Every month I receive and read Barry Zalma’s Fraud Newsletter. It usually has a lot more insurance claims information than stories only about fraud. This month’s edition had a lot of information, and I want to suggest that readers of this blog also subscribe to Zalma’s publication.
Barry Zalma supports insurance claims professional education. His current newsletter listed numerous publications, many found in my library, which he suggests claims professionals should study.
He had an excellent and lengthy article about examinations under oath, which stated in part:
An attorney is not an insurance adjuster. The attorney representing an insurer at an EUO is not a “super adjuster.” The attorney is a lawyer who was retained to provide legal advice and counsel after assisting the insurer in gathering facts at an EUO.
Competent outside adjustment services can be obtained for a great deal less per hour than any attorney. The EUO should complement, and be part of, the thorough investigation of the Insurance Claims Professional.
It should provide the information that the Insurance claims professional is unable to obtain because of the recalcitrance of the Insured, because of the lack of records, or because complex legal and factual issues have made resolution of the claim on an adjusting level impossible.
No lawyer is always right. Perfection is not handed out 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 Insurance claims professional with detail sufficient to make a decision, the insurance claims professional must require the attor¬ney to provide the detail before making a decision.
An attorney who tells the insurance claims professional 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 his or her ability counsel must always know the basis for the advice given.
Counsel’s report to an insurer after completing an EUO should include, at least:
1. All facts learned in the investigation;
2. The applicable policy wording on which counsel relies;
3. The facts must then be analyzed in relation to statutory and case law;
4. The testimony at the EUO that supports his opinions; and
5. Counsel’s recommendations for further investigation or for resolution of the claim.
I do not agree with everything Barry Zalma writes, but I find his honesty of views refreshing, given his background as an insurance defense attorney.
Thought For The day
Question everything. Learn something. Answer nothing.