QuestionQUESTION: 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!
ANSWER: Hello Josh,
It is not uncommon for the SIU to become involved when a loss occurs immediately following an inception of coverage or a change in coverage.
They are trying to determine if your act was somehow intentional.
Now, having said that, let's look at this logically. From the company's perspective, could you have had previous damage that you are now trying to claim with a lower deductible?
What about injury? Would you benefit from the changes in the policy if you claimed injury?
Looking at this objectively, I can understand their concerns. And, of course, the situation is complicated because you cannot substantiate who hit you, much less if the accident occurred as you say. But also looking at it objectively and fairly, if they are going to accuse you of "fraud", they need to be able to substantiate it with actual evidence.
How would they do that? First, they would need to look at your car. Is the damage consistent with your account? And, yes, they could and may likely bring you in for an Examination Under Oath (EUO). If they do, you MUST comply. You must attend, and you must bring whatever documents they require. You do have the right (at your own expense) to bring an attorney with you if you desire.
The simple answer is to tell the truth. Facts will support the evidence.
Jane Pytel
http://SolutionsForYourInsuranceClaim.com
http://FloridaAutoInsuranceCentral.com
---------- FOLLOW-UP ----------
QUESTION: Thanks for your quick response. A followup to this is the process of the SIU investigation. The investigator came over and had me sign a release form indicating my acceptance into allowing them access to my phone records, phone tower etc. Also a background check is being performed which is not a problem except that i have a suspended license at the time of the incident with a probation officer. i believed that i had gotten a restricted license allowing me travel and i had checked my dmv records which showed that it was fine (recently). The question is will SIU leverage this information against me? For instance will they notify the probation officer or threaten me that they will? If they check my cell phone records they can corroborate my whereabouts so that would be fine but they would be aware of this by the time im called into the EUO or would that be after? They are able to pinpoint by way of cell tower (the release mentioned something about that) correct?
AnswerHello Josh,
Keep one thing in the forefront ... an SIU investigator (SI) is NOT a policeman. His/her job is not to "solve a crime" or to prove that you committed a crime. His/her job is to find reasons to pay claims. If, on the other hand, a fair and impartial investigation reveals facts that substantiate that the claim should not be paid, then it is his/her job to present the claims department with the evidence.
What's the difference? Contrary to the police, who investigate crimes, insurance companies are in the business of protecting their policyholders. This obligation also extends to the SIU. It is not the SI's job to "find fraud". It is the SI's job to conduct fair, impartial, and professional investigations which will result in the facts. If the facts reveal that the policyholder could have been involved in a fraudulent act, the SI is responsible to turn the EVIDENCE over to law enforcement. If the facts do not rise the level where they can substantiate fraud, it is the SI's job to turn the claim back over to claims for payment.
It is NOT the SI's job to harass you, to trick you, or to skew the evidence.
The fact that you had a suspended license at the time of the loss is not relevant to the investigation other than to establish, perhaps, why you did not call the police. It could, however be relevant to your future rates, or even if they fail renew your policy. But what does that have to do with the issue at hand? And, no, under no circumstances is it the SI's job to "threaten" you or to "leverage" things against you.
It is the SI's job to fairly investigate the claim based only on facts. If the SI gathers pertinent evidence that contradicts your account of the loss, that is one thing. But the SI cannot manufacture or manipulate evidence or introduce irrelevant circumstances, or threaten you, or violate your privacy in order to twist that evidence. Even the police can't do that!
You were wise to sign the release because your policy requires you to cooperate. And as long as you have nothing to hide, the towers should support your account of the loss. Yes, they can gain access to that information from your cell phone provider.
All of that information should be gathered before an EUO. In fact, if the evidence supports your account of the incident, there should be no EUO. If the evidence supports you, they need to pay the claim.
Stay focused.
Jane Pytel
http://SolutionsForYourInsuranceClaim.com
http://FloridaAutoInsuranceCentral.com
