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Description of Zalma\\u2019s Insurance Fraud Letter   

https://zalma.com/blog

Volume 25 Number 21 The Reason for the Examination Under Oath  Courts that construe submission to an EUO as a condition precedent to  recovery generally do not require the insurer to prove that it suffered  actual prejudice from an insured\'s unexcused refusal to submit to an  examination. Lorenzo\\u2013Martinez v. Safety Ins. Co., 58 Mass. App. Ct. 359,  790 N.E.2d 692, 695\\u201396 (2003). 

The EUO provides a mechanism for the  insurer to corroborate the claim by obtaining information that is  primarily or exclusively within the possession of the insured.  The adjuster, the independent adjuster, the Special Investigation Unit  (\\u201cSIU\\u201d) investigator, the independent insurance adjuster and, in complex  cases, the attorney retained to represent the insurer questions the  person interviewed in a manner similar to a deposition in a legal  proceeding. Because of the formality of the proceeding \\u2014 it includes an  oath, and the presence of a certified shorthand reporter \\u2014 the task of  establishing rapport with the person interviewed so that relevant  information may be obtained from the insured is more difficult than in  an informal interview. Unlike legal proceedings where questions are  limited to those seeking a \\u201cyes\\u201d or \\u201cno\\u201d or brief answer the EUO seeks  narrative responses from the person questioned.  

The person taking the EUO, therefore, must be capable of transitioning  from lawyer like questions in litigation to the broad, inquisitive,  narrative seeking questioning. An EUO should never be conducted as if it  is an adversarial activity but merely a fact seeking activity that is  directed to the needs of an insurance policy and the need to prove a  loss is either compensable or not.  Because the EUO is a tool for gleaning the maximum amount of information  the EUO is an effective weapon against insurance fraud. This is because  the person taking the EUO is knowledgeable about insurance and  insurance law while the person being questioned is only aware of the  claim presented and the fraud he or she may be attempting.  Often, however, the purpose of the EUO is not to stop fraud but to allow  an insured the opportunity to prove his or her claim of loss in cases  where evidence has been destroyed by a casualty or is otherwise  unavailable.  

New California Mandatory Fraud Warning  Insurers in California should note the requirement to update the  mandatory anti-fraud warnings on documents based on the recent signing  into law of AB1511.  This bill makes application fraud a specific crime in the state. 

 Georgia To Pay $870,000 To Whistleblowers Fired by Beck Who Pays for False Claims Act Actions? Health Insurance Fraud Convictions Other Insurance Fraud Convictions Free Insurance Videos  \\xa9 2021 \\u2013 Barry Zalma  Barry Zalma, Esq., CFE, now limits his practice to service as an  insurance consultant specializing in insurance coverage, insurance  claims handling, insurance bad faith and insurance fraud almost equally  for insurers and policyholders.  He also serves as an arbitrator or mediator for insurance related  disputes. He practiced law in California for more than 44 years as an  insurance coverage and claims handling lawyer and more than 54 years in  the insurance business.  

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