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Our client’s insureds are the claimants in this field. Accordingly, it is critical that each insured claiming benefits is attended upon as to the circumstances giving rise to the claim lodged. As such, the methodology adopted may include:
- An informal visit by one of our investigators to obtain information from the insured as to the circumstances giving rise to the claim;
- Obtaining information from the insured as to their medical treatment, progress, current capabilities and future expectations;
- Employment conditions;
- Establishing the insureds future intentions to returning to work;
- Personal or employment conditions that may effect the insureds future intentions;
- Medical or financial documentation to assist our clients assessment of the claim;
- Additionally a formal interview with the insured may be more appropriate where our client requires detailed information as to the claim lodged and the circumstances.
Due to the relationship between our client and the insured, investigations of this class are premised on the client’s requirements as to the methodology to be adopted in all cases.
TPD claims arise as a consequence of serious injury or illness to an insured party, as such; our client and the insured have an existing relationship that requires our investigation to respect whilst obtaining the necessary information for our client to assess a claim for benefits.
In undertaking investigations in this field, the investigation is governed by the client’s specific requirements as to whether a formal or informal approach is adopted when attending on the insured party.
Our investigators attend to TPD investigations to obtain information and documentation pertaining to the policy requirements, terms, conditions and exclusionary clauses. The ambit of investigations of these types includes:
- Informal or formal interview of the insured
- Obtain medical and financial information
- Background of the circumstances giving rise to the claim
- Personal background information
- Employment information
- Medical history as to treatment and condition
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