by Tim D. Tribe,Â CPA, CFF, CFE, CICA, REDW Principal, andÂ Christopher R. Teske, Gieger Laborde & Laperouse LLC.
Reprinted with permission from In-House Defense Quarterly, Summer 2017.
To understand someone, find out how he spends his money.
The central purpose of property insurance is to provide financial assistance to the insured in the event of a loss so that the life or business can continue with as little disruption as possible. Because this is the central purpose, the insuredâ€™s financial situation before the loss is an essential issue in handling nearly every claim for coverage under a first-party property insurance policy. Carriers confronted with these claims must take care to examine the details of the insuredâ€™s finances, both so they can evaluate and pay the appropriate value of the loss and so they can identify situations in which further inquiry is required.
The level of examination required varies dramatically, depending among other things on: (1) the insured; (2) the type of policy and available coverages; (3) the nature of the loss; and (4) other circumstances surrounding the claim. Rarely do two claims feature exactly the same financial issues. There are, however, certain types and sources of information that are very likely to reveal relevant information about the financial components of the claim, regardless of the differences among insureds, policies, and claims.
We recognize that claims examiners, independent adjusters, and even counsel frequently come from backgrounds other than finance and business operations. As such, we have set out in this article to identify common financial issues that confront the team handling first-party claims and offer tools and suggestions to help you obtain the best information possible as you evaluate those claims. Those tools, when used correctly, should procure enough information to allow you to make an informed decision about whether a claim requires the involvement of the Special Investigations Unit (SIU), outside counsel, and expert forensic accountants.
Common Financial Issues in First-Party Claims
Two principal questions serve to illustrate the financial issues that may confront carriers in handling a first-party claim. First, so-called time element losses such as business interruption, loss of use, and additional living expense claims highlight the importance of understanding the insuredâ€™s on-going operations for purposes of evaluating the value of a loss. Second, a discussion of questionable or even fraudulent claims illustrates how a complete understanding of the insuredâ€™s finances can identify red flags and, potentially, proof that the insured has overstated their claim or had a motive to commit arson or stage the theft of goods, services, and materials related to their business. We begin, therefore, with a discussion of those two issues as they arise under common first-party claim situations.
Finance and the Time Element Loss
The first area where the insuredâ€™s finances are important to the investigation of the first-party claim is in the instance of a so-called time element loss. In addition to covering the cost of repairing or replacing property that is physically damaged, most first-party policies also provide coverage for additional expenses and lost profits that the insured is likely to incur following a covered loss. In homeownersâ€™ policies, that coverage usually takes the form of additional living expense or loss of use coverage, which is designed to compensate the insured for the cost of obtaining alternative housing while their home is repaired or rebuilt. Business ownersâ€™ policies and other commercial property policies, on the other hand, usually include coverage for business income losses. Some commercial policies also provide coverage for â€œcontingent time elementâ€ losses where the lost income does not directly result from damage to the insured property itself.
Loss of Use/Additional Living Expenses Provisions
Homeownersâ€™ insurance policy forms such as ISOâ€™s HO 00 03 form, commonly include coverage for the loss of use of an insured property. The HO 00 03 04 91 form, for example, contains the following provision:
COVERAGE D â€“ Loss of Use
The limit of liability for Coverage D is the total limit for all coverages that follow.
1.Â Â Â Â Â Â Â Â If a loss covered under this Section makes that part of the â€˜residence premisesâ€™ where you reside not fit to live in, we cover, at your choice, either of the following. However, if the â€˜residence premisesâ€™ is not your principal place of residence, we will not provide the option under paragraph b. below.
a.Â Â Â Â Â Â Â Â Additional Living Expense, meaning any necessary increase in living expenses incurred by you so that your household can maintain its normal standard of living; or
b.Â Â Â Â Â Â Â Â Fair Rental Value, meaning the fair rental value of that part of the â€˜residence premises’ where you reside less any expenses that do not continue while the premises is not fit to live in. Payment under a. or b. will be for the shortest time required to repair or replace the damage or, if you permanently relocate, the shortest time required for your household to settle elsewhere.
