What an SIU referral usually means
Most insurers have a special investigations unit that reviews claims flagged by software, adjusters, or tips. A referral is not an accusation by itself, but it changes the tone: the insurer may ask for more documents, an examination under oath, or access to phone and financial records. In New York, insurers are required to report suspected fraud to the state Department of Financial Services, and some matters move on to a district attorney. Auto no-fault claims, fire and property losses, disability claims, and staged accidents are common subjects. An insurance fraud investigation can also focus on medical providers, body shops, or others connected to the claim rather than on the policyholder.
Statements, documents, and the policy
Read your policy's conditions, because many require you to cooperate, produce records, and sit for an examination under oath, and refusing can give the insurer a reason to deny the claim. At the same time, an examination under oath is recorded and transcribed, and what you say can later reach investigators. Having your own lawyer prepare you, and attend with you, is common and sensible. Collect receipts, photos, repair estimates, and communications about the loss, and do not alter or reconstruct documents to fill gaps. If something in an earlier statement was wrong, tell your lawyer instead of correcting it on your own with the adjuster.
When it becomes more than a claim dispute
Some SIU reviews end with payment, some with a denial that can be challenged in court or through procedures in the policy, and some with a criminal referral. Signs that a matter is moving toward the last path include contact from a detective, a grand jury subpoena, or questions about other people involved in the claim. Our starting point is the policy, the insurer's requests, and anything you have already said or signed. We then decide whether to treat it mainly as a coverage dispute, a possible criminal matter, or both. Policies often set their own deadline for filing suit, and it can be shorter than people expect, so that clock is part of the review.
