EUO Demand Indicator #6:
When Things Just Don’t Add Up
In some claims, there are more questions than answers. While nothing stands out as outright fraud, things don’t seem to add up. These cases often involve a combination of behaviors—delayed documentation, uncooperative insureds, or conflicting information—that make it difficult to pinpoint what’s wrong.
When your gut tells you something isn’t right, an Examination Under Oath (EUO) can provide the clarity you need.
Why Trusting Your Instincts Matters
Claims professionals develop a sense for when something is off. Even if you can’t immediately identify the issue, your instincts can signal that deeper problems exist within the claim. Key scenarios to watch for include:
- Unanswered Questions: The claim leaves significant gaps that need to be addressed.
- Conflicting Details: The story or documentation provided by the insured doesn’t align.
- A Combination of Indicators: Delays, discrepancies, and other red flags stack up, pointing to a larger issue.
How the EUO Brings Clarity
The EUO is the perfect tool for resolving claims where things don’t add up:
- Comprehensive Investigation: By sitting the insured down under oath, you can address every question and clarify discrepancies directly.
- A Structured Process: The EUO provides a focused environment to gather facts and evaluate the validity of the claim.
- Resolution Through Detail: What may seem unclear or suspicious can often be resolved through thorough questioning and documentation review during the EUO.
When to Consider an EUO
If you find yourself repeatedly asking questions or feeling like the information doesn’t align, consider an EUO. It offers the chance to tie up loose ends and ensure the claim is resolved based on complete and accurate information.
Conclusion
Some claims don’t fit neatly into any single category but still raise concerns. When things don’t add up, the EUO is an essential tool for uncovering the truth and resolving the claim.
Thank you for following this six-part series on EUO demand indicators. With these insights, you’ll be able to identify when an EUO is necessary and use it effectively to protect the company and resolve claims.
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Danny Vazquez
Danny Vazquez is the National EUO, LLC CEO.
Danny is a central leader on Claims, Investigations and EUOs in the insurance and legal industries.
As CEO, Danny took the knowledge and insights gained throughout his 25 plus years legal career to establish National EUO as the Nation's leading company on EUO services and EUO training.
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