Law360 published an excellent article, The Insurance Landscape For Phishing Claims Is Shifting,1 written by Jason Rubinstein and Jasmine Chalashtori. Their summary about the importance of coverage for these computer fraud claims and the need for brokers to discuss these risks with their business clients was highlighted at the end of their article:
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Drew Houghton heads up Merlin Law Group operations in our Oklahoma City office. I was speaking with him just before our holiday party about the American Policyholder Association combating fraudulent engineering reports harming policyholders as noted in, American Policyholder Association Makes Resonating Comments About Insurance Fraud Against Policyholders. Drew then told me about a recently filed Oklahoma class action where engineers were accused of sham reports to help prevent earthquake claims payments.
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Following a devastating loss to one’s home, as is the case throughout California due to recent fires and mudslides, the process of contacting your insurer to begin the rebuilding or repair can be complicated and daunting. Many are quick to begin the rebuilding and repairs immediately or as soon as possible. However, there are requirements in working with your insurer to properly rebuild or repair. If an insured fails to follow appropriate protocols, the insurer can not only deny coverage, but do so on the basis of fraud.
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All insurance companies have a Special Investigative Unit [SIU] that handles elevated claims. Policyholders may be informed by the claims adjuster that their claim has been transferred to the SIU, leaving the insured confused and perhaps apprehensive. So, what does it mean when a claim has been transferred to the SIU?
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Fraud is generally defined as an act done with the intent to deceive or misrepresent others in order to attain or secure some unlawful gain or deprive a victim of a legal right. Different courts, states, and bodies of law throughout our country have their own unique causes of action based in fraud, or where fraud is the primary allegation.
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When insurers investigate insurance claims and suspect that something about the claim is not quite right, they often assign special investigation units evaluate whether the claim lacks merit or is otherwise fraudulent. In Young v. Progressive Casualty Insurance Company,1 a federal district court in California recently upheld an insurer’s denial of its insured’s claim for the theft of his motor home based on the policy’s fraud and misrepresentation provisions. The court’s decision was based primarily on the cell phone records of the insured’s son.
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