When Something Feels Off

Recognizing and Calibrating the Behavioral Cues That Tell You a Claim Deserves a Closer Look

Thursday, July 23rd, 2026 Claims Pages Staff The Claim That Doesn't Feel Right

The claim came in on a Tuesday morning. A kitchen fire, contained to the cabinets and countertop, reported promptly, documented with photographs, supported by a fire department report. The policyholder was polite on the phone, answered every question, and had receipts for the higher-value contents. On paper it was as clean as a fire claim gets. And yet the adjuster who caught the file, a twenty-year veteran named Ray, hung up the phone and sat there for a moment with his hand still on the receiver.

Something felt off. He could not have told you what. The claimant had been cooperative. Maybe too cooperative. The receipts were organized. Maybe too organized, for a household that in every other respect looked like it filed its paperwork in a shoebox. The fire had started in the one part of the kitchen where the damage would total out a set of cabinets the policyholder had complained about, on a recorded service call six months earlier, as being too expensive to replace.

Ray did not deny the claim. He did not accuse anyone of anything. He kept working the file, asked a few more questions than usual, and documented carefully. Three weeks later the claim unraveled on its own when a neighbor mentioned, in passing, that the family had moved most of their belongings into a storage unit the weekend before the fire.

Every experienced adjuster has a version of this story, and every experienced adjuster has the opposite story too, the one where the feeling was wrong and the nervous, evasive, disorganized claimant turned out to be a completely honest person having the worst month of their life. This article is about that feeling. Where it comes from, when to trust it, when to doubt it, and what to actually do with it.

Where Instinct Actually Comes From

The industry likes to talk about a sixth sense for fraud, which is a colorful way of describing something much more ordinary. What we call instinct is pattern recognition operating below the level of conscious thought. An adjuster who has handled two thousand claims has seen two thousand versions of how honest people behave when something bad happens to them. They have heard how a genuine loss gets described, watched how real grief and real frustration present themselves, and absorbed the rhythms of a truthful timeline.

When a claim deviates from those accumulated patterns, the brain notices before the adjuster does. The feeling of wrongness arrives first, and the reasons arrive later, if they arrive at all. This is why veterans get the feeling more often and more accurately than new adjusters. It is also why the feeling deserves respect but never obedience. Pattern recognition is a smoke detector. It tells you to look. It does not tell you what you will find, and it goes off for burnt toast far more often than it goes off for fire.

Understanding this has a practical consequence. If your instinct is built from the claims you have seen, then it carries every bias of that sample. An adjuster whose book has been mostly suburban homeowner claims will get false alarms from claimants whose lives simply look different from that pattern. The feeling is data about your own experience as much as it is data about the claim in front of you. Treat it accordingly.

The Cues That Deserve Your Attention

Some behavioral signals have earned their reputation. Decades of SIU case files and academic study keep pointing at the same cluster of behaviors, and while none of them proves anything alone, they are worth noticing when they arrive together.

• Unusual familiarity with the process. Most first-time claimants do not know what a proof of loss is, how depreciation works, or what their policy limits are down to the dollar. A claimant who navigates the process like a professional may simply be well prepared. Or they may have been through this more times than the loss history shows.
• Pressure for speed that exceeds the situation. Everyone wants their claim paid quickly. But there is a difference between the ordinary urgency of a family that needs a roof and a claimant who pushes for immediate settlement, resists inspection, and threatens escalation in the first phone call, before anything has gone wrong.
• A story that improves under questioning. Honest memories are messy. They contain gaps, corrections, and details that do not serve the teller. A narrative that gets smoother and more favorable each time it is told is moving in the wrong direction. Real recollection erodes. It does not polish itself.
• Indifference in the wrong places. A policyholder who lost genuinely treasured belongings usually cares about them specifically. A claimant who shrugs at questions about sentimental items but knows the exact replacement cost of the electronics is displaying an inverted set of priorities.
• Convenient timing. Losses that arrive shortly after a coverage increase, just before a policy lapse, in the middle of a divorce or bankruptcy, or right after a failed attempt to sell the property are not fraudulent by definition. But timing is context, and context sharpens or dulls every other signal.

Notice what is on this list. Patterns of behavior measured against the claim itself. Not accents, not zip codes, not how someone dresses or what they do for a living. The cues that matter are the ones that show a mismatch between the story being told and the way genuine losses behave.

The Cues That Mean Less Than You Think

Now for the harder half of the lesson, because the folklore of fraud detection contains as much myth as wisdom, and the myths do real damage.

