Examinations under oath help insurers combat fraud and
should be allowed without requiring time-consuming court orders in Kentucky,
the Coalition Against Insurance Fraud
and National Insurance Crime Bureau say in a joint amicus brief filed today
with the state’s highest court.
“This tool benefits insurers and honest claimants by
providing a means for determining the circumstance of accidents and the nature
of injuries, and an intelligent, well-formed decision as to the applicability
of coverage,” the anti-fraud groups say in the brief to the state Supreme
Court.
Two Kentucky motorists claimed they were injured in a
crash. They sought no-fault benefits, yet refused to take part in an
examination under oath (EUO). The state appeals court said the insurer must
obtain a court order to conduct the interview. State Farm appealed to
Kentucky’s highest court.
EUOs uncover information that enables
insurers to make intelligent claim decisions that can stymie fraud and help
keep auto premiums affordable for honest drivers, NICB and the Coalition say.
Importantly, EUOs also validate honest claims and help ensure payment as
promptly as possible.
"EUOs are a time-tested tool, valuable tool. They
are utilized in every form of insurance coverage,” the anti-fraud groups say.
Claims will be needlessly prolonged if EUOs must be
resolved in courts instead of efficiently between insurers and claimants, the
Coalition and NICB contend.
Requiring court orders “encourages litigation by forcing
insurers to obtain a discovery order from a court every time it is necessary to
investigate a claim,” the Coalition and NICB argue.
The expensive, time-consuming effort will weaken
anti-fraud efforts in the Kentucky.
“The result is higher premiums, potentially higher
coverage deductibles, and the threat that insurers will cease doing business in
Kentucky if they cannot efficiently combat suspected fraudulent claims and
financial loss becomes guaranteed,” NICB and the Coalition say.
Insurers must be empowered to resolve claims as promptly as
possible. EUOs elicit vital information and thwart fraud that drives up auto
premiums in Kentucky.
“EUOs allow the insurer to investigate the veracity of
medical reports generated by providers. … They allow the insurer to verify that
treatment actually took place, that the stated treatment was of the nature the
provider claims, and that they value of the service actually provided comports
with the bills the provider submits,” the Coalition and NICB contend in the
legal filing.
The Kentucky Supreme Court is expected to rule on the
case later this year.
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CONTACT:
Dennis Jay, Coalition Against Insurance Fraud;
202-393-7333
Frank Scafidi, National Insurance Crime Bureau;
916-979-1510
