A Video Description of Zalma’s Insurance Fraud Letter Volume 25 Number 21 and the Full Text

See the full November 1, 2021 issue of Zalma's Insurance Fraud Letter at https://www.linkedin.com/pulse/zalmas-insurance-fraud-letter-barry-zalma-esq-cfe-6860914368763326464 and at https://zalma.com/blog plus more than 3950 posts. 

See the full video at https://rumble.com/vogxro-zalmas-insurance-fraud-letter-november-1-2021.html and at https://youtu.be/tfyirYOTU98

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–Martinez v. Safety Ins. Co., 58 Mass. App. Ct. 359, 790 N.E.2d 692, 695–96 (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 (“SIU”) 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 — it includes an oath, and the presence of a certified shorthand reporter — 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 “yes” or “no” 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. 

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

© 2021 – Barry Zalma