How should an adjuster handle a claim involving potential fraud?

In situations involving potential fraud, it is crucial for an adjuster to report any suspicions to the insurance company. This approach ensures that the insurer has the opportunity to investigate the claim further, given that they have the resources and authority to conduct a thorough review and potentially involve law enforcement if needed. The insurer's claims department, often in conjunction with special investigations units, is trained to handle claims that may involve fraudulent activity, enabling them to take appropriate actions based on findings.

Handling the situation independently could lead to mishandling the claim or overlooking critical evidence, while dismissing the claim outright would be inappropriate without a comprehensive investigation. Consulting peers could provide insights, but it does not replace the responsibility of reporting to the insurance company. By reporting suspicions, the adjuster is acting within the professional and ethical guidelines meant to protect the integrity of the claims process.