Where Private Investigation Firms and Claims Professionals Intersect
Prior to joining the private investigation industry, I spent nine years working in insurance claims handling and Special Investigations Unit (SIU) roles. That experience gave me the opportunity to see firsthand how claims professionals evaluate coverage, liability, damages, fraud indicators, litigation exposure, and customer service, all while balancing efficiency, regulatory requirements, and making the best decision possible based on the facts available at the time.
Initially, the transition from the insurance carrier side to the private investigation industry was intimidating. I was leaving an environment that I understood well and stepping into one that was unfamiliar. Going from the “client” to what many consider the “vendor” felt like a significant shift. It did not take long, however, to realize that I was not leaving the insurance industry at all—I was simply stepping into another essential part of the claims handling process.
That realization changed my perspective. Although claims professionals and private investigators work for different organizations, we ultimately share the same objective. We are not simply a vendor checking a box or completing an assignment. We become part of the overall claims process by helping obtain the objective facts needed to move a claim toward an informed resolution. That mindset has continued to shape both my approach to investigations and the culture we strive to build at Hodson PI.
Although their responsibilities are different, the objective is the same: to obtain accurate, objective information that helps claims professionals make informed decisions. Claims professionals evaluate the claim as a whole, while private investigators gather, document, preserve, and report factual information that may not otherwise be available. Neither profession exists to replace the other. Rather, each plays an important role in moving a claim toward an informed resolution.
A common misconception is the belief that investigators have access to everything contained within the claim file. In reality, that is rarely the case. Most private investigation firms do not have direct access to claim notes, policy information, recorded statements, internal claim evaluations, bodily injury related details, photos, or every conversation that has already taken place with insureds, claimants, witnesses, attorneys, or medical providers. Investigators are typically provided only the information necessary to begin an assignment. While that information is often sufficient to get started, additional context can significantly improve the overall investigation.
The more investigators understand what has already been established, what questions remain unanswered, and what information will ultimately assist the adjuster, the better they can tailor their investigative efforts. Likewise, investigators should feel comfortable asking follow-up questions when additional context may prevent duplicating work or uncover opportunities that might otherwise be overlooked. Open communication helps ensure investigative efforts are focused where they provide the greatest value instead of spending time duplicating work that has already been completed.
One question consistently helps guide investigations: “What question are we ultimately trying to answer?” That conversation often changes the investigative strategy. While surveillance may be appropriate in one case, another may benefit more from a recorded interview with an involved party or witness, medical canvass, social media investigation, open-source intelligence (OSINT), scene canvass, Event Data Recorder (EDR) analysis, a comprehensive background investigation, or a combination of investigative services to leave no stone unturned. In some situations, the right recommendation may even be that additional investigative efforts are unlikely to provide meaningful value. Helping a client avoid unnecessary expense can be just as valuable as recommending additional work.
The most effective private investigation firms intentionally build teams that understand both sides of the claims process. Combining experienced investigators with professionals who have firsthand claims handling experience creates a broader understanding of both the investigative process and the practical realities of insurance claims. That perspective helps ensure investigative efforts remain aligned with the information claims professionals need to move files toward informed resolution.
Investigation teams with experience in both claims handling and fieldwork are better positioned to understand file expectations, litigation considerations, documentation requirements, claim timelines, and the information adjusters need to move a claim forward. Combining that knowledge with experience in interviews, surveillance, scene canvassing, social media investigations, background investigations, and medical canvassing helps investigators ask more informed questions and tailor their approach to the objectives of each claim.
Equally important is communication throughout the life of an assignment. Effective investigation firms should ensure updates do more than summarize completed activity. They should explain what has been learned, how those findings relate to the original objective, identify any obstacles encountered, recommend alternative strategies when appropriate, and be transparent when additional efforts are unlikely to produce meaningful results. That approach allows claims professionals to make informed decisions while ensuring investigative resources are used responsibly.
As both industries continue to evolve, we will see the relationship between claims professionals and private investigation firms continue to become even more collaborative. The most successful investigations are not measured by the number of hours worked or photographs obtained. They are measured by whether they answered the questions that needed to be answered and provided the information necessary for the claims professional to make an informed decision.
The most effective private investigation firms strive to be more than investigative vendors—they aim to become trusted extensions of their clients’ claims and legal teams. Firms that combine experienced investigators with professionals who have firsthand claims handling experience bring a broader perspective that strengthens communication, improves investigative strategy, and ultimately supports better claim outcomes.
At the end of the day, a private investigator’s responsibility is not to prove or disprove a claim. Their responsibility is to objectively gather the facts, clearly communicate what those facts show, and provide claims professionals with the information they need to make informed decisions with confidence. When claims professionals and investigators understand one another’s roles and work together toward a common objective, everyone benefits—including the integrity of the claims process itself.
Author Bio
Justin Lloyd is Vice President of Hodson P.I., where he oversees investigative and organizational operations supporting insurance carriers and attorneys across multiple investigative disciplines. He is a licensed private investigator, a member of the California Association of Licensed Investigators (CALI) and is FCLS-certified (Fraud Claims Law Specialist). Prior to joining the private investigation industry, Justin spent more than nine years in the auto insurance industry serving in claims handling and Special Investigations Unit (SIU) roles, providing him with a unique perspective from both the insurance carrier and private investigation sides of the claims process. His work focuses on strengthening collaboration between claim’s professionals and investigators to improve communication, efficiency, compliance, and investigative outcomes.