S.I.B. Approach: Evaluating The Merit Of A Claim

S.I.B. Approach: Evaluating the Merit of a Claim

The success of properly processing an insurance claim requires due diligence/fiduciary duty as an insurance professional to evaluate each claim by conducting a preliminary investigation. We have found time and time again that using the SIB (Statement, Index [ISO], Background) approach to start an investigation yields the most useful and effective results. Following this preliminary approach ensures the most accurate results are obtained.

With the results obtained from the SIB portion of the claims investigation, we form a partnership that acts on these results in the most appropriate ways, such as investigating red flags more thoroughly, digging deeper into a person or entity’s background forming a plan of action to achieve cost effectiveness.

What is So Special About the SIB Approach?

The SIB approach allows crucial questions in the claims process to be accurately answered, such as: Is the person or entity misrepresenting themselves? If so, in what way(s)? Are any pre-existing conditions present that warrant further investigation in relation to the claim? Has the person or entity filed claims for the same or similar incidents with other companies or with your company in the past?

When preliminary information like this is available, the investigator is better able to help their clients know where to go with their claims from that point. It may be discovered that only part of the claim is compensable, or that the person or entity filing the claim is being fraudulent.

Essential details are discovered with the SIB approach that might otherwise be missed. An investigation that begins with the SIB approach ensures all of the information needed to make an accurate determination on the nature of the claim and the one who is filing it is obtained at the very beginning of the investigation, when it will be the most helpful and useful. The next steps in the investigation, if any, will be determined through the SIB approach.

The SIB Approach, Explained

SIB is the logical approach to starting an investigation. Each step in the process has a purpose that leads to the next step in the investigation before the claim is decided.

  1. Statement – A statement is taken from the person This statement can be compared to other information that is gathered later, to determine its veracity.
  2. Index (ISO) – The Index (ISO) is searched to identify if the person filing the claim has a history of filing claims or if there is evidence of pre-existing conditions and/or alerts of fraud, or even has an identical claim open with another company at the same time as the one currently being investigated.
  3. Background – The claimant’s background is looked into thoroughly to help provide the history of a claimant and determine and establish a pattern of behavior.

How We Partner With You

The SIB part of your investigation provides excellent results that aren’t available with any other approach. It gives a clear roadmap of where the investigation should go next. Your company may not have the time and/or resources to do a SIB-based investigation on its own, that’s when you need a partner like the Brumell Group to assist you.

When we partner together, we combine information found in the Statement, ISO (Index) and Background to help form a plan of action which will aid and determine the most efficient, and economical means to move forward in your claims process.

We are experts in the SIU, legal industry. Contact us today at 877-880-5150.