2.Â Â Â Â Â Â Â Â If a loss covered under this Section makes that part of the â€˜residence premisesâ€™ rented to others or held for rental by you not fit to live in, we cover the:
Fair Rental Value, meaning the fair rental value of the part of the â€˜residence premisesâ€™ rented to others or held for rental by you less any expenses that do not continue while the premises is not fit to live in.
Payments will be for the shortest time required to repair or replace that part of the premises rented or held for rental.
HO 00 03 04 91, at p. 3 of 18.
The need for basic information about the insuredâ€™s financial information when adjusting a loss under that provision ought to be somewhat obvious. There is little doubt that a claims examiner handling a homeownerâ€™s property loss will want to know how much it cost the insured to get another place to live while his or her damaged home is repaired, as well as the cost to outfit that alternate location with basic contents and necessities that were likely damaged in the loss. Similarly, an adjuster will clearly want to know the value of rental revenue that the insured loses while the property is under repairs.
Other financial questions that arise under this type of provision may not be so obvious. In the case of widespread catastrophic losses, for example, the value of rental properties may increase dramatically after the event. Following Hurricane Katrina, The United States Department of Housing and Urban Development found that the typical resident of New Orleans paid thirty-three percent more in housing costs than they did before the storm. Gwen Filosa, Post-Hurricane Katrina Housing Costs Put Many on the Edge, New Orleans Times-Picayune, September 14, 2010, available at http://www.nola.com. One HUD analysis indicated that the shock in rental supply caused by Hurricane Katrina resulted in occupancy rates that â€œneared 100 percent and rents spiked by more than 60 percent in 2006.â€ Comprehensive Housing Market Analysis, New Orleans Louisiana, U.S. Dept. of Housing and Urban Dev., Office of Policy Dev. And Research, April 1, 2011, at p. 12. And, according to subsequent reports from HUD, rents have continued to rise at an average rate of six percent per year since the storm. Id.
Catastrophic losses that affect a wide area can also lead to shortages and increased costs of building materials and labor that are necessary to reconstruct damaged property, thereby increasing the length of time required to repair or rebuild the insured location. Thus, it is important for the claims examiner handling a first-party loss to evaluate not only the insuredâ€™s rental history and income prior to the loss, but also trends in the rental market and construction trades in the local area when catastrophic losses occur as part of a comprehensive investigation of the claim.
Commercial Time Element Coverages
Business and commercial property insurance policies, likewise, commonly include coverages that are meant to replace the insuredâ€™s revenue stream during the period when the damaged property is being rebuilt. Such provisions typically take the following form:
B. Business Interruption
(l) Loss resulting from necessary interruption of business conducted by the Insured, caused by direct loss, damage, or destruction by any of the perils covered herein during the term of this policy to real or personal property as described in Clause 7.A. and subject to the Company’s acceptance of coverage for that Damage.
(2) If such loss occurs during the term of this policy, it shall be adjusted on the basis of ACTUAL LOSS SUSTAINED by the Insured directly resulting from such interruption of business, consisting of the net profit which is thereby prevented from being earned and all charges and expenses only to the extent that these must necessarily continue during the interruption of business and only to the extent to which such charges and expenses would have been earned had no loss occurred.
(3) In the event of direct loss, damage, or destruction to property described in Clause 7.A. caused by any of the perils covered herein which results in an interruption of research and development activities which in themselves would not have produced income during the Period of Recovery, this policy shall cover the actual loss sustained of the continuing fixed charges and expenses, including ordinary payroll.
(4) Resumption of Operations: If the Insured could reduce the loss resulting from the interruption of business:
(a) by a complete or partial resumption of operation of the property insured, whether damaged or not; or
(b) by making use of available stock, merchandise, or other property; such reduction shall be taken into account in arriving at the amount of loss herein.
