day, or managing a task once at obvious cost to themselves, does not show that a claim is false. That is why observation needs to cover a representative period rather than a snapshot.

It must also be lawful and proportionate: justified by a genuine question about the claim, limited to what is relevant and carried out in public places. Information gathered outside those limits can weaken the insurer's position rather than support it.

How do insurance companies investigate claims?

They start with the claim file. That usually means checking whether the account of events is consistent, whether the policy covers the loss, and what the supporting documents and claims history show. Where a specific question remains that the file cannot answer, they may instruct an external investigator to help establish the facts.

Do insurance companies use private investigators?

Yes, where a specific question cannot be resolved from the file. An investigator is instructed to help answer that question, such as whether observed activity is consistent with a stated limitation. The findings may support the claim or raise further questions, and the claims team or its advisers assess them in context.