“Good Faith Claim Handling in Fraud Investigations”

Swift Currie attorney Melissa Segel authored an article published by Claims Journal providing insight on, “Good Faith Claim Handling in Fraud Investigations.”

Insurance fraud is more prevalent now than ever with it being firmly positioned as the second most costly white-collar crime. It is important that insurance claim professionals be thorough in their efforts when considering regulatory requirements, industry standards and case law especially if there is concern over suspicious claims.

“It is important to stay up to date on your state’s laws, both statutory and common law, to ensure you are complying with the processes and time limits set forth by the governing body of your state,” recommends Segel.

Segel additionally emphasizes the role of pretrial discovery in uncovering fraud as bad faith is determined by the sufficiency of evidence.

Insurance carriers are vulnerable to penalties if they do not properly investigate fraudulent claims. Often times cost-benefit analyses or the required speed for claims processing might allow for things to slip by, but fraud is a crime, and insurers may end up having to pay for it.

“Fraud is everywhere. Diligent claim handling is more than “dotting the I’s and crossing the T’s.” It is using all resources the policy and applicable law provide you while allowing your inherent curiosity to lead you to the proper legal and ethical conclusion,” remarks Segel.

Click here to read the full article.