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Courts Have Acknowledged the Importance of the EUO Process in the Evaluation of Suspect Claims.
REASONS TO ENGAGE SPECIALIZED INVESTIGATIONS
- Cost effective EUOs conducted by licensed private investigators in lieu of using outside SIU vendors or defense counsel.
- In the life cycle of a claim, the EUO is a separate and distinct coverage investigation.
- The California Private Investigators Act and policy provision of the insurance contract authorize private investigators to provide EUO coverage investigative services.
- Employing attorneys to conduct EUOs is a routine claims function that does not automatically make factual investigations subject to the attorney-client privilege or offer work product protection.
- There is potential for waivers of critical privileges by using defense counsel to investigate coverage and provide legal opinions.
- Our Vice President of Investigations is a Certified Fraud Examiner, Certified Fraud Specialist and Certified Private Investigator with over 32 years investigative experience.
- Our EUO Program Manager, an active member of the State Bar of California, is an SIU defense attorney, fraud investigator and EUO instructor at the NICB Specialized Investigations Academy.
- Senior SIU investigators have over 12 years training and experience and proven ability to investigate complex suspected fraudulent claims and conducting EUOs.
- Statewide EUO investigative services in California and Phoenix/Scottsdale Arizona
EUO Specialty Areas:
- Application Fraud
- Rate Evasion Fraud
- Bodily Injury Fraud (Med-Pay, UMC/UIMC)
- Arson for Profit
- Catastrophe Fraud
- Mold Fraud
- Property Fraud
- Auto Physical Damage Fraud
- Vehicle Glass Fraud
- Motorcycle Theft Fraud
- Staged Auto Accidents
- Vehicle Arson Fraud
- Vehicle Fraud
- Vehicle Rental Fraud
EUO COVERAGE INVESTIGATION SERVICES
- Apply common-sense claims handling and avoidance of outcome oriented investigations.
- Compliance with statutory claims practices and regulations, and the insurer’s claim processing guidelines.
- Review and game plan assignments and objectives to decide upon a EUO action plan and coverage issues reserved or suspected.
- SIU file review, underwriting file and policy contract analysis; identifying rights of the parties, coverage issues and defenses.
- Claim file document identification for EUO; production submission, and substantial compliance verification summary.
- Focused investigation on utilization of document review, witness statements and interviews, site inspection, testing and use of insurers’ internal resources.
- Communication and EUO scheduling upon reasonable notice, time, location and duration
- Clear and distinct EUO and document demand letters and Insurance.Code. §2071.1 notice of rights.
- Selection of appropriate subject matter experts on matters affecting coverage.
- Non adversarial cross examination on all proper subjects of inquiry relevant and reasonably necessary to process the claim to verify coverage.
- Objective and impartial comprehensive reporting of the results of the EUO investigation and realistic evaluations based on the facts and rational inferences.
- Specific investigative reports to make informed coverage decisions based on the whole factual record and not isolated facts or events.
- Retention and maintenance of all documents and records received or generated in the course of the investigation.
- Remote-capability cost containment options to view and participate in the EUO process
Specialized Investigations maintains compliance with the provisions of the following statutes and regulations as they apply to the investigation of suspected fraudulent insurance claims: (1) California Private Investigator Act, B&P.C. §§7521,7539: SIU Regulations, 10 CCR §§ 2698.30-2698.40; Insurance Fraud Prevention Act (IFPA), Ins.C. §§1871-1879.8; Fair Claims Settlement Practices Regulations, CCR §§ 2695.1-2695.10.
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