INVESTIGATION OF
INSURANCE DEATH CLAIMS
By Ralph Thomas
 
The investigation of a death by a private investigator is thought of as a romantic type of case by both the general public and the inexperienced private investigator. Those who have not worked on a great deal of death investigations misconceive this specialization as almost always involving a murder case. Although private investigators do obtain assignments concerning a murder investigation, the great majority of death investigations come from insurance companies and involve death claims in which murder is not present. It is a rare case that involves a murder and even when this is the case, the private investigator is almost never called upon to determine "WHO DONE IT."
 
 
There are some very appealing things about the typical death claim investigation the private investigator is likely to be assigned to. A great deal of insurance polices require a lump sum payment of tens of thousands of dollars. For example, it would not be all that uncommon for a skilled death claims investigator to obtain an assignment that involved a claim of $250,000 in death benefits.
 
Instead of investigating who did what in a homicide case, the investigator will more likely be concerned with the development of facts that have to do with whether or not the insurance company will pay the claim . A great deal of such assignments are routine checks.
 
 
CONTESTABILITY: From the point of view of the investigation, contestability has to do with a time frame. Most policies state that a claim of death is contestable from two to five years after the policy is written and in force. What this means is that statements made by the insured to the insurance company in obtaining the policy can be contested. Naturally, this leads to the original application of the insured. The application can be investigated for mistatements if the claim is contestable. Generally, misstatement of age or sex is contestable at any time. Other statements made by the insured concerning his representations to obtain the insurance can only be contested for two years unless otherwise stated in the policy. So we already see that age and sex can be investigated for misstatement regardless of when the policy went into effect. We will see later that this is a major thing that is verified in the routine death claim.
 
 
Suicide now ranks in the top five causes of death in the United States. In the majority of life insurance policies, if suicide is commited within a two year period of the date of issue, then the insurance company is only liable for the amount of total premiums paid into the insurance.
 
 
Over the years, insurance companies have standardized the kinds and types of death claims investigations and tend to order such investigations only in a progressive manner. The first type of case is generally called a DEATH CONFIRMATION. This will involve only noncontestable cases centering around three basic areas as described below.
 
 
The majority of noncontestable death claim investigations will center around three areas of investigation. The confirmation of death investigation will be the type of investigation most often completed by the investigator. In order to work in this field, the investigator will be required to complete these types of assignments to get the more interesting cases. The three areas of investigation for this standard type of death claim investigation are:
 
 
1) AGE OF THE CLAIMANT
2) PROPER IDENTIFICATION OF THE CLAIMANT
3) CAUSE OF DEATH
 
 
AGE OF THE CLAIMANT: As stated, the age of the claimant will void out any benefits if it has been misstated. Misstatement of sex works in the same manner. The age and sex of the claimant can be verified through various public records documents such as birth certificate, auto registration, etc. Further sources would include information from the claimant's family and neighbors. Some of the various documents that would contain the subject's age (or date of birth) and sex are:
 
1) DRIVER LICENSE RECORDS
2) AUTO TAG REGISTRATION
3) EMPLOYMENT RECORDS
4) BIRTH RECORD
 
 
 
Keep in mind that the basic job of the investigator is to verify the information. When questions as to age or sex arise, further investigation might be needed and authorized by the insurance company.
 
 
Aside from documented verification, age and sex can also be verified through neighborhood sources as well as friends and relatives. Several sources of information could be found both in public records and through people sources.
 
 
IDENTIFICATION OF THE CLAIMANT: Due to the possibility of insurance fraud, proper identification of the decendant should be made. Once again, this is confirmed through interviews with family members and neighborhood sources and also supported with public documents. Of course,
all information obtained should match what shows on the death certificate. Various elements can be used to confirm the I.D. of the subject which could include matching social security numbers, checking criss-cross directories and comparing physical descriptions from various public document sources.
 
 
When the I.D. of the decendant becomes questionable, there are several investigative techniques that can be used to prove or disprove such a claim. This would require further investigation. The most common are:
 
 
1) FINGERPRINTS
2) SKELETAL EXAMINATION
3) VISUAL INSPECTION
4) INSPECTION OF PERSONAL EFFECTS
5) INSPECTION OF TATTOOS AND SCARS
6) DENTAL RECORDS
7) INSPECTION OF DECENDANT'S CLOTHING
8) PHOTOGRAPHS
 
 
FINGERPRINTS: Fingerprints are the fastest and easist way of ascertaining an indentification. However, this would require a match of the subject's fingerprints with fingerprint records already on file. Sometimes such records do not exist or cannot be obtained. Moreover, there are times in a death claim investigation that fingerprints from the remains of the subject are not obtainable.
 
 
SKELETAL EXAMINATION: The majority of persons have a very individual skeletal system that can be used as a means of identification because of past bone fractures. Various bones can also be used to develop information concerning age, sex and race.
 
 
VISUAL INSPECTION: This has to do with friends, neighbors, and/or relatives making an identification of the subject. It should be pointed out, however, that the beneficiary should NOT be used as the sole person to make a positive I.D. based on visual inspection for obvious reasons. There are times in which the body is so decomposed or mutilated that such a technique could not be used. Further, such inspections might have already taken place prior to assignment. In this case, an interview with those who made the inspection could be used.
 
