Claims investigation might seem like a tedious, bureaucratic process. Many assume it’s slow, confusing, and impersonal. But Michael Cokins, an experienced insurance claims investigator in Houston, Texas, believes otherwise. He views the process as an opportunity for clarity, fairness, and support. In fact, he argues that while the process can be intricate, it’s designed to help people — not hinder them.
The Key Stages of a Typical Claims Investigation
1. Claim Filing
The process begins the moment a claim is filed. At this stage, claimants share detailed information about the incident, often providing supporting documents like photos, police reports, and medical bills. This can be a vulnerable moment for many, as they recount difficult events. However, transparency at this point is critical, as emphasized by Cokins.
“The more clear and honest you are about what happened, the smoother the process will be,” he says. “We’re not here to judge but to understand the facts and make sure you get what you’re entitled to.”
Claims submitted online or over the phone are usually followed up by an adjuster, who may ask additional questions to clarify the details. Cokins highlights the importance of an open dialogue during this phase, encouraging claimants to ask their own questions as well. “It’s important to have an open dialogue with your adjuster. They’re there to help, not to create roadblocks,” he advises.
2. Investigation and Evidence Collection
After a claim is filed, investigators get to work. This stage involves collecting evidence, interviewing witnesses, and sometimes inspecting the scene or damage. The complexity of the claim determines the extent of this phase, which can range from verifying basic documents to conducting an in-depth analysis of events.
“Investigation is about painting the full picture,” Cokins explains. “We don’t just accept what’s on paper. We want to understand the context. Who, what, when, where, and why — all those details matter.”
For example, in a car accident claim, investigators might examine the vehicle’s damage, review footage from nearby traffic cameras, and gather witness testimonies. The ultimate goal is not just to confirm the facts but to construct a clear and accurate narrative of the incident.
3. Analysis
Once all the facts have been gathered, the analysis phase begins. This is where investigators assess whether the claim falls within the scope of the policy and whether all the details align with the terms and conditions of coverage. Decisions made during this stage often determine whether the claim will be approved or denied.
“Many think this is the stage where we decide who’s guilty. But it’s not about guilt. It’s about ensuring fairness, understanding, and making sure everything aligns with the coverage and the circumstances,” Cokins explains.
While straightforward claims might be resolved in just a few days, more complex cases can take weeks to analyze. Timelines depend on the specifics of the claim and the extent of evidence required. Cokins acknowledges that while delays can be frustrating, thoroughness at this stage is crucial to ensure an accurate outcome.
4. Resolution and Payment
Decisions are made in the final phase, and the claim is either approved or denied. Payment is issued for claims that are approved, and the case is closed. For those that are denied, claimants are given reasons for the decision, along with an opportunity to appeal or provide further documentation.
Cokins stresses that resolution isn’t just about closing a file—it’s about ensuring satisfaction for both the claimant and the insurer. “Claims aren’t just about closing the case. They’re about ensuring everyone walks away with the right understanding,” he says. “The goal is not just to pay, but to pay fairly.”
Clear communication during this stage is vital. Explaining the reasoning behind a decision can often reduce frustration and help claimants feel heard, even if their claim is denied. “Explaining the ‘why’ behind a decision can go a long way in avoiding frustration,” Cokins emphasizes.
Ultimately, the claims process is about more than just resolving incidents. It’s about building trust, ensuring fairness, and creating clarity for all parties involved.
What Claimants Can Expect at Each Stage
Each stage can be daunting. But Cokins encourages claimants to stay informed and engaged. He recommends they take proactive steps, such as keeping thorough records, communicating openly, and asking for updates.
- At the Filing Stage: Claimants should expect an initial response within 24-48 hours. Cokins suggests, “Have all your documents in order from the start. It’s like building the foundation of a house — if it’s solid, the rest goes smoothly.”
- During Investigation: Expect an adjuster to contact you within a few days. The process can take time, but keep in mind that it’s about collecting the right information. Cokins says, “Don’t expect a quick turnaround. It’s important to be patient and allow us to do our job thoroughly.”
- Analysis and Resolution: Once the investigation is complete, claimants can typically expect to hear back within a few weeks. If complications arise, this might take longer. Cokins adds, “Every case is unique. It’s not about speed — it’s about getting it right.”
How Long Does the Investigation Process Take?
There’s no one-size-fits-all answer to how long a claim investigation takes. Simple claims might be wrapped up in a week, while more complex ones can take months. On average, Cokins estimates that most claims are resolved in 30-45 days.
However, complexity factors into the timeline. “Some claims are straightforward, like a basic auto accident. Others, such as property damage with multiple parties or medical claims, can take longer,” he explains.
The investigation may take longer if there’s an issue with the documentation or if the incident is more complicated. Cokins advises that claimants should be prepared for delays but shouldn’t hesitate to ask for regular updates.
“Sometimes delays are unavoidable, but that doesn’t mean you’re forgotten. Regular updates help keep the process transparent and reduce anxiety,” Cokins shares.
Conclusion
Michael Cokins’ approach to claims investigation is refreshingly practical and empathetic. He views the process as one grounded in fairness and clarity rather than being mired in complexity or pitfalls. “Investigating a claim is not just about facts—it’s about the story behind those facts,” Cokins explains. “We’re here to ensure everything lines up and that no one is left in the dark.”
Understanding the process is crucial for claimants to navigate the intricacies of insurance claims. A clear, patient, and proactive approach can help avoid unnecessary delays and reduce frustration. Ultimately, the investigation process is not meant to create barriers but to ensure fair and equitable resolutions.
The research underscores this perspective. On average, simple claims are resolved within 30 to 45 days. According to a 2023 industry survey, about 60% are finalized without the need for extensive investigation. Furthermore, 80% of claimants who remain engaged throughout the process report higher satisfaction with the outcome.
By fostering open communication and being well-prepared, claimants can work through the process more effectively, leading to smoother experiences and positive resolutions.