You and The Law The case of the felonious doctor and a claims adjuster who had a heart

What Everyone Needs to Know About an Examination under Oath When Making an Insurance Claim

For anyone who claims injuries from an accident or owns or rents insured real property, should it suffer damage or a theft loss, there is always a chance that you will be required to attend an examination under oath by a claims adjuster or an insurance company attorney.

If requested, you must assume the insurance company suspects fraud or has other concerns.

Failure to participate can result in your claim being dismissed or the matter referred to law enforcement if there is a suspicion of insurance fraud.

Today’s story is about one such case—a fact situation so unique that it could be the basis of a motion picture. It began in Southern California when the devil winds were howling.

The Santa Anas

One of the most violent and dramatic wind events in the United States, known as the Santa Ana winds, begin during the months of October to March. These hot and dry devil winds can reach hurricane speeds, toppling utility poles, uprooting trees, knocking over tractor trailers and cutting power.

They also set off burglar alarms as Dr. “K” would discover.

Adored By His Patients

In the small, remote Southern California town where he practiced medicine as a primary care physician and cardiologist Dr. “K” was adored by his patients. He was one of the many foreign-trained doctors so vital to our health care system, often working in towns that otherwise would lack a physician.

One Friday Night

One Friday night the Santa Ana winds were howling and Dr. K’s burglar alarm was set off by a broken glass detector when a tree branch flew onto the office front door, shattering the glass.

He and his office manager were notified by his alarm company, went to the office, and met a deputy sheriff. A brief, superficial inspection appeared to show that everything inside was untouched.

The next day, he returned to the office and “found that 15 wearable cardiac Holter monitors — average price for each one $5,000 — were missing,” according to the insurance claims he filed.

Attend An Examination Under Oath Or Claim Denied

Several weeks later, I was contacted by Dr. K’s colleague a day before a claims adjuster was to conduct the doctor’s examination under oath. “Dennis, he postponed it several times and the insurance company said they will deny his claim if he does not meet with them and have a lawyer present. As a favor to me, please help him. I have no reason to suspect that he did anything wrong.”

I agreed and drove to the small town in a rural part of California that I had never even heard of.

Claims Adjuster and the Company’s Attorney Took Me Aside

Before the session began, “Ed,” the claims adjuster and insurance company’s attorney, “Paul,” asked to speak with me in private.

“Mr. Beaver, Dr. K informed us that you would be here so that his claim would not be rejected. We want you to know that no punitive action will be taken against him and this will be explained following the examination.” Then, the doctor was sworn in and the examination began.

Paul: “Doctor, would you please tell us, step by step, everything that you did that evening and the following day of the wind event that set off your alarm system.”

Dr. K explained that he inspected his office briefly that evening and then returned the next day for a more thorough search to see if anything was taken or damaged.

Next, the claims adjuster spoke:

“Doctor, I am going to show you a video that was recorded by the security system on an office building across the street from your medical office and ask if you can identify the person in the video and what he was doing.”

They played the video. In broad daylight, it showed Dr. K enter his office and coming out with a box containing objects that had what appeared to be wires or loose straps on the sides of the box. The person made three trips and his face was clearly visible.

“Can you tell me who that person shown in the video is?” asked the claims adjuster.

His head lowered, covering his face with his hands, Dr. K said, “That’s me. I am so sorry.”

A Good Deed Rewarded

Paul, the attorney, next spoke:

“We knew all along what had taken place but obtained permission from the claims supervisor to close this case — not pay the claim — and not go after you for insurance fraud. And why?”

“It is because Ed and I are brothers and grew up in this town but moved away before you came here.”

“Years ago, we were both away at college. Our grandfather had chest pains and grandma drove him to your office, as an ambulance would take too long. Pops was having a heart attack! His heart stopped and you shocked him back to life!

“There is no way that we could do anything that would take you from us and this little town where we grew up. You have done so much for so many people. I don’t know why you did it, but the planets are all aligned now, and I am confident you have learned a lesson.”

And there sat my client, sobbing, apologizing.

There was something so powerful, so touching and what Paul said, so charitable, so right. It has been years. Yes, the planets were indeed all in alignment that day.

Dennis Beaver practices law in Bakersfield and welcomes comments and questions from readers, which may be faxed to 661-323-7993, or e-mailed to Lagombeaver1@gmail.com. And be sure to visit dennisbeaver.com.