The Role of Quality Reporting in Claims Investigations

When it comes to choosing a claims management partner, a lot of factors are important to consider. But according to a 2025 survey, one factor rose to the top: quality reporting. 66% of respondents ranked it as the most important factor when choosing a claims investigations partner, outpacing price, speed, coverage, reputation, and range of services.

Even the most sophisticated claims investigations lose their value if the findings aren’t reported clearly, accurately, and in a way clients can act on immediately. Reputation was ranked the second most important factor in the same survey, which makes sense, as strong reporting not only drives outcomes but also protects the credibility and reputation of organizations involved.  

Why Quality Reporting Matters More Than You Think

A report isn’t just paperwork. It’s the bridge between raw data and informed decisions. In claims and investigations, that bridge determines whether: 

• Red flags are caught early or missed entirely.
• Cases hold up under legal scrutiny or fall apart due to weak documentation.
• Claims teams feel equipped to act or are left second guessing what really happened.

Example:

The importance of reporting can be seen in utilization review (UR). A reviewer might evaluate whether a certain treatment is medically necessary based on clinical guidelines. If the final report simply states, “treatment not necessary,” it leaves too much room for interpretation. Claims teams can’t confidently act on that conclusion because they don’t know the rationale behind it. 

Now compare that to a high-quality UR report. Instead of a vague sentence, it clearly explains: 

• Which guideline was applied (ODG, MCG, etc.)
• Why the treatment doesn’t meet the standard of medical necessity
• What alternative options, if any, could be considered

That kind of reporting transforms the review into something actionable. The claims team can move forward knowing the decision is backed by evidence, defensible in an appeal, and transparent enough to share with stakeholders. 

The same principle applies across all claims investigations: the value of the work depends on the strength of the report. Without clarity and context, even the most thorough investigation risks being overlooked. 

Example:

Consider a Workers’ Compensation claim where surveillance shows a claimant with a back injury moving heavy furniture for several hours. If the final report only includes a vague note like, “claimant observed lifting heavy boxes”, without time stamped stills, detailed descriptions, or a clear narrative, the evidence loses its weight. The facts exist, but they aren’t presented in a way that empowers decision making.  

When reporting is vague, incomplete, or poorly structured, the consequences are real:  

• Claims get delayed.
• Litigation risks increase.
• Clients lose confidence in the process.

What High-Quality Reporting Looks Like in Practice

Going back to the Worker’s Compensation example, a high-quality report would include:  

• A clear timeline of events, such as “2:15-4:45 pm, claimant carried multiple boxes weighing approximately 30-40 pounds each.”
• Time-stamped still images from video surveillance
• Context explaining why this matters, such as “activity is inconsistent with reported restrictions on bending and lifting.”  

The evidence itself didn’t change, but the reporting did. That’s what gives claims teams the confidence to act quickly and decisively.  

The Benefit for Clients

Strong reporting gives claims teams the confidence to make decisions on a claim.  

Quality reporting gives claims teams:

• Clarity: Claims teams can see exactly what happened, documented in a way that removes guesswork.
• Speed: When findings are laid out clearly, claims teams can move forward faster without extra back and forth.
• Confidence: Claims teams can make decisions knowing documentation will hold up if they’re challenged.  
• The Full Picture: Everything claims teams need—photos, videos, documents—are all in one place, providing a 360-degree view of the claim.

Want a 360-degree view of claims investigations? Sightline brings reports, video, medical records, and investigation updates together in one secure portal. Ask us about it today.