If an adjuster suspects fraud during an investigation, what should their immediate action be?

When an adjuster suspects fraud during an investigation, the appropriate immediate action is to report findings to the appropriate authorities. This step is crucial for several reasons. First and foremost, fraud undermines the integrity of insurance systems and leads to increased costs for all policyholders. By reporting suspicions, the adjuster plays a key role in preventing further fraud and protecting the insurance pool from losses.

Additionally, the adjuster’s role includes safeguarding the interests of both the insurer and the insured. By escalating these suspicions, necessary investigations can be initiated to confirm or refute the potential fraud, which helps to uphold ethical standards within the industry.

While it may be tempting to confront the claimant directly or to ignore suspicions for the sake of maintaining good customer relations, these actions can lead to more significant issues down the line, including potential legal repercussions for the adjuster or further financial loss for the insurer. Reporting to the relevant authorities ensures that proper protocols and investigations can take place to address the suspected fraud appropriately.