(5) Experience of the Business:
(a) In determining the amount of net profit, charges, and expenses covered hereunder for the purposes of ascertaining the amount of loss sustained, due consideration shall be given to the experience of the business before the date of damage or destruction and to the probable experience therefore had no loss occurred.
(b) With respect to alterations, additions, and property while in the course of construction, erection, installation. or assembly, due consideration shall be given to the available experience of the business after completion of the construction, erection, installation, Oi assembly.
In addition to the traditional business income coverages, commercial policies may also provide coverage for contingent business income losses caused by property damage to the insuredâ€™s suppliers or customers. A typical contingent business interruption clause provides as follows:
5.Â Â Â Â Â Â Â Â CONTINGENT TIME ELEMENT: If direct physical loss or damage to the real or personal property of a direct supplier or direct customer of the Insured is damaged by a Covered Cause of Loss under this Policy, and such damage:
a.Â Â Â Â Â Â Â Â Wholly or partially prevents any direct supplier to the Insured from supplying their goods and/or services to the Insured, or
b.Â Â Â Â Â Â Â Â Wholly or partially prevents any direct customer of the Insured from accepting the Insuredâ€™s goods or services;
then this Policy is extended to cover the actual loss sustained by the insured during the period of interruption with respect to such real or personal property. The property of the supplier or customer which sustains loss or damage must be of the type of property which would be Insured Property under this Policy.
Like the Loss of Use coverages provided in a homeownersâ€™ policy, the commercial time element coverage provisions require the carrier examining a loss and claim to obtain considerable, detailed information about the insuredâ€™s financial situation. The carrier will want to know, for example, the revenue history of the insuredâ€™s business at the property that was damaged by the event and the expenses associated with that history. Moreover, it is critical to obtain sufficient data to analyze the impact of any seasonality on revenue, as well as any trends in terms of the growth or decline of revenue immediately preceding the loss event.
In some cases, such as insureds that operate at a single location, that information is easy to discern. In others, such as operators of multiple hotel or restaurant franchise locations, however, parsing out the history of one particular location can present significant challenges.
The purpose of the inquiry, of course, is to determine the actual loss sustained by the insured. And, while insureds have repeatedly tried to argue that the concept is new or ambiguous, the courts have repeatedly rejected those claims. See, e.g., United Land Investors, Inc. v. Northern Insurance Co. of America, 476 So. 2d 432, 436 (La. App.2d Cir. 1985) (interpreting virtually identical policy language as Clause 7. B. (2) here, and finding that courts nationwide have held that policy language is unambiguous and enforceable as written), cited in Cotton Bros. Baking Co., Inc. v. Industrial Risk Insurers, 774 F. Supp. 1009, 1027-28 (W.D. La. 1989); accord Associated Photographers v. Aetna Casualty and Surety Co., 677 F.2d 125 (8th Cir. 1982); Eastern Associated Coal Corp. v. Aetna Casualty and Surety Co., 632 F.2d 1068, 1077 (3d Cir. 1980); Rogers v. American Ins. Co., 338 F.2d 240, 242 (8th Cir. 1964); American Alliance Insurance Co. v. Keleket X-Ray Corp., 248 F.2d 920, 928 (6th Cir. 1957); Shelter Mut. Ins. Co. v. Culbertson’s Ltd., Inc., 1999 WL 461826, *5 (E.D. La. 1999) (Duval, J.); Lyon Metal Products, L.I.e. v. Protection Mut. Ins. Co., 321 Ill. App. 3d 330, 345 (Ill. App. 2 Dis!. 2001); Steel Products Co. v. Millers National Insurance Co., 209 N.W.2d 32, 37 (Iowa 1973) (“no ambiguity is suggested by the policy terms”).
