When an Examination Under Oath Becomes Part of the Property Damage Claims Process

Insurance fraud is a major problem for insurance companies, but, as with most problems, the wrongdoing of a small percentage of the population forces the rest to endure major inconveniences. If you’re shopping at a big box store, you may be required to stand in a long line to wait while an employee checks receipts. However, the inconvenience and potential problems are much greater when you need to file a property damage claim.

You may be required to submit to an Examination Under Oath.

Insurers are legally permitted to require this in many states, including Florida. It is important to understand your rights and what you need to do to preserve them regarding benefits under your insurance policy. Failure to comply could give your insurance company legal grounds to deny your claim.

What is an Examination Under Oath?

Buried in the language of the insurance policy for your home, car, boat, or other property, you are likely to find language that requires you to undergo an Examination Under Oath and sign to attest that your statements are truthful. An Examination Under Oath is a live, question-and-answer process conducted by an attorney representing the insurance company. The policyholder must take an oath of truthfulness and is usually not permitted to be accompanied by someone else insured under the policy.

While the policyholder does not need an attorney to represent their interests during questioning, it is advisable to have one present. Unlike a hearing or mediation, which is conducted by a neutral legal professional, the Examination Under Oath is conducted by a legal professional employed by a company whose interests are diametrically opposed to those of the policyholder. In other words, the enemy is in charge of the proceedings, and the results of the proceedings will be a sworn statement that can be used against you.. To keep the process fair, it makes sense to have a knowledgeable legal advocate on hand to protect your interests.

The Purpose of an Examination Under Oath

Officially, the Examination Under Oath is a tool insurance companies use to prevent fraud by gathering claim details. Unofficially, the Examination Under Oath is a tool insurance companies use to give themselves a legal reason to minimize or deny your claim for damage.

If a policyholder answers questions appropriately during the process, then there is nothing to fear. However, policyholders often make mistakes during the examination that can cause serious problems later. For instance, in a famous case, the court held that because insurance claimants refused to answer a question they deemed irrelevant during an Examination Under Oath, the claimants breached the policy’s terms and were not entitled to recover. 

The questions in that case concerned personal income and criminal history, and the court found this information material to the issue of fraud. It can be dangerous to refuse to answer questions during an Examination Under Oath without having solid legal grounds for doing so. However, if a policyholder does not know the answer to a question or does not have access to the information requested, it is perfectly acceptable to say “I don’t know.”

Preparing for an Examination Under Oath

If you are working with an attorney, it makes sense to follow your legal advisor’s recommendations regarding preparation for the Examination Under Oath. You will be expected to provide information in answer to questions, so it is a good idea to review documents related to the claim, such as a list of damaged items. It is helpful to be prepared to respond to questions such as:

• What condition was the property in prior to the damage?
• When did you first become aware of the damage?
• Did you take any steps to prevent the damage from worsening or to repair it?
• When did you call the insurance company?
• What did you say to the insurance company?
• If repairs were made, who made them and how much did they cost?

You are not expected to memorize all the details, and you may bring notes for reference. You should be aware, however, that if you rely on notes during questioning, the insurance company’s attorney will ask for a copy of them. They can be used as evidence against you, so it is important to ensure that the notes are consistent with your claim and do not contain any potentially harmful information.

It can be helpful to bring documents relevant to the claim. For example, if repairs have been performed, it is a good idea to bring the receipt. As noted above, it is generally wise to answer all questions asked during the examination, even if you do not believe them to be relevant. While privacy is a valid concern, there is often an instinctive negative reaction when someone refuses to answer a question and an assumption that the person questioned has something to hide. 

Fraud is a key concern for insurance companies, so any questions that could conceivably be related to the veracity of a claim may be permissible. If you are concerned that the insurance company might ask questions you don’t want to answer, then it is a good idea to discuss your concerns with your attorney and have your attorney present during the examination.

When Insurance Problems Arise, You Can Count on Ver Ploeg & Marino

While we can’t fault insurance companies for wanting to earn a decent profit, we often disagree with the approaches they take to improve their bottom line. When insurance companies fail to meet their obligations to policyholders or attempt to mislead them into actions that devalue their claims, we work to secure a fair outcome. If you have an insurance dispute, we invite you to contact Ver Ploeg & Marino for a confidential discussion to learn about the ways we may be able to assist.

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