QuestionQUESTION: Car was stolen from parking lot of Enterprise car rental 2/8/11, cooperating plus submitted all paperwork requested. Received letter that they will need 30 more days to process claim. After giving tape recorded interview with SIU, he called me threatening that he was going to pull up records of GPS locations of my phone of the night in question, look at Enterprise video footage and turn eveidence into the police. Told him that all of the above wasn't a problem since I had nothing to do with car being stolen but now I ask, what are my rights as a customer since the insurance company is treating me like a criminal and is this their normal rule-out process?
ANSWER: Hello Meli,
Speaking as a former SIU investigator, I am astounded.
First and foremost, an SIU investigator has no subpoena powers. He is not a police officer. He has no authority to "pull up records of your GPS" unless you give him permission to do so.
Secondly, an SIU investigator, in fact no employee of any insurance company, has the freedom to "threaten" you.
He might be able to persuade Enterprise to reveal their surveillance tapes, but Enterprise should consider that only at their own peril. In my opinion, Enterprise should not insert themselves into this. If the police want it, fine. In fact, the police should have access only by subpoena.
SIU becomes involved in a claim when there is a suspicion that a claim could be fraudulent. If the adjuster perceives "red flags", they will refer a claim to the SIU. On the surface, this is fine. Problems begin to surface when insurance companies use their SIU's as a means to avoid legitimate claims settlements, or when their SIU's act outside the scope of the law.
I can tell you from experience that theft/fires are automatically suspect. On the surface it would not be out of the ordinary for an adjuster to refer the claim to SIU. In fact, many insurance companies follow procedures that require all theft fire claims to be referred to SIU for further review.
The point here is that while a "routine" referral is probably OK, it is not within the authority of the SIU to take the claim to a new level. If the insurance company, by way of its SIU chooses to deny your claim based on fabricated evidence, the insurance company is in serious trouble. Serious trouble, that is, if you, by way of an experienced bad faith attorney, decide to sue them.
Based on what you have told me, in my opinion you are dealing with a rogue SIU. In fact, if there is any evidence that you set fire to your car, the police should be working the case. I should add that the insurance company can secure forensics evidence, and they can turn that over to the police. The police would have to be able to substantiate "probable cause" that you were involved.
While the insurance company does not have to meet the standards of a criminal charge, nonetheless if the insurance company denies your claim, they had better have solid evidence that you were involved.
Do not allow the SIU to intimidate you. You must, however, cooperate in the alleged investigation. If they call you to an EUO, you must attend. Anticipate that they will ask for authority to gain access to your GPS or other phone records. They key is, do they have sufficient cause to ask you for these very personal documents? And even if you grant them access, what could it possibly tell them? Is it possible that they would "manufacture" facts for the purposes of denying your claim?
You do have the right to have an attorney represent you at the EUO if you so choose. You might want to seriously consider that. And, understand that anything you say in the EUO can be turned over to the police.
If the insurance company denies your claim, make sure the denial is in writing and that it specifies the exact policy provision that you are alleged to have violated. I assume that will be the fraud clause.
If you are not involved in this as you state, either directly or indirectly, and your claim is denied, I suggest you obtain an insurance attorney who specializes in Bad Faith.
If you need me to follow up, please let me know.
Jane Pytel
http://SolutionsForYourInsuranceClaim.com
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QUESTION: Is there anything I could do to speed up the process? My rental reimbursement won't take over until after their investigation and I'm running out of funds for my rental car.
ANSWER: Hello Meli,
Continued amazement ... Sounds like they have you convicted already.
You need to find out exactly what it is in your claim that:
1. Authorizes them to deny you of your benefits
2. Allows them to investigate at their own speed to your detriment.
Understand that your insurance company has a contractual obligation to you to fairly and promptly investigate your claim. Any questions or concerns, without supporting evidence, must be resolved to your favor.
I suggest you do this in writing to the claims manager and the SIU manager. If you cannot obtain their names, at least find out the exact address where the adjuster and the SIU person are and address it generically to the managers. Make certain you include your claim number. I would also add that you are in the process of retaining an attorney. Or, if you prefer, get the attorney first, quickly, and let him do the corresponding. Personally, I think that is the better choice.
You don't mention what state you are in. Depending on the state laws, you should be able to file for bad faith if they deny your claim, or if they just continue to stall. But there are certain steps that you must take to get this process started. I would consider doing the groundwork now. As I suggested before, find a plaintiff insurance attorney who also specializes in bad faith. Initially, the attorney might serve to expedite your claim. Insurance companies do not like it when a plaintiff attorney appears on the scene. This alone could force them to settle. If not, at least your attorney could provide you with the professional advice you need on how to proceed from this point.