Similarly, with respect to contingent business interruption claims, the insurer will want to have a comprehensive picture of the insuredâ€™s business model, including the suppliers and customers upon whom its operations rely. In some instances, the insurer will need to have additional information about the customer and supplierâ€™s finances to help determine whether their ability to supply materials to, or purchase products from, the insured is truly related to a covered cause of loss or some other event that is wholly unrelated to the claim.
Questionable and Fraudulent Claims
The second area in which the insuredâ€™s finances are important is in the evaluation of suspicious or questionable claims. In those cases, information about the insuredâ€™s financial situation can help identify red flags that suggest a problem with the insuredâ€™s claim and, after an appropriate investigation of those red flags, it may provide evidence of the insuredâ€™s motive to set a fire or stage a loss.
It is important to note at the outset of this discussion that red flags are simply tools to help you identify when further investigation is required. They are not evidence or proof of fraud. It is also important to note that there is such a thing as too many red flags. Sometimes there are so many red flags that the fraud seems obvious, and in those cases courts have occasionally held that the insurer is precluded from denying coverage or recovering the amounts it paid under the policy because it should have recognized the fraud before falling victim to it. See, e.g., Atlantic Lloyds Ins. Co. of Texas v. Butler, 137 S.W.3d 199 (Texas App. Apr. 8, 2004) (finding that testimony by the insurerâ€™s expert identified so many red flags that the insurer, who claimed it was deceived into a settlement with the plaintiff, should have recognized the fraud before settling the case).
That said, because defenses to coverage under a property insurance policy based on arson or staged thefts usually require proof of the insuredâ€™s motive, it is important to discuss the financial aspects of investigating a property loss in that context. In other words, the critical question to be addressed is â€“ â€œHow did the insured stand to gain from submitting a fraudulent claim?â€
Careful review of the insuredâ€™s financial situation, claims history, policy application, and underwriting file can provide the adjustment team with insight into a number of red flags that suggest that further investigation is required. This is true whether the insured is an individual or a business. Naturally, there are differences in the actual documentation to obtain depending on whether the insured is an individual or business, but the focus remains the same â€“ what does the history of this insured tell us about the claim at hand?
Red Flags Associated with the Propertyâ€™s Value
One good example of a red flag is the insuredâ€™s purchase of new or additional insurance on a building or other property shortly before the loss. Similarly, an unexplained change of insurance companies immediately prior to the loss; a property that the insured has listed for sale for a significant period of time before the loss; and a history of sales that have fallen through without explanation can all be cause for suspicion when combined with indications that a fire was incendiary in origin or a theft was committed in unusual circumstances.
Carriers must exercise care not to rely entirely on those circumstances before concluding that a loss is false or fraudulent, however. In the case where an insured has purchased additional insurance shortly before the loss, for example, the carrier will want to review underwriting information related to the increase in limits. That review should look to determine when the insured value of the property was last increased and what information was given to support the current increase among other things. It is possible, for example, that an insured who has not increased the coverage on their property in four or five years is merely adjusting their coverage to account for increased costs of reconstruction or an increased property value due to the natural inflation of the real estate market. The examiner will, therefore, want to compare the current increase to appraisals and other information about the local real estate market in an effort to verify that the increased coverage is consistent with the current trends in property values and restoration costs in the local market.
Red Flags Associated with Contents Claims
Other signs of suspicion can turn up in the insuredâ€™s statement of their claim for personal property or inventory. The claims examiner will want to compare the items of personal property that are claimed in a sworn statement in proof of loss and supporting inventory forms to actual receipts from the purchase of the alleged inventory and information about what was actually observed at the scene of the loss.
Insureds often forget that when combustion occurs, solid physical objects consumed by the fire degenerate but they do not evaporate! It is important, therefore, to compare the insuredâ€™s inventory of damaged contents to the debris that is actually observed within the field of a fire scene. Often that comparison can give a good indication of whether the insured is claiming significantly more or less property than was actually destroyed.
