Tuesday, August 17, 2010

What is SIU and why are they handling my insurance claim?

SIU stands for Special Investigation Unit. It is not related to NCIS, CSI, or the NYPD and it is highly doubtful that anyone will ever feature it in a television series. In any event, most insurance companies have some variation of SIU. Claims with questions of fraud, misrepresentation, or concealment are typically referred to SIU.

The investigators within SIU often look, act, and dress like detectives (minus the shield and gun) and proceed with their investigation in a very similar manner. Their investigation will include taking recorded statements, visiting the location of the loss, collecting evidence, and basically confirming the contents of any prior statements, applications, or submissions. SIU investigators rely upon the "cooperation clause" in an insurance policy which requires that the insured cooperate with the insurance company's investigation as is reasonably necessary. They will push and probe, hoping to unearth some level of concealment or misrepresentation of material fact, both of which are grounds for denial.

If you are an insured, being contacted by an SIU claim representative should be a cue that something is up. There is a question about coverage or there's something that you may have done to raise a red flag. While it is not the time to panic that your claim will be denied, it is the time to be prudent about your next steps, document your cooperation, and speak with any attorney who can guide you through the process. Quite often claims that are referred to S.I.U. require an Examination Under Oath, which is a sworn deposition administered by the insurance company's attorney pursuant to the terms of the policy.

Knowing what SUI is an does can help avoid the potential for a big problem later. It is quite similar to being contacted by a detective investigating a crime. Cooperate but beware and proceed with caution, but always in full compliance with the insurance policy provisions.

Scott E. Agulnick

Wednesday, January 6, 2010

Bad Faith Insurance - It really is you against them...

Nowadays, more and more people who go to sleep at night believing they are protected by their home or business insurance policies are waking up to reality. Insurance companies have become experts at the ridiculous. Denial letters are issued by the truckload based upon any and every conceivable loophole which they perceive exists and quite often based upon nothing more than a misunderstanding of their own policy. The most disheartening are those denials based upon the paranoia of the claim representative, and the most disturbing are those based upon the spite of a power hungry rep.

Lets start with those involving the claim rep actually not understanding the policy. When approaching an insurance claim, it is important to keep in mind that the mid-level claim representative is not an expert in insurance. They train in finding ways to deny claims but fail to understand the actual text of the policies. It is that failure which can provide the most valuable ammunition.

One example is a case where a protective safeguard provision set forth that a certain type of fire suppression system. Lets call it "Brand X Hood and Duct System". There was a fire at the restaurant and the insurance company denied, stating that the insured's fire suppression system was not functioning properly. At the deposition of the insurance rep following the filing of the lawsuit, the rep was asked what that provision of the policy meant...In reality, Brand X did not make a product called a Hood and Duct System. The insurance company meant to require a fire suppression system but didn't and just assumed no one would notice. The attorney for the claim rep couldn't say what it meant...and their attorney objected stating that the claim rep, who denied the claim, was not a lawyer or expert and couldn't answer the question.

Interesting. Especially considering the average person is supposed to understand the policy itself. So from the outset of your claim, think three steps ahead of them and prepare for a battle of wits.

Scott E. Agulnick