In these matters attorneys take a "contingency" fee which means they get paid when you do. If the attorney forces a settlement, he would get a percentage of your settlement. The amount depends on your state laws.
At least get a legal opinion to protect yourself. You can do some research online. Check your state Bar to check on the credentials and history of an attorney before you contact them. Or, you can go through the Bar directly. Most state Bars provide referral services.
You can consider my ebook, power To Profit, on my website for $19.95. But quite frankly, I think you are at the level where you need an attorney's advice.
I wish you well. Follow up if you need to.
Jane Pytel
http:SolutionsForYourInsuranceClaim
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QUESTION: After contacting the Ca Dept of Insurance via internet in regards to my rights as a consumer and rental reimbursement not being honored, received a call from the spv. of theft dept at Geico staing that he was responding to my complaint to the Ca Dept of Insurance and that they now wanted an interview under oath with a court reporter, wanted all maintenance records for the car, current and previous rental invoices and other paperwprk!!!!! I think I need a lawyer being that Geico is now being malicious. Do you have any advice for me? and I asked them about paying the premium for this month and he said it was up to me. Is that true?
Answer Hello Meli,
You MUST pay your premium unless you want to have your insurance cancelled. Especially now, before this is concluded, you do not want to be looking for another insurance company. Insurance companies have access to each others claims history information via what is called C.L.U.E. I highly recommend you stay where you are for now.
Good choice to contact the Dept of Insurance (DOI). They cannot intervene directly into your claim, but they can make things very uncomfortable for an insurance company. Having said that, based on my experience, Geico has likely replied to them informing them that they are investigating your claim for insurance fraud. If Geico is on the ball at all here, they will need to actually investigate your claim. And, hence the Sworn Statement/Examination Under Oath (EUO). As I said before, you absolutely must attend the EUO. Your policy requires it. If you fail to attend, they can and will deny your claim. You won't have a leg to stand on.
Again, based on my experience, they might take your EUO with the hopes that can catch you misrepresenting the facts. Although it is unethical in my opinion, in such a situation you would be asked trick questions in an effort to confuse you or in an effort to make it appear that you are not telling the truth. While an EUO is not supposed to be a confrontation - because it involves the insured to whom the company has a contractual obligation - too often an EUO is just that. And if an insurance company can "prove" you are lying, most likely they will deny your claim.
If they had something at this point to establish that you were involved in the theft and fire of your car, (such as facts and evidence) they would probably already have denied it, as they should. Unfortunately, this is why EUO's are too often used to attempt to deny claims when the facts and the evidence do not support what the insurance company wants them to support. I don't know if that is happening here, but you have to assume the worst.
While the police have a higher standard of proof than an insurance company, nonetheless, if the police had a suspicion that you are involved in a crime, they most likely would have contacted you by now. Hence my conclusion that there is insufficient evidence to implicate you - and hence the EUO.
Do you need an attorney? I can only answer that from my perspective and having seen what happens from the other side. I would not even consider appearing for an EUO without an attorney to represent me. So, yes, I believe you must get an attorney. If they set your testimony before you have the time to obtain that attorney, legitimately hiring an attorney is a valid reason to delay the EUO. You would have to notify them appropriately before the first scheduled EUO.
Another point. Other than during the EUO, your company can no longer speak to you directly once they have received notice that you are represented. One thing this does is stop harassing phone calls. Once you are represented, they must speak to your attorney.
Here are a few important facts that apply in your predicament:
1. Absolutely obtain a lawyer that can prove that he/she has extensive experience in insurance. And, even more specifically, look for an attorney that specializes in, or is an associate with lawyers who do specialize in insurance bad faith. It is always good to obtain a plaintiff attorney who used to be an insurance defense attorney. Though this is not necessary. Probably your best bet is to contact the CA Bar and ask for some referrals.
2. An attorney cannot participate in the EUO like in a court proceeding such as a deposition. His job is to advise you and to listen. He cannot interrupt during the EUO, but he can speak to you privately by asking for a break.
3. If your attorney tells you to leave during the EUO, that is a bad idea. If an attorney acting on your behalf interferes in your requirement to cooperate, the insurance company can deny your claim. An experienced an attorney will not do this. But if this does happen, ask for a break and speak with you attorney privately. Do not walk out of that EUO!
4. You have no 5th amendment rights in an EUO. And, the insurance company can turn your testimony over to the police.
5. You should comply with all document requests. However, if some of their requests are invasive, harassing, or completely unrelated, let your attorney handle that. Again I stress the need for a skilled, experienced insurance attorney.
If this proceeds to a bad faith action, you will absolutely need legal representation.
I wish you well.
Jane Pytel
http://SolutionsForYourInsuranceClaim.com