We are also aware of more than one instance in which an insured bar or restaurant claimed that they were open for business just hours before the fire, and yet the first investigators on the scene found a complete absence of any liquor bottles or other bar supplies when they surveyed the debris field. Discoveries like that should, of course, prompt the insurer to ask additional questions about the loss and the insuredâ€™s operations in the days immediately before it.
Another useful practice involves inspection of the insuredâ€™s bank statements. If you are successful in obtaining the insuredâ€™s bank statements, a quick review of activity just prior to the fire or theft event may reveal a recent rental of a storage room. Believe it or not, fraudsters who are hiding the same items they are claiming were destroyed or stolen, will leave you a paper trail leading you to the actual location of the items.
When dealing with contents claims, it is also worth consulting exchange of information sources like the Property Insurance Loss Register and National Insurance Crime Bureau. Through those sources, investigators can see whether insureds have reported the loss of or damage to similar items of property and inventory in other claims. Mr. Tribe recently consulted on a case where the same insured made a series of claims based on the theft of inventory from his cellular telephone stores in two different states and against multiple different insurance carriers that each insured slightly different iterations of the same business. Ultimately, they determined that the insured was likely hiring local homeless individuals to â€œrobâ€ his stores (thus creating a security video of the act), and then claiming losses on inventory not actually stolen. Reviewing the insuredâ€™s purchase invoices for his inventory was a crucial element in the investigation.
There are any number of reported decisions where the insured was caught in the act by sharp comparisons of contents claims across multiple losses. One arsonist was caught, for example, when an investigator noticed that he had made claims for identical stuffed mackerels in two different and unrelated fire losses. Identical Stuffed Fishes Listed Lost in Two Fires Tips Arson Investigation, Insurance Crime Prevention Institute Report, VII, No.1, 7 (Jan.-Feb. 1979). Another was caught when he tried to recover the cost of the identical paintings that were allegedly destroyed by three different fires in three different countries. Barley, Fire: An International Report 204 (Hamish Hamilton, Ltd., 1972).
Such claims raise further questions about the insuredâ€™s ability to afford the contents that they claim to have lost and seek coverage for under the insurance policy. A careful investigation of the insuredâ€™s financial circumstances is therefore important to determine whether there are other problems with their claim for lost inventory or personal property. Recognizing that fact, a Georgia federal court recently held that the insuredâ€™s failure to produce tax returns, financing documents, and other financial records in response to the insurance companyâ€™s request precluded the insured from suing his insurance company to recover damages for the loss of his house in a fire. See Farmer v. Allstate Ins. Co., 396 F.Supp. 2d 1379 (N.D. Ga. 2005). At least one Louisiana court has agreed, finding that the insuredâ€™s failure to comply with the insurance carrierâ€™s reasonable requests for an examination under oath and additional financial records and documents was a breach of contract that precluded his lawsuit. See Brent Honore v. AIG Property Cas. Ins. Agency, Inc., 2014 WL 4986780.
Courts considering similar cases will ordinarily give an insurer significant latitude to obtain information about the insuredâ€™s financial situation as part of that investigation. The Mississippi Supreme Court held, for example, that expert testimony that a fire was intentionally set provided an insurer with a legitimate reason to question the finances of the insured and her spouse to determine whether there was a possible monetary motive for them to set the fire. Thus, the court ruled that an investigation into the insuredâ€™s finances was warranted in settling the claim. See Monticello Ins. Co. v. Mooney, 733 So.2d 802 (Miss. 1999). That ruling is generally consistent with various courts that have recognized that the motive for arson is often financial. See, e.g., Allstate Ins. Co. v. McGory, 527 So.2d 632 (Miss. 1998); Sumrall v. Providence Washington Ins. Co., 60 So.2d 68 (La. 1952); Pennsylvania Nat.â€™l Mut. Cas. Ins. Co. v. Lane, 656 So.2d 371, 375-76 (Ala. 1995).
