Claims Investigation

Claims Investigation

We are a professional insurance claims investigation company, focusing on assisting insurance companies in providing professional investigation services in insurance claims.

Composed of experienced professionals with a long history of insurance investigations, we boast a comprehensive information investigation network and a highly efficient service system. We have established close, long-term relationships and excellent cooperative relations with government agencies and law enforcement departments across China, including those responsible for social security and healthcare, to ensure timely, accurate, and effective investigations. Headquartered in Shenzhen, Guangdong Province, the company has, after several years of development, established branches in Hong Kong, Guangzhou, Nanjing, Jinan, Chengdu, and other locations. Our proprietary investigation network spans 32 provinces, municipalities, and autonomous regions nationwide, with investigators stationed in major cities. We maintain close ties with hospitals, disease control centers, health bureaus, physical examination centers, and social security bureaus, and possess an extensive network of personal connections, enabling us to undertake claims investigations nationwide. We have established long-term claims investigation partnerships with numerous insurance companies, and our professional investigation services have been highly praised by our partners.

Survey Type

We are currently mainly engaged in the following insurance investigations

On-site investigation

02

Visits by public security and relevant departments

04

Fraud investigation

06

Injury verification

01

Medical Cases

03

Personal liability insurance and employer liability insurance verification

05

Investigation channels and methods

We provide insurance investigation services to professional property and casualty insurance companies in mainland China, Hong Kong, Taiwan, and other countries. At the request of insurance companies, we dispatch highly trained investigators to handle liability insurance cases, assessing claims for potential fraud and establishing the facts of liability claims. Our case investigations primarily encompass the following areas:

On-site investigation, drawing, and photography (according to different case requirements)

02

04

Secret investigation

Case Analysis

01

Interviews with key personnel, collection of clues and evidence

03

Personal liability insurance and employer liability insurance verification

05

We have excellent insurance fraud investigators and extensive information channels. Our investigators understand the mentality of the parties involved in various cases and the possible fraudulent means they may adopt. They are experienced in obtaining evidence and are familiar with relevant insurance laws and regulations.

Internet investigation

In addition to our employees' on-site investigation and evidence collection, we also obtain relevant information through some networks/channels. Our channels for obtaining information mainly include:

Public Security Bureau, Traffic Police and other government agencies

02

04

Media, online reports, and other online information

Medical institutions

01

Background Check

03

Serving Customers

So far, we have established long-term and good cooperative relationships with many insurance companies, including domestic customers and foreign insurance companies.

Service Process

1. Confirmation of acceptance of the case

Handover of case materials and information between the two parties

2. Analyze the case and determine the investigation plan and costs

Sorting out case information, firstly, conducting an objective, comprehensive and thorough analysis of known information and materials, identifying problems and doubts in the case, thus determining the correct direction and focus of the investigation, designing the form and method of investigation, formulating an investigation plan and program, achieving the goal and requirements of a fast, efficient and accurate investigation, and confirming the case costs

3. Arrange resources and personnel, and set a timetable

Arrange investigators based on the principle of proximity according to the investigation plan

4. Conduct field investigations

Utilize your own investigative network and personal connections to investigate and collect evidence from relevant institutions, including but not limited to hospitals, disease control centers, health bureaus, physical examination centers, social security bureaus, etc. d.

5. Write a report

All cases are analyzed and discussed with the team before final report

Serving Customers

1	Copy of medical records of this hospitalization	Copy full medical records
2	List of current hospitalization expenses	Print all lists
3	First confirmed pathological examination	Verify pathology diagnosis and procedures
4	Verification of historical hospitalization records	Copy full medical records
5	Historical outpatient record verification	Take photos or print out outpatient records
6	Check at a hospital near your residence	Hospital screening within a 10km radius
7	Check at hospitals near the place of residence	Hospital screening within a 10km radius
8	Social security and agricultural insurance reimbursement records	Take a photo or print
9	Commercial insurance claim records	Take a screenshot or print the file
10	Relevant personnel visited and inquired about the verification	Taking notes, taking photos, recording audio and video
11	Network Investigation	Multi-platform query and screenshot proof

Investigation implementation

1	Copy of medical records of this hospitalization	Copy full medical records
2	List of current hospitalization expenses	Print all lists
3	First confirmed pathological examination	Verify pathology diagnosis and procedures
4	Verification of historical hospitalization records	Copy full medical records
5	Historical outpatient record verification	Take photos or print out outpatient records
6	Check at a hospital near your residence	Hospital screening within a 10km radius
7	Check at hospitals near the place of residence	Hospital screening within a 10km radius
8	Social security and agricultural insurance reimbursement records	Take a photo or print
9	Commercial insurance claim records	Take a screenshot or print the file
10	Relevant personnel visited and inquired about the verification	Taking notes, taking photos, recording audio and video
11	Network Investigation	Multi-platform query and screenshot proof

Verify the authenticity of the information provided by the insured

Interview the treating physician; review medical records; verify handwriting in the medical records; inquire about the insured's diagnosis and treatment, medical history, health status, and course of illness.
Review relevant medical test records, such as laboratory test results, X-rays, electrocardiograms, and ultrasounds.
Verify medical expense receipts.
Understand the relationship between the treating physician, laboratory personnel, and other relevant medical personnel and the insured.
Compare and verify the information provided by the insured. If there are any discrepancies, alterations, or omissions, make copies or photographs for evidence. Copies should be stamped with the hospital's official seal if possible.

Requirements of the investigation process

When obtaining relevant materials, our company will pay attention to timeliness, authority, and authenticity, and will thoroughly and objectively review and verify that the supporting documents meet the following requirements:

Must be objectively factual materials
Must be relevant to the case
Must be legally permissible
Must be factual materials obtained through legal channels

Writing an investigation report

After the investigation is completed,

our company will prepare and submit a

Case Claims Investigation Report,

which will primarily record:

Insured Person Information
Brief Investigation Details: including time and location of the investigation
Medical Records: including hospital, time of visit, condition, diagnosis, expenses, medical history, etc.
Attach relevant supporting documents