What SIU does
- Reviews claims flagged for fraud indicators
- Conducts interviews (examinations under oath)
- Retains experts (forensic, accounting, causation)
- Files regulatory or law-enforcement referrals when warranted
- Supports denial decisions with fraud findings
Common triggers
Loss-date proximity to policy
- Policy effective < 30 days before loss
- Newly-added coverage then claimed
Prior claim clustering
- Multiple claims at same property
- Common contractors or adjusters across claims
- Pattern across insureds (rare; usually fraud rings)
Inconsistent documentation
- Conflicting statements about loss
- Photo timestamps that don't match narrative
- Contractor estimates that exceed comparable claims
High-value contents without proof
- Large contents claims without receipts
- High-value items without prior documentation
- Scheduled items claimed without schedule
Specific red flags
- Arson indicators in fire claims
- Staged-loss indicators
- Forged documentation
What to expect if SIU reviews your claim
Notification
- Often no formal notification
- Claim slows / pauses
- Adjuster becomes evasive about timing
Requests
- Comprehensive documentation requests
- Recorded statement (voluntary)
- Examination Under Oath (required by policy)
- Financial records (commercial)
Timeline
- 60-180 days typical
- Can extend significantly
- Statutory deadlines often suspended during investigation
How to handle SIU
Cooperate thoroughly
- Provide requested documentation
- Attend EUO with counsel
- Answer truthfully
Document everything
- Chronology of loss and claim
- Contractor relationships
- Prior claim history
Retain counsel
- EUO should never proceed without counsel
- Florida first-party attorneys experienced with SIU
- Public adjuster can represent on claim issues; attorney on fraud
Don't agree to things under pressure
- Statements made during SIU are admissions
- Policy exceptions (material misrepresentation) can void coverage
- Careful, documented responses
When SIU concludes
Favorable finding
- Claim resumes normal processing
- Often no explicit "cleared" communication
- Resume documentation push
Unfavorable finding
- Claim denied citing material misrepresentation
- Potential policy rescission
- Legal action by insured often follows