The team handling a suspicious claim should also consider going beyond the personal finances of the individual insured or those of the company making the claim. Often, analysis of the financial records for other businesses that the insured owns or participates in can reveal information that is helpful to understanding why the insured might have a motive to submit a fraudulent claim. A few years ago, for example, we were involved in litigation over a claim for property damage and business income losses suffered by the owner of an apartment complex in Houston, Texas, as a result of Hurricane Ike. As we tried to gather information about the business income loss, something did not look right. The insuredâ€™s representative claimed to manage a series of similar properties for a group of European and Israeli investors. But, when we asked for rent rolls, copies of leases, and monthly income statements, the representative told us that no such formal records were kept.
We also questioned why the insured had not started to repair the alleged property damage immediately after the storm, given that our client had advanced more than $250,000 toward the property damage loss. In response to that question, the representative informed us that the mortgage lender had taken all of that money and refused to release it and the investors he represented had no other funds available to make repairs.
That story seemed particularly odd to us, considering the fact that one of the known investors was the head of a family that has historically played an active role in the Antwerp diamond market. We asked some additional questions about the identity of the investors in the project and their financial situation in an effort to get to the bottom of the apparent inconsistencies. We also asked our clientâ€™s SIU to research public records regarding the financial dealings and operations of the investors in the property and other claims related to their various business interests.
A few days later, the SIU investigator informed us that a partner in one of the investorâ€™s other ventures stood accused of conspiring to stage two massive diamond and gem heists in the Manhattan Diamond District. Chad Smith, Alison Gendar, and Thomas Zambito, Diamond District Jeweler Behind Two Massive Gem Heists, Feds Say, N.Y. Daily News, December 8, 2008. According to their investigation, the related business had made significant claims against its insurer for the value of the allegedly stolen gem stones, which the insurer was investigating as a fraudulent claim. Further, as a result of those claims, the insurers had refused to renew the companyâ€™s insurance coverage and De Beers Group had stripped the investorâ€™s family of its status as a Sightholder in the London and Antwerp markets. That information gave us reason to look again at the insuredâ€™s claim for damage and business income losses with respect to the apartment complex.
Practical Advice for the Claims Team
Given the importance of financial information in evaluating first-party claims, how should an insurer approach the process of gathering and evaluating that information as a practical matter? Our suggestion is that in almost every claim, this process should involve a team of individuals comprised of: (1) the inside claims examiner or adjuster; (2) the field or outside independent adjuster; (3) a SIU investigator; and (4) outside counsel. Within that team, the inside claims examiner can coordinate the efforts of the remaining members, each of whom can assist by gathering specific components of the financial information that is relevant to the adjustment of the loss.
Where appropriate, the inside claims examiner and counsel should obtain the assistance of a forensic CPA, who can assist them in understanding the information that they obtain from the insured and other independent sources. What follows below is a guide to some of the key financial information that the carrier should seek to gather as part of its adjustment of a financial loss or investigation of a suspicious claim.
Key Financial Information to Gather
The Basic Documentation of the Claim
As a starting point in the handling of any first-party claim, the insurance company should obtain the following information:
- The underwriting file, including any financial statements, applications, appraisals, or other information submitted by the insured;
- A personal financial statement or profit and loss statement from the insured, showing all assets and outstanding liabilities. Preferably, obtain monthly profit and loss statements for at least the 12 months immediately preceding the loss event. However, more is generally better;
- A profit and loss statement for all business entities under an individual insuredâ€™s control. Again, monthly profit and loss statements for 12 or more months is better;
- State and federal income tax returns. We suggest getting the two years preceding the loss event year, if possible;
- Mortgage statements for any mortgages on the property;
- Public records of any bankruptcy or foreclosure proceedings involving the insured and the insured property;
- A sworn statement in proof of loss and a contents list of all of the allegedly damaged contents and inventory.
Additional Information Helpful to the Analysis by a Forensic CPA
When a CPAâ€™s input becomes necessary, additional information is also critical to the investigation of the loss. The exact information that is important depends on the type of claim addressed. For convenience, we have divided the list of information that you should request into two categories: business losses and individual losses.
