Why Has My Claim Been Transferred to the SIU?
Have you received a notification from your insurance company that your claim has been transferred to the SIU? 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. Let’s take a look at the process more comprehensively.
What Is an SIU?
SIU stands for “Special Investigations Unit.” These units are tasked with investigating and preventing insurance fraud. Almost all insurance companies have departments that handle these investigations, though they may call them by other names.
A claim is usually transferred to the SIU when an insurance company believes there could be fraudulent activity. Claims are also sometimes submitted for routine audits by the SIU as a general fraud deterrent.
The SIU will investigate the claim more thoroughly than the normal claims handling process to determine potential fraud. Such investigation may require that the insured participate in an Examination Under Oath, or EUO, much like non-elevated claims.
What Does an SIU Investigator Do?
SIUs typically employ professionals with backgrounds in law enforcement, legal studies, finance, or forensic accounting. When a claim is flagged as potentially suspicious, SIU investigators use various tools and techniques to investigate the claim, including interviews with claimants and witnesses; gathering and analyzing evidence; data analysis, and potentially even surveillance or collaboration with law enforcement agencies.
What Should You Do If Your Claim Was Sent to SIU?
If your claim has been transferred to an SIU, it’s best to take a proactive approach. Attempt to find out what about the claim has been deemed suspicious, and provide additional documentation or evidence to support your side. It’s often valuable to have the assistance of an attorney who can represent you and your interests.
What Is the Process for an SIU Investigation?
The investigation process can vary from one agency to another, but generally, once a claim has been flagged for further investigation, the process for an SIU investigation will proceed along these steps:
Investigation Planning – The SIU team develops an investigation plan tailored to the specifics of the case. This plan outlines the investigative steps needed, resources required, and the objectives of the investigation.
Evidence Gathering and Analysis – SIU investigators gather evidence through various means, including but not limited to, interviews, background checks, review of financial records, and consultation with experts. Digital evidence and social media may also be scrutinized.
Legal and Compliance Considerations – Throughout the investigation, SIUs are required to ensure compliance with all applicable laws and regulations, which vary from state to state. This includes respecting privacy laws and ensuring that any investigative techniques used are legal and ethical.
Findings and Decision – Upon completing the investigation, the SIU compiles its findings and makes a decision on the claim. This could result in the denial of a claim, seeking recovery for losses to the insurer, referral to law enforcement for criminal prosecution in the case of fraud, or, if the claim is found to be valid, approval and payment.
Reporting and Learning – The findings from the investigation are documented and used for reporting to regulatory bodies, as needed, and to refine future fraud detection and prevention strategies.
SIUs and Public Adjusters in Florida
Some policy holders may find themselves transferred to the SIU if they have retained a public adjuster to assist with handling their claim. However, an insurance company transferring a claim to the SIU solely because of the involvement of a public adjuster violates Florida Administrative Code §69B-220.201(3)(b), which requires that an adjuster treat all claimants equally.
Contact Merlin for More Advice
If your claim has been transferred to the SIU, don’t panic. However, it’s important to know your rights. The Florida Administrative Code requires that insurance companies follow guidelines for the proper and fair handling of claims. If you’re unsure why your claim has been transferred to the SIU or you feel you are being treated unfairly, consulting with an attorney may help ensure that your claim is being handled in accordance with the law.
At Merlin Law Group, our attorneys have decades of experience defending policyholders from insurance companies that wrongfully deny claims or drag their feet making payments. To learn more about how Merlin helps its clients, check out these resources:
