A small percentage of insurance claimants are investigated by an insurance company through what is called an examination under oath. If your examination has been requested, you need to be prepared. This article is meant to provide information on some of the critical dos and don’ts for an examination under oath.
What is an Examination Under Oath
Most Florida insurance policies contain a provision that requires a policyholder to submit to an examination under oath if requested by the insurance company. This stems from the insurance company’s right to investigate an insurance claim. It is important to understand that your policy likely contains a clause that requires you to submit to an examination under oath. In other words, it is something you likely agreed to when you purchased the policy.
An examination under oath is similar to a deposition in a few important respects. The insurance company can ask you questions and your answers must be sworn and under oath. The questions that are asked need to be related to the insurance claim, the insurance policy, or some facts related to the insurance claim or policy. Unlike a deposition, your examination is not subject to the rules of civil procedure and the insurance company is given broad latitude to ask you questions that it believes to be relevant.
When you receive a request for an examination under oath, you will often receive a separate request to produce a long list of documents. These documents may include estimate, pictures, inspection reports, purchase documents, maintenance records, financial records, and much more. Many clients have a difficult time understanding why certain records requested by the insurance company are relevant and can be produced in the first place.
What Are The Limitations on an Examination Under Oath?
It is important to understand that the insurance company is taking an examination pursuant to its contractual right to investigate the claim. You agreed to the examination when you purchased the insurance policy. Still, an insurance company cannot abuse its investigative right by seeking information that is completely irrelevant or that is only be sought to intimidate or harass the policyholder. For example, the mere fact that you have made a standard property damage claim does not entitle the insurance company to obtain years of financial records. Likewise, an insurance company that seeks personal, embarrassing, or sensitive information not important to the policy or claim could be viewed as harassing or seeking to improperly intimidate the policyholder.
What Will Happen if you Do Not Comply with the Examination Under Oath?
Every insurance policy contains a provision generally referred to as a cooperation clause. This generally states that you will cooperate with the insurance company by producing information/documents and submitting to an examination when requested. If you fail to cooperate in the investigation of your claim, your claim can be denied. In short, ignoring the investigation and examination request will almost certainly not go well.
Another potential hazard is failing to answer questions at the examination accurately. Many policyholders do not have clear understanding of all facts that the insurance company may be investigating. We have seen examples where an unprepared policyholder answers questions by essentially guessing the answers or simply stating things that are inaccurate. This can be devastating to your insurance claim because the insurance company will use the inaccurate answers to argue that the policyholder was acting deceptive or fraudulently. This is why having an experienced insurance coverage attorney to represent you is key.
Is an Examination Under Oath a Sign that Your Claim will be Denied?
Sometimes. Examinations are somewhat rare. They are typically taken when the insurance company believes there may be a reason to deny all or a significant portion of your claim. Many times the insurance company may suspect that some form of insurance fraud has occurred and are looking to confirm facts that will support a coverage denial.
For insurance companies, denying a claim can pose a risk as well. In Florida, the wrongful denial of a claim can potentially subject the insurance company to a bad faith insurance claim and the policyholder can potentially recover significantly more damages plus attorney’s fees. This is why insurance companies will often take an examination under oath prior to denying a claim.
What Types of Claims or Issues Usually Lead to an Examination?
There is really no way to anticipate if you will be required to submit to an examination under oath. However, the following are some possible factors making an examination under oath more likely:
- You are being investigated for arson, insurance fraud, or some other crime related to the insurance claim.
- You have claimed damages significantly higher than the insurance company’s estimate or undisputed tender.
- You are alleged to have withheld relevant information when applying for the insurance policy.
- The cause of the damage was unwitnessed or is in dispute.
- The insurance company believes the claim may be excluded under the policy and is seeking information to support a denial.
Tips for an Examination Under Oath
If your insurance company wants to take your examination under oath, here are a few tips:
- Review closely all letters sent by the insurance company.
- Produce all documents requested by the insurance company.
- Inform the insurance company in writing if you do not understand a request for documents.
- Review the damage estimates, proof of loss, photographs, and other documents related to the value of the claim.
- Do not guess about expert conclusions or opinions. This includes the opinion of adjusters, contractors, engineers, and many others.
- Do no answer questions by guessing or assuming facts that you do not know with complete certainty.
- Avoid making inconsistent statements.
Is an Attorney Necessary for an Examination Under Oath?
Having an attorney to represent you through the examination process (as well as potential litigation) is important. Examinations are somewhat rare and it is important to take caution once the insurance company begins investigating you claim closely. An attorney can help you prevent the following mishaps:
- Failing to produce relevant documents.
- Understanding the scope of documents and evidence requested.
- Ensuring insurance company requests are handled timely.
- Understanding the questions that will likely be asked at the examination.
- Preparing responses in a clear, truthful, and consistent manner.
- Preparing thoroughly to provide sworn testimony.
The insurance company will have an experienced lawyer representing it at the examination under oath. Having an experienced Florida insurance attorney in your corner can mean the difference between a good and bad outcome. If your examination has been requested, call today for a free consultation. We have assisted hundreds of clients through complicated insurance claims.
