What to know when an insurance company examines a claim by way of an investigation, and how to protect accuracy and privacy.
Why an examination is carried out
An insurer is entitled to examine a claim by lawful means and in accordance with the rules. The purpose of the examination may be to compare actual function with the information provided.
The important rule: truth and consistency
Do not change a routine, conceal an ability or manufacture a limitation. Equally, do not let an exceptional moment replace the description of an ongoing need for help. Accurate documentation prepared in advance reduces discrepancies.
When a stranger makes contact
Do not hand over documents, medical information, a code or a signature before verifying identity and purpose. You can ask for details in writing and approach the insurance company through its official channel.
- Do not give out passwords
- Do not sign under pressure
- Do not give out information about family members
- Record the date of the approach
If an investigation is mentioned in a refusal
Ask to understand which findings the decision relied on and compare them against function over time. A claim of breach of privacy or a legal dispute requires individual legal advice.
Frequently asked questions
Is an insurance company allowed to send a private investigator in a long-term care claim?
An insurer is entitled to examine a claim by lawful means and in accordance with the rules. The purpose of the examination may be to compare actual function with the information provided in the claim.
What do we do when a stranger arrives asking for information?
Do not hand over documents, medical information, a code or a signature before verifying identity and purpose. You can ask for details in writing and approach the insurance company through its official channel.
Should we change our routine because of a concern about an investigation?
No. The only rule that protects a claim is truth and consistency — do not conceal an ability and do not present a limitation that does not exist. Accurate documentation prepared in advance reduces discrepancies.
What do we do if an investigation was used as the basis for a refusal?
Ask to understand which findings the decision relied on and compare them against function over time rather than a single moment. A claim of breach of privacy requires individual legal advice.
Official sources for further checking
This is general information and does not replace personal medical, legal or insurance advice. Eligibility is determined by the documents and rules that apply to each case.
