What is the first action an adjuster should take when handling a suspected fraud claim?

What is the first action an adjuster should take when handling a suspected fraud claim?

• A. Notify the policyholder of the suspicion
• B. Conduct an on-site inspection
• C. Send the claim to the special investigation unit
• D. Estimate repair costs

Answer: (C)

In handling a suspected fraud claim, the first action an adjuster should take is to send the claim to the special investigation unit (SIU). This is crucial because the SIU is specifically trained and equipped to handle potential fraud cases. They have the expertise and resources necessary to thoroughly investigate the claims, gather evidence, and determine the validity of the suspicion. Involving the SIU early in the process helps ensure that the investigation is conducted properly and follows appropriate protocols. This can prevent potential pitfalls that an adjuster may encounter if they try to address the suspicion on their own. Additionally, if the adjuster were to notify the policyholder of their suspicions or conduct an on-site inspection without the specialized training, it could potentially compromise the investigation or escalate the situation unnecessarily. Engaging the SIU allows for a more structured and legally sound approach to the suspected fraud.

In handling a suspected fraud claim, the first action an adjuster should take is to send the claim to the special investigation unit (SIU). This is crucial because the SIU is specifically trained and equipped to handle potential fraud cases. They have the expertise and resources necessary to thoroughly investigate the claims, gather evidence, and determine the validity of the suspicion.

Involving the SIU early in the process helps ensure that the investigation is conducted properly and follows appropriate protocols. This can prevent potential pitfalls that an adjuster may encounter if they try to address the suspicion on their own. Additionally, if the adjuster were to notify the policyholder of their suspicions or conduct an on-site inspection without the specialized training, it could potentially compromise the investigation or escalate the situation unnecessarily. Engaging the SIU allows for a more structured and legally sound approach to the suspected fraud.