After a policyholder submits a claim to an insurance company, the insurer investigates to determine whether to pay the claim, as the insurer is permitted to do under its insurance policy. On occasion, after an insurer has begun to investigate a claim, it may come to believe that the claim is fraudulent, or at least that it requires further investigation to determine whether it is fraudulent or should not be paid for other reasons.

Typically, when investigating a claim, an insurer will seek the cooperation of the policyholder, as the insurer also is permitted to do under its insurance policy. The policyholder’s cooperation, which is required under the policy, can help persuade the insurer to pay the claim, or may confirm to the insurer that the claim should not be paid.