Entities that are facing questionable insurance claims generally need to evaluate the facts without negatively impacting the integrity of their defense options. When evidence doesn’t support an account of a reported motor vehicle crash, for example, injury timelines, treatment plan or damages, digging deeper into the matter at issue is going to be necessary.
In some cases, staged accidents, exaggerated injuries, inconsistent statements, litigation funding issues and unusual billing practices are some of the matters that might need to be scrutinized. Insurance defense isn’t necessarily about assuming fraud. Instead, the goal is to identify red flags while preserving important evidence to build a strategy based on the policy terms, claim history, medical records and applicable New York laws.
SIU’s role in defense
The Special Investigation Unit’s (SIU) findings can become an important part of suspicious claim evaluations. These findings can include a host of information, such as recorded statements, social media findings, scene information, medical chronologies, provider patterns and inconsistencies in the reported losses.
Throughout the defense review, there are many questions about any injuries that will be considered:
- Do the injuries match the damage to the vehicle?
- Do the treatments for the injuries begin at a reasonable time?
- Do the named providers appear across related claims?
- Do witness statements support the accident reports?
All of these details can help to determine if a claim should be negotiated, defended, investigated more or denied. If the claim is moving through the litigation process, the information may affect motions, discovery, expert review and overall trial preparation.
Insurance defense matters
Insurance defense claims are often complex because of the steps they require. Evaluating coverage issues, responding to demands, organizing evidence and managing various deadlines are all part of this process.
While every inconsistency will not signal fraud, patterns can’t be ignored. Early review and consistent claim handling are beneficial throughout the insurance claim defense process. It may be beneficial to work with a legal professional familiar with these matters as well, primarily because of the complexities and nuances at issue and all that is at stake.