How Questionable Claims Are Investigated
Questionable claims rarely announce themselves outright. More often, they whisper.
A loss reported immediately after a policy change. An injury claim that surfaces late. Documentation that feels almost right—but the timeline doesn’t align. Medical treatment or costs that escalate faster than recovery or repairs reasonably allow.
These are the kinds of red flags that warrant a closer look.
At Roman & Associates, investigations are conducted using clear, defensible methods designed to produce answers that hold up—not just for adjusters, but for counsel and the courts.
Step One: Trust the Evidence, Not the Story
Every investigation begins with a comprehensive review of the case file. All documentation is examined closely to identify inconsistencies such as mismatched dates, conflicting statements, recycled or AI-generated images, or policy changes occurring shortly before the reported loss.
This initial review sets the tone for the investigation. It allows investigators to verify sources and validate facts.
Building the Baseline
In injury investigations, background analysis provides the framework that gives meaning to newly uncovered evidence. Investigators establish a baseline of what is “normal” for the claimant or plaintiff.
This includes reviewing:
· Recent and prior addresses
· Prior losses or claims history
· Criminal records, where applicable
· Business affiliations and asset timelines
· Medical and treatment history
· Seasonal and lifestyle activity patterns
Understanding these elements helps identify inconsistencies and behavioral patterns that either support or undermine the claim.
Statements, Documentation, and Verification
When statements are required, the investigation expands. Signed statements are obtained from reliable sources, duplicate image searches are conducted to confirm authenticity, and all relevant documentation is retrieved and reviewed.
This process allows investigators to either verify the reported incident—or establish that the evidence contradicts it.
Site Investigations: What the Scene Reveals
When necessary, a site investigation may also be conducted to determine what actually occurred at the loss location. Conditions on site often answer questions that documentation alone cannot.
· Was there a broken step or hazardous defect?
· Were icy or weather-related conditions present?
· Or was the area well maintained and in proper condition?
These facts can significantly influence how a claim moves forward.
During a site investigation, investigators may collect photographic documentation, take measurements, and capture video footage to preserve the condition of the scene. This evidence helps establish—or challenge—causation and provides objective support for coverage and liability decisions.
Surveillance with Purpose
When surveillance is warranted, investigators focus on confirming or refuting specific claim points, such as physical capabilities, activity levels, and locations visited.
Before surveillance begins, a pre-surveillance plan is developed that reviews:
· Case objectives
· Legal considerations
· Optimal timing and locations
The result is time-stamped, recorded observations that directly relate to the claim at issue.
Expert Analysis When It Matters
Some cases require specialized expertise. Fire examiners, linguists, medical experts, professional engineers, or digital forensic accountants may be brought in to address complex or disputed issues.
Experts are used when there are conflicting medical narratives, causation disputes, cause-and-origin questions, or language and translation concerns. Their findings either dispute the claim or corroborate it with objective clarity.
Reporting and Resolution
Once the investigation is complete, findings are organized to directly answer the questions raised. Reports clearly map out verified facts, documented evidence, and observed patterns. All materials are labeled and accompanied by a straightforward chain of custody.
Where appropriate, recommendations for next investigative steps are provided.
Speed, Reach, and Purpose
Same-day and rush investigations can be accommodated. Investigations are conducted nationwide—including Puerto Rico. We also have an international reach. Attorney-trained investigators and expert partners are available and are prepared to testify when needed.
The purpose of an investigation is simple: to accelerate claims that can be substantiated—and isolate the few that are questionable.
Contact Roman & Associates — 24/7/365 Claims Intake • Rush Cases • Attorney-Ready Reports
info@romansearch.com www.romansearch.com 1-800-422-9032