10/21/2016

Partnering for Success on Suspicious Premises Liability Claims

How SIUs can use their backgrounds and knowledge to partner with insureds and deter suspicious losses.

By Robert Kohn

SIU cases present special challenges—that’s why the “s” in SIU stands for “special.” However, various types of coverage present different challenges. Let’s focus on how SIUs can assist not only with investigating suspicious claims, but also by using their backgrounds and knowledge to partner with insureds to deter suspicious losses on premises liability claims.

What makes premises liability claims so challenging is that the occurrence itself can be difficult to prove. The most common type is a slip and fall on ice or liquid (also common is its sibling, the trip and fall on an alleged defect). Quite often, the loss is unwitnessed and, in such a case, the following nonexhaustive list of concerns arise:

  1. Did the loss occur at the location?
  2. Did the loss occur at all?
  3. If a defect or hazard was confirmed, was it the proximate cause of loss?

The simplest method for a property owner to address these questions is with video surveillance. Quite often, an insured will look at video surveillance as being necessary only to address crimes like theft or vandalism, or safety issues such as muggings or physical assault.

It is becoming all too frequent that claimants refuse to take responsibility for their actions. When they trip and fall over their own two feet—something we have all done—they feel someone else should be blamed. The claimant then often looks for a nearby cause, such as a defect in a sidewalk or minor defects on the edges of stairs, in the precise vicinity of the loss or even at a neighboring property. These typically are minimal things but become fodder for the claimant to point to as the proximate cause of loss.

Video surveillance levels the playing field. What’s more, just advertising that there is video surveillance in operation will deter many would-be claimants. One drawback of surveillance, however, is the cost to maintain the video for long periods of time.

Despite the tremendous growth in affordable storage, video cloud storage remains prohibitively expensive for extended video. When someone embellishes the manner in which an incident occurs, they frequently wait some length of time to present their claims, thereby making it more difficult to confirm or refute that the incident occurred as reported.

That means the insured needs to maintain video for at least 90 days, and closer to 180 days for the video to be effective in targeting opportunistic claimants. A suggestion would be for trade groups, property managers, or real estate owners to leverage their scale and invest in cloud storage together, which can be done without sharing access to each other’s data. Alternatively, the high cost of storage may be offset by the difference in premium that would occur if too many claimants begin to target an insured.

When investigating a suspicious loss, SIU personnel need to review all video, including video from a neighboring property, and work with their risk management departments (and their insureds) to proactively address video surveillance.

Another weapon in fighting these opportunistic claim is the boots-on-the-ground method of interviewing as many people as possible. Investigations frequently include attempts to interview those physically closest to a loss but not necessarily those most likely to “know something.” It is common for residents or a commercial tenant’s employees to either witness a loss or observe suspicious activity. A canvass for witnesses can be difficult since many individuals often do not want to get involved, but insureds typically know those people  in the neighborhood or building who are in the know. Those folks should be located and interviewed in addition to random canvass efforts. These individuals may not always be able to provide the SIU with definitive answers, but they often can provide enough information to confirm whether a deeper investigation is warranted.

When claimants are successful in exaggerating or fabricating their losses, the word spreads and those insureds become targeted for additional suspicious claims. Signs advising of video surveillance or the presence of cameras themselves are an excellent deterrent, and costs for these continue to drop. Deterrence of suspicious claims can be more useful than an investigation, and it is incumbent on SIU departments, based on their knowledge of how suspicious claims evolve, to partner with insureds and risk managers to design fraud deterrent measures while also aggressively investigating suspicious claims when they occur.



Robert Kohn is director of risk management services for Preferred Concepts, an Alliant Insurance Services company. He has been a CLM Fellow since 2014 and can be reached at rkohn@preferredconcepts.com.

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