Anti-Fraud Groups Support EUOs Without Court Order in Kentucky

July 19, 2016

Examinations under oath (EUO) 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 (NICB) said in a joint amicus brief filed last week 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 said in the brief to the state Supreme Court.

The agencies provided an example of a case where 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. 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 said. Importantly, EUOs also validate honest claims and help ensure payment as promptly as possible.

“EUOs are a time-tested, valuable tool. They are utilized in every form of insurance coverage,” the anti-fraud groups said.

Claims will be needlessly prolonged if EUOs must be resolved in courts instead of efficiently between insurers and claimants, the Coalition and NICB contend.

The groups argue that 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.”

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.

“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,” the NICB and Coalition said.

The expensive, time-consuming effort will weaken anti-fraud efforts 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 stated in the legal filing.

The Kentucky Supreme Court is expected to rule on the case later this year.

Source: Coalition Against Insurance Fraud

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