What SIU does
The Special Investigations Unit investigates claims flagged for potential fraud. SIU investigators:
- Review claim files for inconsistencies
- Interview claimants and witnesses
- Conduct surveillance in some cases
- Coordinate with law enforcement
- Prepare files for prosecution if warranted
Most SIU reviews don't result in fraud charges. Most result in either clearance or claim denial based on misrepresentation.
What triggers SIU review
Timing triggers
- Loss date close to policy effective date (within 30 days)
- Claim filed shortly after policy change increasing coverage
- Pattern of claims at seasonal intervals
Pattern triggers
- Multiple claims from same insured
- Multiple claims from same address (prior owners)
- Common contractors across claims
- Common adjusters or PAs across claims (rare, not a fraud indicator on its own)
Content triggers
- Inconsistencies between initial statement and documentation
- Photos with metadata inconsistencies
- Damage inconsistent with claimed cause
- Valuation substantially exceeding comparables
Industry triggers
- Fraud rings (arson-for-profit, staged losses)
- Bust-outs (coordinated claim patterns across a region)
- Specific contractor or adjuster with pattern of flagged claims
The investigation process
Initial review
Internal SIU review of claim file, policy, and prior claim history.
Documentation request
Additional documents requested from policyholder. RFI-heavy.
Recorded statement
Often requested. Policyholders should not give recorded statements without counsel.
Examination Under Oath (EUO)
A formal sworn statement under oath before a court reporter. Policy right; typically required.
Witness interviews
Contractors, neighbors, prior residents, family members.
Document verification
Receipts, estimates, prior inspection reports: all verified for authenticity.
Surveillance (occasionally)
Physical or social-media surveillance in specific cases.
Typical duration
SIU investigations typically take 60–180 days. Some run longer. The claim is typically "under investigation" during this period, meaning statutory deadlines may be effectively paused.
Outcomes
Clearance
Investigation concludes no fraud. Claim returns to normal handling.
Denial for misrepresentation
If the investigation identifies material misrepresentation, the claim can be denied on that basis: even if the underlying loss was covered.
Rescission
In extreme cases, the carrier may rescind the policy entirely (treating it as never having existed).
Prosecution referral
If criminal conduct is identified, referral to law enforcement.
Protecting yourself if SIU reviews your claim
Don't give a recorded statement without counsel
Even for legitimate claims. Anything said becomes evidence.
Retain a Florida insurance attorney
SIU is adversarial. Attorney representation is essential.
Document everything consistently
Timeline, damages, causation: all must be consistent across submissions.
Don't speculate
Answer what you know. Don't guess at things you don't.
Preserve documentation
Don't destroy photos, videos, or records during an investigation. Spoliation of evidence is a separate issue.
When SIU involvement is wrong
Legitimate claims do get caught in SIU review. Patterns can be coincidental. The solution is thorough documentation and professional representation.
How Ocean Point handles SIU-involved claims
We refer to Florida first-party insurance attorneys and continue claim-scope documentation in parallel. The PA role is claim-handling; the attorney handles SIU response.