See the full video at https://youtu.be/6LSCmmwDhtM  A well-executed EUO is not only one of the insurer's most effective weapons against fraud. It can also be very instructive for the adjuster. If a lawyer is responsible for conducting the investigation, the adjuster must clarify that it is his or her duty to provide sufficient factual information supported by the legal authority for the insurer to make a decision in the claim.
The adjuster should also, if possible, attend the EUO to assist the lawyer and study interrogation techniques. Lawyers, whose job it is to ask questions, will usually do a more in-depth job for EUO than insurance claims staff will do.
After the EUO, the lawyer will usually propose further investigation and may also provide the court with legal advice on the insurer's rights, obligations and obligations.
The Counsel's report should include all the facts necessary to support all decisions, whether learned during the investigation or from testimony at the EUO. The adjuster must analyze the facts in relation to statutory and case law; only then will he or she be able to make a fully informed decision about the claim. Often, the examination will not get the insurer's lawyer to recommend full compensation to the insured.
If the lawyer advises the insurer that compensation should not be paid the adjuster should carefully analyze recommendations to independently verify that there are sufficient facts, supported by policy language and legal precedent, to support the conclusion. It is the injured party who makes the decision, not the lawyer. Decisions made by insurers sometimes have to be based on reasons other than the law.
Insurers should use the EUO tool wisely. It should only be used in cases where the insured is unable to prove his loss, when the insurance's proof is inconsistent or incomplete, or when the insurer has a reasonable conviction that a fraud is being attempted.
© 2020 – Barry Zalma
Barry Zalma, Esq., CFE, now limits his practice to serving as an insurance consultant specializing in insurance coverage, insurance claims handling, cheating and insurance fraudsters almost equally for insurers and insurance policyholders . He also acts as an arbitrator or mediator for insurance-related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims lawyer and more than 52 years in the insurance industry. He is available at http://www.zalma.com and firstname.lastname@example.org.
Mr. Zalma is the first recipient of the first annual Claims Magazine / ACE Legend Award.
For the past 52 years, Barry Zalma has devoted his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to enable insurers and their claims staff to become insurance claims staff.
https://zalma.com/zalmas-insurance-fraud-letter-2/ Last read two issues of ZIFL here.
Go to Barry Zalma videos on Rumble.com at https://rumble.com/c/c-262921  Read posts from Barry Zalma at https://parler.com/ profile / Zalma / post
Listen to the podcast: Zalma om försäkring https://anchor.fm/dashboard/episodesZalma om försäkring
Go to Barry Zalma on YouTube – https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg/
Go to the Insurance Claims Library – https://zalma.com/blog/ Insurance -claims libraries /
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