PERSONAL EFFECTS: Although this technique can be unreliable because of the mobility of so called personal effects. However, they can be used as supportive evidence concerning the I.D. of the subject.
 
 
BODY MARKINGS: Things like moles, scars and tattoos can be very helpful as supportive evidence in the establishment of a positive identification.
 
 
DENTAL RECORDS: Sometimes the teeth are the only remaining indentifiable item left of the corpse that can be used. Moreover, dental records can be used as legal evidence of the subject. Some of the problems in such cases is obtaining the dental records of the decedant unless the investigator is able to uncover the subject's dentist.
 
 
 
CLOTHING OF SUBJECT: Not only can clothing be used as identification by friends and relatives, details of the subject's clothing such as laundry markings and size of clothing can be helpful to support the I.D.
 
 
PHOTOGRAPHS: Photographs make an excellent means of matched identification and are almost always obtainable from relatives. Moreover, photographs can be preserved as evidence.
 
 
CAUSE OF DEATH
 
Details concerning the cause of death are important. Causes of death such as acts of war are almost always excluded in the standard insurance policy. The investigator should always be on the lookout for possible suicide. When the decedant's death resulted from actions taken by him involving a crime, life insurance coverage would not apply. Accidential deaths for most policies in the United States will pay double the face amount in the event of accidential death.
 
In the investigation, the investigator should center the investigation around the following:
 
 
1) WAS THE DEATH CAUSED BY AN ACT OF WAR.
2) DID THE DEATH CENTER AROUND ANY VIOLATION OF THE LAW.
3) WAS THE DEATH A POSSIBLE SUICIDE.
4) WAS THE DEATH THE RESULT OF AN ACCIDENT.
 
 
It is also common for American insurance companies to rider such things as deaths caused by air travel other than on a commerical airline and certain sports activities such as scuba diving.
 
 
When the confirmation investigation reveals questions that need to be investigated, the insurance company will likely order further investigation on an hourly rate. Authorization is usually given for further investigation in dollar amounts. They generally order investigations in increments of $500.00, $1,000 and $2,000.
 
SUICIDE
 
We have already mentioned that suicide ranks in the top ten causes of death in the United States. There are four basic factors to investigate concerning a suicide.
 
1) WAS A SUICIDE NOTE LEFT.
2) DID CLAIMANT TELL ANYONE HE WAS GOING TO KILL HIMSELF.
3) INVESTIGATE ALL LIFE INSURANCE COVERAGE.
4) INVESTIGATE MOTIVES FOR SUICIDE.
 
 
INVESTIGATION OF MOTIVES: In looking for motives to suicide, it is important to keep the investigation targeted around three areas:
 
 
1) FINANCES
2) DOMESTIC/ HOME LIFE
3) HEALTH
 
 
FINANCES: A complete financial investigation should develop types and sources of income as well as any loses due to investments, business failures, loss of job etc. A complete court house records check should be made to determine any mortgages, tax liens, suits and/or judgments. Credit rating should also be developed and all financial sources should be checked.
 
 
DOMESTIC LIFE: Marriage problems are a leading factor in suicide and should be investigated in every detail. Was the claimant's home life stable? If not why?
 
 
 
HEALTH: Any recent health problems? Had claimant recently been told of a serious illness or disease? Special attention should be given to any mental illness such as major depression as such illnesses have a very high rate of suicide.
 
 
SOURCES OF INFORMATION
 
In a death claims investigation, the investigator needs to understand that certain things have almost always already been investigated. Chances are likely that an investigation has been conducted by a law enforcement body and the medical examiner's office. It is sometimes the investigator's job to obtain copies of these investigations for the insurance company. Generally, the insurance company is not interested in paying an investigator to obtain a death certificate as this can be done by the insurance company by mail.
 
 
There are a number of standardized sources the investigator should use:
 
INTERVIEWING BENEFICIARY: This is likely to be a close family member. Care should be taken in such interviews because the source is likely to be in grief. Much information can be obtained from this source. However, it should be verified elsewhere. One thing the investigator is often asked to do while interviewing this source is to obtain a medical authorization to obtain both medical and police records. It should be pointed out that if the beneficiary has retained an attorney, no direct contact with this source should be made as the law requires all communication to go through the lawyer.
 
 
NEIGHBORHOOD SOURCES: Neighborhood sources are in a position to give the investigator information concerning the I.D. of the decedent, maybe verify his age and sex and might know a little about the death. However, in today's mobile society, neighborhood sources seem to know less and less about the people who live around them.
 
 
MEDICAL SOURCES: These sources become the most important sources when it comes to obtaining information on the three elements of the basic investigation ( age-I.D.-cause of death). Moreover, in a contestable case, medical sources will have very detailed information regarding the subject's medical history. Medical sources could consist of both physician's and hospital records, drug store records and the coroner's of medical examiner's office.
 
OTHER SOURCES OF INFORMATION: Various sources of information are often needed in the death claim investigation just like any other kind if investigation. Background investigations on contestable cases will take the investigator into court house records checks and credit records checks. Police reports and signed statements from witnesses to the death are also often needed. Newspaper accounts of the subject's death can also help the investigator develop needed facts. Other insurance companies might already have done various kinds of investigations concerning the death.
 

 

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