Auto Insurance Claims: SIU, insurance expert, SIU

Question
Expert: Jane Pytel - 6/12/2012
RE:
Question
QUESTION: I recently had a policy change made in order for an extended travel plan outside of my residence. The day after the policy change i was involved in an accident in a parking lot and i did not get any information about the other driver. As it stands the policy change included a reduced deductible from the previous deductible and the insurance company sent a special investigations unit. What can i expect from this? I have been reading these questions and I was curious to know how often such situations lead to an examination under oath. Thank you!




I am also in a very similar situation.  I made a minor change to the deductible and had an accident a couple months later.  Now they are investigating the accident and my residency.  However, I feel very violated as the SIU is asking for very personal information such as bank statements and such business documents and asked very personal questions that have nothing to do with the accident itself.  What happens if I refuse to sign the consent for release of bank documents and employment records?  Would it be wise to get an attorney?

Answer
Hello Chantel,

Incidents such as lowering a deductible and then immediately filing a claim under the new terms almost always trigger what insurance companies call "red flags".  

Practically speaking, a parking lot fender bender should not be a subject for an SIU unless there are other issues.  Those issues could include a claim for pre-existing damages claimed as current damages, or if the damages were not consistent with a parking lot accident, etc.

If I'm reading you correctly, this is the second incident where you changed your deductible and an accident occurred a short time later.  Sine insurance companies do review claims history when a new claim is reported, the involvement of SIU is not surprising.

SIU does, however, have a duty to thoroughly review the claims before they proceed with a full blown investigation.  In that you have received requests for additional information not ordinarily required in a "routine" claims investigation, one would hope that SIU is requesting this information as a part of a legitimate investigation.  This does not mean you are "guilty".  It simply means that SIU reasonably believes (or should reasonably believe)that your claim has sufficient question to warrant additional investigation.

If you refuse to cooperate your claim(s) will almost certainly be denied.  Your policy requires cooperation.  The same would be true for an EUO.  An EUO may be requested under the terms of your policy.  If you refuse to appear, your claim will almost certainly be denied.  An EUO is a condition precedent to your coverage.  When claims are denied for failure to cooperate and/or for failure to appear for an EUO, your chances of mounting a successful legal challenge are at about zero.

Should you hire an attorney?  For what?  To contest the terms of your policy?  My opinion - don't waste your money.  Can the attorney be present at the EUO?  Yes.  But this is not a deposition - it is an EUO.  Your attorney is there to represent you, but he/she does not have a speaking role.

If you believe from the tone of the investigation that you are legitimately in danger of being accused of insurance fraud, then yes, you need an attorney.  In claims where there is actual fraud, I would suggest the defense attorney should encourage the client to withdraw the claim.


Jane Pytel