What should an adjuster do upon suspecting fraud in a claim?

When an adjuster suspects fraud in a claim, the appropriate course of action is to report the suspicion to the insurance company and follow established protocols. This is crucial for several reasons.

First, an insurance company usually has specific procedures in place to handle allegations of fraud, which may involve specialized personnel trained to investigate such matters. By reporting the suspicion, the adjuster ensures that the claim is handled in accordance with these protocols, which helps maintain the integrity of the investigation and protects the rights of all parties involved.

Additionally, by following the correct procedures, the adjuster safeguards themselves and the company. Independent investigations or discussing suspicions directly with the policyholder can lead to complications, including potential legal issues or breaches of professional conduct. Therefore, adhering to company policy is essential in addressing fraud allegations responsibly and effectively.