Insurance claim investigation is the key to the success of insurance claim. In recent years, China's insurance industry has developed rapidly, and the ensuing insurance fraud is also increasing. The amount of insurance fraud in China accounts for 20% to 30% of the compensation. In this context, many insurance companies will ask a third-party investigation company to conduct an investigation. These insurance investigation companies have gradually grown up with the development of the insurance industry in China. Most companies use reasonable and legal means to collect relevant data and information about customers' claims. When insurance companies can't get some information related to claims, these insurance investigation companies will play an active role in insurance claims to prevent insurance fraud and other illegal acts.
If necessary, the insurance company will investigate with a third party. Taking medical insurance claims as an example, there are three main ways for insurance companies to obtain the medical records of the insured when making claims:
1. Investigate the medical records of social security: the social security card is an individual's card, and all personal medical visits and drug purchases will be recorded one by one, such as the drug purchase records of pharmacies, outpatient or inpatient medical records of hospitals, etc.
2. Investigating hospital medical records: Investigators of insurance companies will look at the medical records of hospitals and other local hospitals or clinics that may see a doctor, and make a comprehensive analysis and judgment based on basic information such as medical records, complaints, medical records, treatments and doctor's orders.
3. Inter-bank information sharing: Most insurance companies need the other party to make claims, such as establishing resource sharing or inter-bank communication groups to improve the investigation efficiency.