What should an adjuster do if they suspect a claim to be fraudulent?

When an adjuster suspects that a claim may be fraudulent, the appropriate action is to conduct a comprehensive investigation. This step is critical because it ensures that the adjuster gathers all relevant information, assesses the validity of the claim, and determines whether the suspicion holds true.

A thorough investigation may involve reviewing medical records, obtaining witness statements, examining surveillance footage, or consulting other relevant evidence. This process not only protects the integrity of the workers' compensation system but also upholds the rights of the claimant, ensuring that legitimate claims are processed fairly.

Taking immediate action without proper investigation could lead to wrongful denial of benefits for a legitimate claimant or legal repercussions for the adjuster or the insurer if the claim is later proven to be valid. Therefore, conducting a comprehensive investigation allows for a fair and just resolution for all parties involved.