- Payroll records for at least three pay periods immediately preceding the claim, as we well as payroll records during the period of restoration. This allows for analysis of the insuredâ€™s claim regarding both historical payroll levels and actual continuing payroll after the loss event;
- Copies of any lease agreements applicable to the loss location. Often, commercial leases will have an abatement clause that substantially reduces or eliminates rent during the period of restoration. This is especially important when the same person who owns the business also owns the building and leases it to the business;
- Permission to speak directly with, and obtain documentation from, the insuredâ€™s outside accountants;
- If the investigation has proceeded to a level that warrants a significant review of detailed information, consider attempting to obtain the following:
- A backup copy of the businessâ€™s accounting records, assuming they use an off-the-shelf accounting software package (e.g., QuickBooks);
- Copies of bank statements that correspond in time with the profit and loss statements mentioned above;
- Copies of any sales and property tax returns filed with the local municipality, county, parish, or state (depending on the local requirements)
- Industry-specific items:
- Hotels and resorts â€“ rate sheets, historical and current occupancy reports, and profit and loss statements for any ancillary businesses on site (e.g., restaurants, bars, etc.);
- Apartments â€“ lease agreements for impacted units, current rental rate information, and occupancy reports (both historical and current);
- Restaurants and bars â€“ lease agreements (especially if there is a percentage rent clause), franchise agreements, and justification for continuing payroll (e.g., is there a chef that the restaurant cannot afford to lose, etc.). Invoices supporting claimed amounts of liquor on hand, as well as its cost. Reports detailing the amount and nature of comps supplied to customers;
- Retail â€“ lease agreements (especially if there is a percentage rent clause), justification for continuing payroll, invoices supporting inventory quantities and cost claimed as on-hand at the time of the loss event, recent inventory count sheets, and reports detailing rates of returned items;
- Manufacturing – complete detail on how the overhead costs included in inventory (and cost of goods sold) is calculated and allocated. Invoices supporting raw materials inventory claimed as on hand. Copies of any communications from customers canceling orders as a result of the loss event;
- Professional Services â€“ example businesses would include accounting firms, law firms, architectural firms, etc. Obtain historical and current time and billing records. Require explanation and documentation for the cancellation of services versus the simple delay of services;
- All bank statements, brokerage statements, investment holdings reports, etc. for the 12+ months immediately preceding the loss event;
- All credit card statements, loan statements, mortgage statements, etc. for the 12+ months immediately preceding the loss event;
- Copies of any liens, judgments, etc. available from public records;
- Copies of personal income tax returns for the two years preceding the loss event;
- Copies of any communications between the insured and any taxing entities regarding back-taxes, penalties, fines, etc.
It is easy to overlook the importance of the insuredâ€™s finances in handling a first-party insurance claim. Often, however, the financial issues associated with such a claim are at least as important, if not more so, than the property damage and other aspects of the investigation. The discussion presented here should guide you in identifying relevant financial issues that a claim presents. It should also help you to understand when it is appropriate to engage outside counsel and forensic accountants to assist in the evaluation of this type of claim.
About the Authors:
Christopher R. Teske is a member of the law firm of Gieger Laborde & Laperouse LLC in New Orleans. His practice focuses on complex disputes involving insurance coverage, including the pre-suit investigation of first-party property insurance claims, the trial of catastrophic loss first-party and bad faith claims, and construction defect related disputes. He is a member of the DRI Insurance Law Committee. Tim D. Tribe, CPA, CFF, CFE, CICA, is the practice leader for REDW LLCâ€™s Forensic and Litigation Services, located in Phoenix. He has approximately eighteen years of experience as a Big 4 auditor, as an adjunct college instructor, and as a forensic accountant. His practice focuses on fraud examinations, litigation and expert witness services, and insurance claim support.