Claims Investigations: Dos and Don’ts for Investigators

Insurance investigations walk a careful line. On one hand, insurers have a duty to verify claims through thorough claims investigations and protect themselves from fraud, a problem that costs Americans over $308 billion every year across all lines of insurance. On the other hand, claimants have legitimate rights to privacy, and crossing those boundaries can expose insurers to legal risk, complaints, or allegations of bad faith. As technology evolves, understanding what investigators can and cannot do has become more important than ever for ethical claims investigations.

What Investigators Cannot Do in Claims Investigations

1. Record Private Areas Inside a Home

Claimants have a legally protected reasonable expectation of privacy inside their homes. Investigators cannot record:

• Through windows
• Inside bedrooms, bathrooms, or living spaces
• Using drones, telescopic lenses, or advanced tech to peer inside

Courts have consistently held that surveillance crossing into interior residential spaces is intrusive, regardless of visibility from outside. As tools become more sophisticated, maintaining compliant claims investigations requires strict boundaries.

2. Trespass or Enter Private Property Without Consent

Investigators must stay within publicly accessible locations. They cannot:

• Enter fenced-in yards
• Step onto a claimant’s porch or driveway
• Slip into gated communities or apartments without authorization
• Lift cameras over fences
• Access personal items or mail

Even brief trespassing can compromise claims investigations and expose insurers to liability.

3. Install GPS Trackers Without Consent

After the U.S. Supreme Court’s ruling in United States v. Jones, attaching a GPS tracker to someone’s vehicle without permission is widely considered a search and is illegal without a warrant.

Many states now explicitly prohibit private GPS tracking. For example:

• Florida criminalizes installing a tracking device without the owner’s consent.
• California Penal Code §637.7 prohibits tracking someone’s vehicle without permission.
• Texas similarly limits electronic tracking to authorized individuals only.

4. Access Private Digital or Device Data

Investigators cannot:

• Hack into social media accounts
• Access private messages, emails, or photos
• Pull data from smart home devices
• Use wearable fitness tracker data without permission
• Deploy facial-recognition tools without proper authorization

The Federal Trade Commission has repeatedly warned that the misuse of consumer data in claims investigations, even when obtained indirectly, can trigger federal enforcement action. In its 2024 Privacy and Data Security Update, the FTC underscored that even “public” data gathered deceptively can violate consumer protection laws.

5. Record Conversations without Consent

Recording laws vary by state:

• 38 states follow one-party consent, meaning one participant must know the recording is happening.
• 12 states, including California and Florida, require all parties to consent.

Even in a public place, a person may still have a “reasonable expectation of privacy.” Investigators may listen to conversations in public, take notes, and observe, but recording them without proper consent may violate state wiretapping statutes.

6. Access Private Social Media Through Deception

Courts have repeatedly held that investigators may not:

• Create fake profiles
• “Friend” a claimant under false pretenses
• Bypass privacy settings
• Ask others to obtain private content on their behalf

Deception undermines lawful claims investigations and can breach platform policies and legal standards.

What Investigators Can Do in Claims Investigations

1. Document Publicly Visible Activity

In claims investigations, anything that can be seen from a legally accessible public area, including streets, sidewalks, and parking lots, can be photographed or recorded.

This includes:

• A damaged roof
• A claimant carrying heavy objects
• A vehicle with new damage
• Outdoor activity visible without trespassing

The National Association of Insurance Commissioners (NAIC) notes that public-domain observation remains one of the most foundational and least legally risky investigative tools.

2. Conduct Fixed, Mobile, and Unmanned Surveillance

Insurers have the right and obligation to investigate claims in good faith. Surveillance methods may include:

• Fixed (stationary) surveillance
• Mobile surveillance, such as following a claimant on public roads
• Unmanned camera monitoring in public areas
• Reviewing publicly accessible information online

The key is reasonableness in claims investigations. Surveillance should never cross into harassment, intimidation, or privacy invasion.

3. Review Public Social Media Content

Social media is one of the fastest-growing sources of fraud detection. With 5.4 billion global users, investigators can legally review:

• Public posts
• Public photos and videos
• Public comments
• Public profiles of friends or family that tag the claimant

This content is considered publicly available and carries no reasonable expectation of privacy in claims investigations.

For example, if a claimant with a reported back injury appears in a publicly posted video lifting furniture, that contradiction is legitimate evidence.

4. Use Drones with Careful Limits

Drone use is growing across insurance, especially for property inspections. The FAA recorded more than 1 million registered drones in the U.S. by 2024, and Part 107 rules allow their use under certain conditions.

Investigators may use drones to:

• Inspect roofs and exteriors
• Capture storm or fire damage
• Document areas visible from lawful airspace

They cannot use drones to:

• Look into windows
• Hover at low altitudes over private backyards
• Capture activity inside fenced or enclosed spaces

Several states, including California, Florida, and Texas, enforce drone privacy statutes that restrict aerial surveillance of private property.

5. Request Statements and Conduct EUOs

A claimant’s policy typically outlines their obligations. Many policies permit insurers to request:

• Recorded statements
• Signed written statements
• Examinations Under Oath (EUOs)

While claimants may decline additional interviews beyond policy requirements, refusal to participate in an EUO can justify a claim denial.

6. Seek Second Opinions and Review Expert Findings

Investigators may:

• Ask treating providers to clarify inconsistencies
• Use independent medical examinations (IMEs)
• Compare reports from multiple experts

What they may not do is ignore medical evidence without justification.

7. Document Inconsistent Activity in Public

If a claimant states they cannot:

• Lift more than 5 lbs
• Drive
• Walk without assistance
• Stand for long periods

…but they are observed doing so in public places, investigators may lawfully record that activity. Consistency matters in claim investigations, and publicly observable contradictions are admissible evidence.

The Importance of Lawful, Ethical Claims Investigations

The NICB reports a 23% increase in suspicious claims from 2018 to 2023. As fraud trends evolve, the pressure on insurers to investigate thoroughly is real. But evolving laws, rising consumer concern, and federal scrutiny mean insurers must investigate within firm ethical and legal boundaries.

Fair claims investigations respect two truths:

1. Claimants deserve privacy and dignity.
2. Insurers must protect policyholders and themselves from fraud.

Clear boundaries help accomplish both. When investigators stay within public spaces, obtain proper consent, follow state and federal privacy laws, and document evidence transparently, they can conduct strong investigations without risking legal exposure.

Want to learn more about ethical claims investigations? Register for our “A Claimant’s Right to Privacy” CE.

Check out our sources:

Coalition Against Insurance Fraud. The Impact of Insurance Fraud on the U.S. Economy. 2022, https://insurancefraud.org/wp-content/uploads/The-Impact-of-Insurance-Fraud-on-the-U.S.-Economy-Report-2022-8.26.2022.pdf.

DataReportal. Digital 2024 Global Overview Report. DataReportal, 31 Jan. 2024, https://datareportal.com/reports/digital-2024-global-overview-report.

National Insurance Crime Bureau. “Prevent Fraud & Theft.” NICB, https://www.nicb.org/prevent-fraud-theft.

United States v. Jones, 565 U.S. 400 (2012). Justia U.S. Supreme Court Center, https://supreme.justia.com/cases/federal/us/565/400/.