Working with insurance adjusters and SIU

Insurance work, including workers’ compensation, liability and disability claims, is steady, volume-driven business for many investigators. It’s also demanding. Adjusters and special investigations unit (SIU) staff manage large caseloads, work to budgets and internal guidelines, and compare vendors against each other constantly.

Pursuit Magazine’s “Out in the Cold” is a frank account of the downside: high-quality work doesn’t guarantee more referrals, vendor relationships can end without explanation, and protocol details can matter as much as results. This guide covers the habits that make you the investigator an adjuster keeps assigning to.

Understand what the adjuster needs

An adjuster isn’t asking “what’s the truth about this person’s life?” They’re asking a narrower question tied to a claim: is the claimant’s activity consistent with the reported injury or restrictions? Is the claimant working elsewhere? Is the loss what it’s described as?

Before you start, get clear answers to:

• The question: what exactly the adjuster wants to know.
• The claimant’s restrictions, if relevant, so you know what activity matters. You don’t need the medical file; you need to know what to look for.
• Authorized hours and days: how many, over what period, and whether that includes travel and report time.
• Deadlines: a hearing date, a medical exam, a review date. Surveillance timed around a scheduled appointment is often the most useful.
• Their protocols: report format, update rhythm, how they want video delivered, and what they require before you exceed hours.
• Who else gets the report: defense counsel, a case manager, a claims committee.

Put these in the assignment record. Many carriers issue their own referral forms and vendor guidelines; read them fully, because they’re what you’ll be measured against.

Respect the authorized hours

Budget discipline is one of the main ways adjusters judge vendors. Treat authorized hours as a ceiling, not a target.

• Track time live, against the authorization, including travel if it counts.
• Report hours used in every update: “Day 2: 7.5 hours; 15 of 24 authorized hours used.”
• Ask before exceeding, in writing, with a reason: “Subject left at 16:40 for an out-of-town trip. Recommend continuing; request authorization for up to 6 additional hours.” Wait for a written yes.
• Stop when you’ve answered the question. If you’ve documented the activity on day one, say so and ask whether to continue. Adjusters remember investigators who save them money.

Our time tracking and billing guide covers tracking against a budget.

Communicate on a schedule

Adjusters juggle dozens of files and hate chasing vendors. Agree a rhythm and keep it:

• Same-day activity note after each day in the field: hours, whether the claimant was seen, notable activity, video obtained yes or no.
• Immediate call for anything significant: the claimant doing heavy work, being at a second job, or leaving the area.
• Pre-surveillance check results before the first day, if you do one: confirmed address, vehicles, possible schedule. Pursuit Magazine’s case-management framework puts this research step before any fieldwork for good reason.

Keep updates factual and short. See client communication for private investigators.

Write the report the way it will be read

Insurance reports are read quickly and compared across vendors. A consistent structure helps:

1. Assignment summary: claim reference, claimant, dates, hours authorized and used, the question asked.
2. Summary of findings: a few sentences answering the question, with the key activity and where it appears in the video.
3. Day-by-day summary table: date, hours, claimant observed (yes/no), activity observed, video duration.
4. Detailed chronology for each day, time-stamped, observations only.
5. Pre-surveillance and background research, if done.
6. Exhibit and video index: each clip with date, start time, duration, description and file hash.

Stay strictly factual. “The claimant carried two bags of mulch from the truck to the backyard, one on each shoulder (Video 3, 10:14–10:16)” is useful. “The claimant is clearly not injured” isn’t yours to say, and invites an argument about your objectivity. Pursuit’s “39 Things a Good Surveillance Operative Knows” lists unbiased reporting among the essentials, “regardless of client expectations.” See writing reports clients understand and our surveillance report guide.

Report the quiet days in full. A report that shows eight hours with no sighting on day one is more credible, not less.

Video: what adjusters look for

Video is often the whole point, and adjusters notice quality.

• Establish identity early in the footage, with the claimant’s face and a clear connection to the address or vehicle.
• Record time accurately. Set your camera clocks at the start of each day, and note in the report where times come from (see surveillance video and photo file management).
• Keep the originals and deliver edited clips as extras, not replacements. Record hashes of the originals.
• Deliver securely. Claim files contain medical, financial and personal information. Use a delivery method with access control rather than email attachments or open links (see sharing files securely).

Stay objective under pressure

Insurance work comes with pressure, sometimes explicit, to find something. Resist it. Your value to an insurer is that your findings stand up when the claimant’s attorney reads them. Pursuit Magazine’s list of workers’ compensation “red flags” is a useful reminder of what can prompt a referral, but a red flag is a reason to look, not a finding.

Also know your limits in the field. Follow your state’s rules on surveillance, recording, trespass and pretexting, and when in doubt, check with your state board or an attorney. An investigation that crosses a line can damage the claim you were hired to help with.

Handle claimant information carefully

You’ll receive sensitive details: diagnoses, restrictions, home addresses, sometimes Social Security numbers. Keep only what the assignment needs, store it encrypted, don’t forward it to subcontractors who don’t need it, and follow the carrier’s instructions on retention and return. Some carriers ask vendors to complete security questionnaires; answer them honestly (see data security for private investigators).

Build the relationship, but don’t depend on one

• Invoice promptly, in the format requested, matching the hours in your report exactly.
• Keep your certificate of insurance current and send it before you’re asked.
• Ask for feedback after a few assignments.
• Diversify. As “Out in the Cold” warns, vendor relationships can end suddenly, even after years of good work. More than one carrier, and some non-insurance work, protects your practice.

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