I feel there was definitely enough red flags to warrant an SIU referral and definitely enough misrepresentations (either intentional or accidental) by the insured to support the carrier’s denial after they concluded their investigation.
Love the fact that the Judge indicated “Surely, American National cannot be faulted for failing to inquire about items that it did not know existed.” and that Felix seemed to require American National to ask about details of the items, such as the color of the purse and the style of the earrings, ***that he failed to include in the proof of loss and never mentioned in his two statements under oath****”
I feel there was definitely enough red flags to warrant an SIU referral and definitely enough misrepresentations (either intentional or accidental) by the insured to support the carrier’s denial after they concluded their investigation.
Love the fact that the Judge indicated “Surely, American National cannot be faulted for failing to inquire about items that it did not know existed.” and that Felix seemed to require American National to ask about details of the items, such as the color of the purse and the style of the earrings, ***that he failed to include in the proof of loss and never mentioned in his two statements under oath****”
Seems like the court got this decision right.
Moral of the story – Pigs go to slaughter.