Copyright held by The John Cooke Fraud Report. Reprint rights are granted with attribution to The John Cooke Fraud Report with a link to this website.
By G. Andrew Nagle, Esq.
Claim representatives and insurers face civil and criminal liability exposure for statements and writings made to others in the course of investigations of fraudulent activity. The following rules are intended to assist the claims personnel in minimizing exposure while maximizing investigative tools to detect insurance fraud.
Rule Number One
INSURANCE COMPANIES HAVE THE RIGHT TO INVESTIGATE ALL CLAIMS. INVESTIGATIONS MUST BE REASONABLE AND MAY NOT INTIMIDATE, HARASSOR INVADE ONE’S PRIVACY.
Rule Number Two
UNLESS YOUR STATE HAS ENACTED THE INSURANCE INFORMATION AND PRIVACY PROTECTION ACT WITH PROVISIONS FOR FREE EXCHANGE OFINFORMATION WITH OTHER CARRIERS PURSUANT TO FRAUD INVESTIGATIONS, DO NOT DISCLOSE PERSONAL OR CONFIDENTIAL INFORMATION WITHOUT A
PROPER WRITTEN AUTHORIZATION OR LAWFUL SUBPOENA.
Rule Number Three
IF YOU CHOOSE TO MAKE POTENTIALLY DEFAMATORY STATEMENTS TO YOUR INSURED (SUCH AS YOUR BELIEF THAT HE IS PARTICIPATING IN A FRAUDULENT CLAIM), DO NOT DISCLOSE YOUR DEFAMATORY STATEMENTS TO ANY THIRD PARTIES.
Rule Number Four
IF YOUR STATE PROVIDES QUALIFIED OR CONDITIONAL PRIVILEGES AGAINST DEFAMATION TO INSURERS, POTENTIALLY DEFAMATORY REMARKS MAY BE MADE TO THE PLAINTIFF’S COUNSEL, PLAINTIFF OR INSURED IF STATEMENTS ARE MADE IN FURTHERANCE OF THE CLAIM. IF IT IS NECESSARY OR USEFUL TO MAKE DEFAMATORY STATEMENTS, DO NOT PUBLISH THE REMARKS TO THIRD PARTIES.
Rule Number Five
DISCLOSURE OF CONFIDENTIAL INFORMATION MAY BE MADE TO LAW ENFORCEMENT AND STATE DEPARTMENTS OF INSURANCE IF YOUR JURISDICTION HAS ENACTED AN IMMUNITY LAW ALLOWING SAME.
Andy Nagle is an attorney with Fields and Creason in Santa Ana, CA.
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