How to Choose a Claims Investigations Partner

What you will find below:

• Qualifications to Look for in a Claims Investigations Partner
• Why Licensing, Experience, and Legal Compliance Matter
• How Documentation, Reporting, and Communication Support Reliable Investigations
• Questions to Ask When Evaluating an Investigative Partner

Choosing the right claims investigations partner is an important step in obtaining reliable information to support insurance claim decisions. A qualified investigative partner brings more than experienced investigators. Strong documentation practices, legal compliance, clear communication, and a consistent approach to managing assignments are equally important.

For insurance carriers, third-party administrators (TPAs), and claims professionals, understanding what to look for can help identify an investigative partner suited to their needs.

What to Look for in a Claims Investigations Partner

Evaluating an investigative partner involves reviewing its qualifications, processes, and experience with similar assignments. The following seven qualities provide a practical framework for selecting a partner for insurance claims investigations.

1. Proper Licensing

Licensing is an important consideration when evaluating an investigative partner. Requirements vary by state and may differ for individual investigators and investigative agencies. Certain roles and activities may also qualify for exemptions.

Before assigning a case, ask whether the firm and its investigators meet the licensing requirements applicable to the assignment. Credentials can be verified through the appropriate state licensing authority.

2. Relevant Investigative Experience

An investigative firm’s experience should align with the type of assignment. Surveillance, fraud investigations, background research, and digital investigations involve different methods and skills.

For example, surveillance assignments involve documenting observed activities, while background investigations may focus on researching and verifying information.

Ask prospective partners about their experience handling similar cases and how they determine which investigators are appropriate for each assignment.

3. Strong Documentation Practices

Accurate documentation provides a clear record of investigative activity and findings. Detailed activity logs, timestamps, organized evidence, and factual reporting allow claims professionals to understand what investigators observed.

In surveillance assignments, reports should accurately describe relevant activities and identify supporting footage.

Consider requesting a sample report to evaluate how a firm documents findings and presents investigative information.

4. Understanding of Legal and Ethical Boundaries

Investigative methods must comply with applicable laws and regulations. Requirements concerning surveillance, privacy, recording, and information gathering can vary depending on the jurisdiction and circumstances.

A reliable investigative partner should have procedures for recognizing and addressing legal or ethical concerns.

Ask how the firm approaches compliance and handles questions about potentially restricted investigative methods.

5. Ability to Explain Investigative Findings

Investigators should be prepared to explain their observations and methods if findings become relevant to litigation or another formal proceeding.

Clear documentation and firsthand knowledge can help an investigator accurately describe what occurred during an assignment. The requirements for presenting testimony depend on the applicable forum and rules.

Ask whether the firm’s investigators have experience providing testimony and explaining their findings in formal proceedings.

6. Clear Communication and Reporting

Effective communication helps claims professionals understand the status and findings of an investigation. An investigative partner should establish expectations for updates, report delivery, and responding to questions.

Reports should distinguish documented observations from interpretations or conclusions.

For example, describing a claimant lifting an object provides an observable fact without making unsupported assumptions about their medical condition or physical limitations.

Ask how the firm communicates significant developments and provides updates throughout an assignment.

7. Transparent Pricing and Expectations

Clear pricing helps claims professionals understand an investigation’s anticipated costs and scope before authorizing work.

Discuss hourly rates, minimum billing requirements, potential travel expenses, and expected deliverables. Clarify how additional investigative time or changes in scope are approved.

Establishing these expectations in advance helps clients evaluate proposals and manage investigative assignments.

With experienced investigators nationwide, litigation-ready reporting, and a full suite of investigative services, Ethos provides the experience and support claims professionals need. Connect with our team to learn more.

Sources:

• ASIS International. “ASIS International Introduces New ANSI-Approved Investigations Standard.” ASIS International, 17 June 2025, https://www.asisonline.org/security-news/press-room/asis-introduces-new-investigations-standard/.
• Florida Department of Agriculture and Consumer Services. “Private Investigation Licenses.” Florida Department of Agriculture and Consumer Services, https://www.fdacs.gov/Business-Services/Private-Investigation-Licenses.
• Legal Information Institute. “Rule 602. Need for Personal Knowledge.” Federal Rules of Evidence, Cornell Law School, https://www.law.cornell.edu/rules/fre/rule_602.