Every month I receive and read Barry Zalma’s Fraud Newsletter. It usually has a lot more information about insurance claims than stories about just fraud. This month’s edition had a lot of information, and I would like to suggest that readers of this blog also subscribe to Zalma’s publication.
Barry Zalma supports vocational training for insurance claims. His current newsletter listed numerous publications, many found in my library, that he suggests argue professionals should study.
He had an excellent and lengthy article on investigations under oath, which read in part:
An attorney is not an insurance adjuster. The attorney representing an insurer at an EUO is not a “super adjuster.”; The solicitor is a lawyer who was engaged to provide legal advice and counsel after helping the insurer gather facts on an EUO.
Competent outside alignment services can be obtained for much less per hour than any attorney. The EUO should supplement, and be part of, the thorough investigation of the insurance fund.
It should provide the information that the insurance fund cannot obtain because of the insured’s reluctance, because of the lack of records or because complex legal and factual issues have made it impossible to resolve the claim at an adjustment level.
No lawyer is always right. Perfection is not awarded with a law degree. Decisions made by insurers must sometimes be based on reasons other than the law. If the attorney fails to provide the claims professional with details sufficient to make a decision, the claims specialist must require the attorney to provide the details before making a decision.
A lawyer who tells the underwriters to do something “because I say so” is courting disaster for his client and himself. In order to advise the insurer to the best of their ability, agents must always know the basis for the advice given.
The agent’s report to an insurer after completing an EUO should include at least:
1. All facts learned during the investigation;
2. The applicable policy language relied upon by the attorney;
3. The facts must then be analyzed in relation to law and case law;
4. The testimony at the EUO supporting his views; and
5. The representative’s recommendations for further investigation or for resolution of the claim.
I don’t agree with everything Barry Zalma writes, but I find his honesty of opinion refreshing, given his background as an insurance defense attorney.
Here is the link to subscribe to Zalma’s newsletter: https://barryzalma.substack.com/
Question everything. Learn something. Answer nothing.