Examinations Under Oath, Part III
(Note: This guest blog is by Nicole Vinson, an attorney with Merlin Law Group in the Tampa, Florida, office. This is part of a series she is writing on Examinations Under Oath and Public Adjusters).
Everyday, I talk with various people about insurance claims. I meet with public adjusters, consult with clients, discuss cases with my colleagues, talk with defense counsel, and, often, take testimony of witnesses or experts concerning insurance claims. My focus in all of these communications is to find a way to help the client and solve the problem. Many times this is easier said than done.
Yesterday, I was talking to a lawyer who practices in a different area of the law and in a different state. We were having a friendly chat, but then the conversation turned. She began telling me how unhappy she had become practicing in her area of the law. She felt she was not serving her client. My friend wanted to be evaluated on her assistance to the client and the client trust she built over the years but, instead, her boss recently only offered her feedback on the number of hours she billed. She asked me whether I thought her client relationships and quality of assistance mattered. I told her that her clients appreciated her work, even if the firm seemed to have a different focus. She then told me she felt it was time to change from defending medical malpractice claims to something new. She said she wanted to help people and wanted her work to have meaning. She wants to do plaintiffs work.
It sounds simple, but helping a client can be a challenge. Assisting policyholders with insurance claims is a great way to help people get what they rightfully deserve -- the benefit of what they bargained for when they purchased an insurance policy. However, the path and tactics used to help the client can vary.
With respect to demands for examinations under oath, the best approach is what will help the client. Consider how your actions affect the client’s claim in the short term and in the long run. Think about how your actions will encourage a positive resolution for the client. The words seem simple, but I think public adjusters sometimes feel personally attacked when an insurance company adds an additional hurdle to a claim payment. If the insurance policy has a provision which stretches the EUO requirement to those other than the insured, consider the claim, the client and what is the best way to get the claim paid quickly. Whenever an examination under oath is demanded, a lawyer should be retained.
Lawyers who handle examinations frequently know how important the examinations can be in connection with the claim as a whole. Also, a lawyer who has a “client focus” can help to ensure the actions taken before, after, and during the EUO are in the client’s best interest. One example of a way to help includes pre-EUO stipulations. The lawyer can help the client with the claim by reaching agreements about who will testify, the documents requested, and the time, place, and manner in which the EUO will occur. The lawyer may be able to substitute the requested testimony of one insured for another or for a public adjuster. Depending on the case, a public adjuster’s assistance in the EUO may help the client’s claim reach a prompt and proper resolution.
By making sure your focus is on the client, you will be able to best resolve the claim. For example, consider the elderly or widowed client who has relied on hired professionals for the entire claim. If the insurance company really wants answers about the claim presentation, the PA may be the best person to testify. The client’s responses may be incomplete, and the public adjuster may be able to speak to various aspects of the claim and explain the claim evaluation in a sophisticated manner based on first-hand knowledge. As in any industry, there a common language in insurance, and an EUO between two professionals may go more quickly and with fewer instances of miscommunication.
In sum, I challenge you to truly consider what is the best for a prompt resolution of your client’s claim.
Nicole:
Your comments go right to the heart of many of the problems that my industry faces today. Being a public adjuster means much more than being in a well paying profession. Bad things happen when the p.a. puts his (or her) interests before the client's interests. If I believe my EUO will help move a claim to a favorable disposition for my client without causing them any prejudice than I will give one. If I have done an ethical and professional job I should have nothing to hide.
Don-
Thank you reading my post and thank you for the comment. Your words mean a lot to me and it shows you are a true professional. I agree with you and think bad things happen when any professional forgets about the clients' interests. I am glad you have the focus and hope others take your comment to heart.
I often tell the insurance company reps to remember the subject claim is my client's only claim. Sure, as professionals in this industry we have many cases and clients. When one claim is finished there is another to work on but the client only has the one claim. Your comments lets me know you acknowledge the client's situation. Thanks for helping the insureds and representing their interests with professionalism.
By the way, I look forward to hearing you speak at the panel discussion at FAPIA.
Thanks again, Nicole
Your info is so helpful policy holders should read it regardless if they filed a claim or not just to know the process of insurance companies.
The thing which bothers me the most is every examination under oath I have read about involves the hammering and delving into people about irrlevant matters. All were policy holders with coverage and it was obvious what the intent of the questioner was to find misrepresentations.
Coverage in effect policies weren't the issue. They should be paid and denied because the policyholder mistakenly said she shopped at Walmart to purchase items, but was shopping at K-mart instead.
Thanks for the comment Ed!
It really goes back to some of my main attitudes regarding claim investigation-- the information the insurance company really needs can be gathered without the need for an examination under oath. If the insurance company wants an EUO, there are likely some Walmart/K-Mart type inconsistencies that need to be clarified but there are other ways to clear up true questions of the claim without this adversarial action. However, EUOs can also be demanded by the insurance company in an attempt to find MORE ways and reasons not to pay the claim. Because of the considerable free range of questioning and severity of the consequences of the EUO, qualified counsel should alway be hired.