Beware of an Examination Under Oath by Your Insurance Company
Your insurer might suspect a claim is fraudulent, as was the case for a doctor in a small town in Southern California — but there’s a plot twist.
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For anyone who claims injuries from an accident or owns or rents insured real property, should it suffer damage or a theft loss, there is always a chance that you will be required to attend what is called an examination under oath (EUO) by a claims adjuster or an insurance company attorney.
An EUO is not a routine part of processing most claims. If asked to attend an EUO, you must assume that the insurance company might suspect fraud or has other concerns.
Failure to participate in the EUO can result in your claim being dismissed or the matter referred to law enforcement if there is a suspicion of insurance fraud.
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Today’s story is about one such case, a fact situation so unique that it could be the basis for a motion picture. It began in Southern California when the “devil winds” were howling.
The Santa Ana Winds Wield Dangerous Force
One of the most violent and dramatic wind events in the United States, known as the Santa Ana winds, take place during the cool season months of October to March. These hot and dry devil winds can reach hurricane speeds, toppling utility poles, uprooting trees, knocking over tractor trailers and cutting power.
They also set off burglar alarms, as “Dr. K” would discover.
This Doctor’s Patients Adored Him
In the small, remote Southern California town where he practiced medicine as a primary care physician and cardiologist, Dr. K was adored by his patients. He was one of the many foreign-trained doctors so vital to our health care system, often working in small towns that otherwise would lack a physician.
One Friday night, the Santa Ana winds were howling, and Dr. K’s burglar alarm was set off by a broken-glass detector when a tree branch flew into the office front door, shattering the glass, though it remained in place.
He and his office manager were notified by his alarm company, went to the office and met a deputy sheriff. A brief, superficial inspection appeared to show that everything inside was untouched.
The next day, he returned to the office and “found that 15 wearable cardiac Holter monitors — average price for each one $5,000 — were missing,” according to the insurance claim that he filed.
Attend an Examination Under Oath or Claim Denied
Several weeks later, I was contacted by Dr. K’s colleague a day before a claims adjuster was to conduct an EUO of the doctor. “Dennis, he postponed it several times, and the insurance company said they will deny his claim if he does not meet with them and have a lawyer present. As a favor to me, please help him. I have no reason to suspect that he did anything wrong.”
I agreed and drove to the small town in a rural part of California that I had never even heard of.
Claims Adjuster and the Company’s Attorney Take Me Aside
Before the session began, “Ed,” the claims adjuster, and “Paul,” the insurance company’s attorney, both asked to speak with me in private.
“Mr. Beaver,” Paul said, “Dr. K informed us that you would be here so that his claim would not be rejected. We want you to know that no punitive action will be taken against the doctor, and this will be explained following the examination.”
Then the doctor was sworn in, and the examination began.
Paul, the insurance company attorney: “Doctor, would you please tell us, step by step, everything that you did that evening and the following day of the wind event that set off your alarm system.”
Dr. K explained that he inspected his office briefly that evening and then returned the next day for a more thorough search to see if anything had been taken or damaged.
Next, Ed, the claims adjuster, spoke: “Doctor, I am going to show you a video that was recorded by the security system on an office building across the street from your medical office and ask if you can identify the person in the video and what he was doing.”
They played the video. In broad daylight, it showed Dr. K enter his office and come out with a box containing objects that had what appeared to be wires or loose straps on the sides of the box. The person made three trips, and his face was clearly visible.
“Can you tell me who that person shown in the video is?” asked the claims adjuster.
His head lowered, covering his face with his hands, Dr. K said, “That’s me. I am so sorry.”
A Good Deed Rewarded
Paul, the insurance company’s attorney, next spoke: “We knew all along what had taken place but obtained permission from the claims supervisor to close this case — not pay the claim — and not pursue the doctor for insurance fraud. And why, you are wondering? It is because Ed and I are brothers, and we grew up in this town but moved away before Dr. K came here.
“Years ago, we were both away at college. Our grandfather had chest pains, and Grandma drove him to Dr. K’s office, realizing that an ambulance would probably take too long. Pops was having a heart attack! His heart stopped, and Dr. K shocked him back to life!
“There is no way that we could do anything that would take Dr. K from us and this little town where we grew up. Dr. K has done so much for so many people. I don’t know why he did it, but the planets are all aligned now, and I am confident he has learned his lesson.”
And there sat my client, sobbing and apologizing. There was something so powerful, so touching in what Ed had said, so charitable, so right.
It has been years. Yes, the planets were indeed all in alignment that day.
Dennis Beaver practices law in Bakersfield, Calif., and welcomes comments and questions from readers, which may be faxed to (661) 323-7993, or e-mailed to Lagombeaver1@gmail.com. And be sure to visit dennisbeaver.com.
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