What Constitutes Adequate Participation in an Examination Under Oath?

J.P. Gonzalez-Sirgo
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Founder of J.P. Gonzalez-Sirgo, P.A.

If a fire or storm damages your home, your insurance carrier’s policies and procedures for handling claims will dictate the timing and amount paid on your claim.  In many cases, the insurance carrier will request that you participate in an Examination Under Oath (EUO), which permits the insurer to ask questions and request information and documents.  The documents and information are to be used by the insurer to determine issues, such as coverage, fraud and the value of loss.  A policyholder must both show up for an EUO and participate or risk having the claim denied since cooperation with a EUO is typically a mandatory condition imposed on an insured under a homeowner's policy.

However, sometimes insurance disputes arise based on an EUO when a policyholder participates but not to the extent or in the manner anticipated by the insurer.  When an insured refuses to cooperate with an insurer who is demanding an EUO, the insurer cannot necessarily justify denying the claim.  While an insurer has a right to use this process to gather information, an EUO cannot be used as an open ended fishing expedition for the insurer to probe for information outside topics relevant to the claim.

The Fourth District Court of Appeal case Solano v. State Farm provides an example of a case where the extent of participation by the insured was alleged to be less than satisfactory.  The insured submitted a claim to the insurer following Hurricane Wilma.  The insurer initially indicated that the claim was covered, but the policyholder eventually requested the claim be reopened, so the policyholder could pursue more extensive compensation.

After the insurance company re-opened the claim, the carrier requested that the insured appear for an EUO.  The insured appeared for the EUO and answered the questions posed by the attorney for the insurance company.  However, the wife of the policyholder did not appear at the EUO.  Further, the public adjuster retained by the insured refused to appear because the adjuster claimed he was not required to participate.  The adjuster did submit extensive documents to the insurer despite refusing to appear for the EUO.  The trial judge found that the failure of the insured’s wife and the public adjuster to appear for the EUO justified denial of the claim.

On appeal, the court reversed the trial court based on the fact that the insured appeared and cooperated by answering questions and providing requested documents.  The court pointed out that the insurer failed to establish that the public adjuster had a duty to appear at the EUO.  The decision noted that the adjuster voluntarily provided a plethora of documents.  The court concluded that the insurer was provided with adequate facts for the insurer to pay the claim or proceed to an appraisal.

When your insurer requests that you participate in a EUO, it is important that you do not disregard this request.

You can reach Miami Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

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