Insurance Claims Investigations
Drawing upon the expertise and skills of its various practice groups, Schiller Barnes Maloney PLLC attorneys regularly handle the investigation, analysis and litigation of suspicious insurance claims. All attorneys have the expertise and ability to provide coverage analysis of suspicious claims, as well as the trial experience needed to defend and litigate every aspect of first and third-party fraudulent claims in arbitrations and trials.
Examination Under Oath (EUO)
An Examination Under Oath (or EUO) is a interview conducted by an an attorney working with an insurance company to review a claim. Typically, the insurer will ask for an EUO to help make a determination of coverage or value for a claim. The process is very similar to a deposition in a civil court case. The insured is sworn to tell the truth and then asked questions regarding the loss and the claim to assist the insurer in its investigation.
At SBM, our attorneys are trained and experienced in assisting insurance companies and their special investigations units (SIUs) to uncover fraudulent insurance claims. By conducting extensive fact investigations, including taking examinations under oath (EUOs), we aid insurers throughout the claims process and beyond. Whether the loss concerns a suspected fraudulent motor vehicle accident or arson or anything in between, we work in conjunction with insurers to make sure any claims made are valid before they are ever paid.
Expert Opinions (Regarding Basis for Denial or Payment)
Expert opinions are necessary during some insurance claims investigations, particularly in complex construction or fire loss claims. However, they are often helpful in seemingly simple cases as well. Cases where potential liability seems low, but the damages claimed are high. Cases where the subjective claims do not correlate with the objective evidence presented.
Whether the issue is liability, damages, or both, SBM attorneys are prepared to engage relevant experts to assist them in their investigations and evaluations. SBM attorneys use this knowledge to advise insurers on both the legal and technical aspects of every given claim. This allows an insurer to confidently deny liability or payment for damages on invalid claims, while also justifying an insurer’s payments on those claims which have been diligently determined to, in fact, be valid.
Insurance fraud happens when individuals or businesses take any actions with respect to an insurance claim with the intent to bring about an outcome which is favorable to them, but to which they are not otherwise entitled. Insurance fraud is not a victimless crime. According to the National Insurance Crime Bureau (NICB), insurance fraud is ranked as the second most expensive white-collar crime in the United States, costing the nation upwards of $80 billion per year. At SBM, our attorneys work tirelessly to investigate claims which may be fraudulent. We use every discovery tool available, including but not limited to, EUOs and consulting experts to work directly with insurers and their special investigation units (SIUs) to develop evidence to prove fraudulent plans or patterns if, and when, they exist.