On The Pulse...Special Investigative Unit Practice Group Profile

By
James H. Cole

The economic slowdown has effected the entire nation and has brought with it sharp increases in the unemployment rate, foreclosures, repossessions, and bankruptcies. The financial hardships many are experiencing have correlated to an increase in Special Investigative Unit ("SIU") referrals across many lines of insurance. If unemployed, or if creditors, mortgage companies, and lien holders are calling on past due accounts, the temptation may exist to take the "easy" way out and "give up" a vehicle, set fire to property, "loose" a scheduled piece of jewelry, or exaggerate an injury. Our SIU attorneys have seen a sharp increase in SIU assignments over the last year and remain ready to assist our clients with any issue calling for our experience.

Insurance fraud takes an enormous toll on both the insurance industry and the public as a whole. Unfortunately, dishonest insureds, attorneys, providers, and organized rings see fit to have honest policyholders bear the costs of their quest for easy money. Furthermore, the ever-growing expertise of those whose goal it is to rip off the system makes fighting fraud both a challenge and a priority.

No line of insurance is immune from fraud, and insurers must contend with a wide range of issues including:

  • Arson;
  • Personal articles policy disappearances;
  • PIP fraud;
  • Provider fraud;
  • Application fraud;
  • Rate evasion;
  • Straw purchaser situations;
  • Hit-and-run situations;
  • Staged accidents;
  • Jump-ins;
  • Boat claims;
  • Mortgage fraud;
  • Vehicle give-ups;
  • Organized rings; and
  • Lien holder issues.

In addition to contending with the ever-evolving types of fraud relative to every line of insurance, and determining accurate facts concerning every claim, an insurer must also contend with the myriad of peripheral issues that go hand-in-hand with every investigation. These issues include bad faith, coverage, privacy, conflicts, reporting requirements, and cooperation with law enforcement. The attorneys in Marshall, Dennehey's SIU Practice Group deal with all of these issues as part of their daily practice and are always available to offer advice on these subjects,

Marshall, Dennehey, Warner, Coleman & Goggin's Special Investigative Unit ("SIU") Practice Group consists entirely of attorneys dedicated to dealing with these unique issues and fighting fraudulent claims. Whether pre-litigation or post-litigation, the focus of the Practice Group is to work closely with our clients toward the goal of eliminating insurance fraud. Because of this practice concentration, we are uniquely positioned to assist insurers with all of the various issues that arise in any SIU investigation and formulate the most effective and cost-efficient strategy for contending with every claim scenario. The experience level in the Practice Group, combined with the close working relationship enjoyed with the firm's Insurance Coverage/Bad Faith and Property Damage Practice Groups, allow our attorneys to effectively counsel our clients concerning the complexities that arise due to these overlapping areas of practice. Additionally, the SIU Practice Group is uniquely positioned not only to coordinate an investigation, but, if the investigation uncovers fraud, to use the evidence developed in that investigation to recover amounts paid out to unethical providers or insureds.

Our firm does not assign SIU cases to any available attorney. Instead, all SIU cases are assigned to the attorneys in the dedicated SIU Practice Group, who spend the majority of their time investigating and prosecuting fraudulent claims. The Practice Group recognizes the importance of education and meets regularly and is in constant contact to keep up to date on the latest technologies, stories, scenarios, rings, and questionable medical procedures. Additionally, the members of the Group regularly attend and are asked to present at local, regional, and national SIU seminars and conferences.

Our SIU Practice Group is staffed with attorneys who relish this unique area of practice and, as a practice group, have experience assisting with every type of SIU scenario. From a recently divorced insured whose engagement ring has disappeared under mysterious and questionable circumstances, to an insured in financial distress whose transponder-equipped vehicle is reported stolen and found burning within a mile of his home, to a complex medical provider initiative involving hundreds of insureds, dozens of medical providers, and millions of dollars, our attorneys are available to assist insurers.

If you have any questions or would like further information relative to the Special Investigative Unit Practice Group, please call James H. Cole, Esquire at (267) 880-2026 or Robert Kingsford, Esquire at (407) 420-4409.

*Jim, a shareholder and Chair of our SIU Practice Group, works in our Doylestown, Pennsylvania, office. He can be reached at (267) 880-2026 or jhcole@mdwcg.com.

Defense Digest, Vol. 15, No. 2, June 2009