Our firm has an extensive track record of handling moral risk cases. Depending on the nature of the case, we form a team of attorneys to select whom to interview in our capacity as advisors to the insurance company, and also to develop the content of those interviews. We also represent the insurance company in conducting interviews and on-site investigations, and if the matter proceeds to litigation, we have the ability to support the insurance company as their legal counsel.
Even in cases where an insured event has occurred and the policyholder has made an insurance claim, there are cases in which fraudulent claims, such as accidents being staged, are suspected. The insurance company must determine whether or not a claim is fraudulent and decide promptly whether or not to accept the claim.
In deciding whether to accept a claim, the insurance company needs to understand legal precedent according to the type of insurance, such as fire insurance, automobile insurance, or accident insurance, as well as which party, the insurance company or the claimant, bears the burden of proof when a claim is filed.
Also, even if the burden of proof is clarified, in cases where a claim is suspected of being fraudulent, due to the nature of the case, direct evidence is scarce, and in many cases indirect evidence must be accumulated and verified. In such cases, it is difficult to determine how indirect facts should be evaluated individually and how they should be judged as a whole.
For this reason, in cases where a fraudulent claim is suspected, the insurance company must consider various viewpoints as it conducts interviews and investigations with relevant parties as soon as possible and also collects relevant documentation.