SIU & Insurance Fraud

Fraud Matters We Handle

The firm also handles inflated or fabricated injury claims, vehicle theft and theft-related insurance fraud, misrepresentations in insurance applications, and organized schemes involving multiple claimants, medical providers, or repair facilities.

Assignments range from advising an SIU investigator on a single claim to defending a coverage denial in litigation and pursuing affirmative civil claims against those responsible for a fraudulent scheme.

We also advise on claim handling while an investigation is underway, including communications with the insured, requests for records and recorded statements, and the point at which the investigation supports a coverage decision. Clear communication during this period reduces the risk that the investigation itself will later be criticized as unreasonable delay.

Building a Defensible Investigation

SIU referrals start with the claim file and the investigation to date. From there, the carrier receives an early case evaluation of what the evidence shows, what still needs to be developed, and whether the facts support a denial, rescission, or further investigation.

When the policy permits, our attorneys conduct examinations under oath and request documents and records under the policy's cooperation conditions. The firm works with cause and origin investigators, accident reconstruction experts, and forensic accountants to test the claim against the physical and financial evidence.

Thomas Rubin & Kelley PC writes its reports to support a decision the carrier can defend later, with a clear account of the evidence and the policy provisions that apply. If the matter becomes the subject of bad faith litigation, the file will show why the carrier acted as it did.

Fraud must be proven with evidence before a judge or jury. We prepare coverage and fraud cases for trial, whether the carrier is defending a denial or bringing its own claims.

Issues That Shape SIU & Insurance Fraud Cases

Fraud cases are built on evidence of intent, motive, and opportunity, and on proof that the claim does not match the physical or financial record. We handle fraudulent claim matters under A.R.S. §20-463 and civil racketeering claims under A.R.S. §13-2314.04, and we develop the record needed to support each one.

Application misrepresentation cases turn on materiality and on the insurer's underwriting reliance. Our attorneys handle rescission and coverage defenses under A.R.S. §20-1109 and work with underwriting personnel to document how the misrepresentation affected the decision to issue the policy.

A fraud denial is frequently challenged as bad faith, so we conduct and document each investigation with that scrutiny in mind. The firm's bad faith litigation practice informs how investigations are conducted and documented.

Working With Law Enforcement and Regulators

When a matter warrants criminal referral, our attorneys assist carriers in coordinating with law enforcement and state regulators while keeping the civil claim on track and protecting the carrier's privileges. The firm also helps carriers decide what to share with investigators, and when, so that a criminal referral does not compromise the handling of the civil claim.

Referring a Suspicious Claim

SIU investigators and claims professionals can refer a suspicious claim, schedule an examination under oath, or raise a coverage question by calling (602) 274-8289 or using the contact page.