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

No comments:

Post a Comment