When a personal injury claim is submitted, a number of factors are looked at to ensure that the individual is legitimately injured and eligible for a payout. In order to verify that no fraud is committed, there are a number of tools that the insurance company may use to investigate the claim.
Documentation & Medical Assessment
A medical assessment will likely be conducted to prove the extent of an injury. The claimant will be asked to provide regular updates regarding their treatment and any assistance required as a result of the injury. A part of this process may also involve updates on employment and how it is affected due to current physical condition. The types of documents that may be submitted to prove a claim include:
- Medical and hospital records
- Employer information
- Medicare and Centrelink records
- Tax information
- Pay slips and bank statements
- Expert medical reports
- Workers’ compensation claims history
- Relevant injury claim files
- Medication & travel expenses
Some insurers will go even further when investigating a claim, especially in cases where they want to devalue the potential payout. Surveillance may be used to prove that the claimant is not being honest or that their allegations are not accurate.
Social media offers another type of surveillance that people often do not think about. This is a newer development in the court system, so case law related to it is limited.
Cross-Examination in Court
The injured person or claimant will have to give evidence if the claim cannot be settled and has to go to Court. These days cases rarely go to Court, as most cases will settle. The claimant will be cross-examined in Court, meaning that the lawyer for the insurer will get to ask the claimant questions. This is done to ask questions that either prove honesty or reveal inconsistencies in their story.
Insurance Claim Settlement
Your lawyer will put together a quantum, or financial assessment, of your injury claim and present it to you. This can be submitted to the insurer to begin settlement negotiations. This process may involve a conference or phone call to discuss details. If an agreement cannot be reached, then the court proceedings will begin. The best way to navigate the legal process and get a claim paid is with the help of a legal professional. Contact us today to discuss your personal injury claim.
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