Nervousness is the big one. New adjusters routinely read anxiety as guilt, and it is one of the least reliable signals in the entire catalog. Honest people are nervous when they talk to insurance companies. They are afraid of saying the wrong thing, afraid of being doubted, afraid the claim will be denied over a technicality. Meanwhile, practiced fraudsters are frequently calm, warm, and likable, because comfort with deception is precisely what makes them practiced. If you sorted your caseload by nervousness, you would investigate the honest and pay the guilty.

Inconsistency in small details belongs in the same category. Memory research is unambiguous on this point. Truthful accounts of stressful events contain errors, especially about peripheral details like times, sequences, and weather. A claimant who says the fire started around nine and later says it was closer to ten is behaving like a person with a normal memory. It is the perfectly consistent account, recited identically on every telling, that should raise an eyebrow.

Anger is another poor signal. Some of the angriest claimants you will ever encounter are honest people who feel disrespected by the process, and their anger grows in direct proportion to how much suspicion they detect. Suspicion has a way of manufacturing the very behavior that seems to justify it. Treat a person like a suspect and they will start acting like one: defensive, short, uncooperative. That is a feedback loop, and the adjuster controls the input.

Calibration Is the Skill

So the real skill is calibration. Raw instinct comes with experience whether you want it or not. Calibrated instinct requires deliberate effort, and it rests on a few habits.

First, keep score honestly. When a claim gives you the feeling, note it privately, work the file properly, and then pay attention to the outcome. Most adjusters remember their hits vividly and forget their misses entirely, which trains overconfidence. If you track both, you learn what your own instinct is actually worth, and more usefully, you learn which specific cues drive your accurate calls and which drive your false alarms.

Second, separate the feeling from the file. Your suspicion is not evidence and it does not belong in your claim notes as a conclusion. What belongs in the notes are facts: the claimant stated X on this date and Y on that date; the receipt is dated two days after the reported loss; the loss occurred eleven days after coverage was increased. Facts survive scrutiny. Feelings, written down, become exhibits in a bad faith suit.

Third, ask yourself the disciplined question: what specifically triggered this? Force the intuition to explain itself. Sometimes it can, and you discover a genuine inconsistency worth verifying. Sometimes it cannot, and you discover that the trigger was something with no evidentiary value at all, like the claimant reminding you of someone from a previous fraudulent file. That discovery matters. It is the difference between an instinct and a prejudice.

Fourth, borrow another set of eyes. The fastest calibration tool available to any adjuster is a colleague with a different two thousand claims behind them. Describe the file to a veteran on your team, without editorializing, and watch whether their eyebrows move. If two experienced people with different histories get the same feeling from the same facts, the signal is likelier to be in the claim than in your biography. If the feeling is yours alone, that is worth knowing too, and it costs nothing but a conversation at the coffee machine. The adjusters with the best-calibrated instincts are almost never the ones who trust themselves most. They are the ones who check.

What to Do With the Feeling

Suppose the feeling arrives and survives the disciplined question. There are facts behind it, small mismatches that you can name. What now? The answer is deliberately boring.

You keep adjusting the claim. You handle it exactly as you would handle any other file, with the same timelines, the same courtesy, and the same commitment to paying what is owed. What changes is thoroughness, not tone. You verify things you might otherwise accept at face value. You ask open-ended questions and let the answers accumulate. You document with more precision. You request the documents the claim legitimately calls for, because a suspicious claim is investigated with the ordinary tools of good adjusting used well, and nothing more.

What you do not do is play detective. You do not run surveillance, confront the claimant with accusations, slow-walk payments as leverage, or deny first and investigate later. Every one of those moves is above your pay grade at best and a bad faith claim at worst, and the next article in this series deals with those boundaries in detail. If the mismatches keep accumulating and cross the threshold your carrier has defined, the file goes to SIU with a clean, factual referral, and trained investigators take it from there.

Ray, from our opening story, did exactly this. He never told the claimant he was suspicious. He never wrote the word fraud in his notes. He asked good questions, verified where verification was warranted, and documented what he found. When the neighbor's comment surfaced, the file was already in perfect condition to hand to SIU, and the claimant had no grievance about how the claim had been handled, because it had been handled correctly at every step.

The Instinct Worth Developing

The feeling that something is off will never be evidence, and it should never be treated as a conclusion. But it is not nothing. It is the accumulated pattern knowledge of your career asking for a moment of your conscious attention, and adjusters who learn to hear it, question it, and act on it with discipline are better at this job than those who ignore it and those who obey it.

Trust the smoke detector enough to look. Be honest enough to admit when it was burnt toast. And when it was not, be professional enough to let the process, and the people trained for it, do their work. That combination of alertness and restraint is what fraud awareness looks like when it is done well, and it is the theme every article in this series returns to.