We are frequently retained to combat insurance fraud on behalf of insurers in three separate contexts. First, on behalf of insurers, we conduct the examination under oath of their own insureds, shortly after a claim is made. Second, we defend insurers in cases where an insurer or third party has instigated civil proceedings, and where the insurer alleges that the claim is either wholly or partly fraudulent. Third, we subrogate against service providers on behalf of insureds and insurers, where an insurer has paid out on a loss based on a fraud.
Examinations Under Oath
Examinations under oath are sought by insurers most often in personal injury and property claims. In personal injury claims, vigilant insurers request examinations under oath of their insureds where the information they receive in the accident benefit process from their insured and from third parties is not independently verifiable, and where an insured fails to provide adequate information to support his or her request for benefits. The authority for examinations under oath in the personal injury context is found in the Insurance Act.
In the property context, vigilant insurers request examinations under oath when the circumstances of a claim appear suspicious and where the insured or third parties fail to provide proper information and documentation to support an insured’s claims. The authority for examinations under oath in the property context is found in the insurance contract itself.
Often, the examination under oath process reveals an innocent insured who simply fails to understand his or her obligation to provide the insurer with sufficient information. In other cases, the examination under oath process uncovers exaggerated or even outright fraudulent claims. Either way, the examination under oath process is often a good investment for insurers.
Defence of Fraudulent Claims
From time to time, insurers refuse to provide coverage for personal injury and property claims based on their own investigations, examinations under oath results, and based on the claims review process. When this happens, an insured may bring an action seeking judgment against their own insurer for their loss. Often, such claims include an allegation of bad faith against an insurer, and a plea for punitive damages. In response to such claims, an insurer may claim a variety of defences, including alleging fraud by virtue of the insured being responsible for their own loss.
Subrogation and Recovery Claims
At Investigation Counsel, we have successfully alleged fraud against third parties and have obtained recovery for insurers. For example, an auto body company issued a claim against an insurer and their insured for failing to pay its invoices relating to the repairs of an insured’s vehicle. The insurer paid its insured for the loss, but then sued the auto body company alleging fraud, including particulars that the auto body company had caused additional damage to the insured’s vehicle while it was in their possession. On the eve of trial, the auto body company paid the claim, including punitive damages. The costs for litigating the matter were ordered to be assessed against the auto body company.
At Investigation Counsel, we are familiar with investigating and litigating many forms of insurance fraud, and we welcome you to contact us to discuss an investigation, litigation and recovery plan.