My claim is under SIU review: what to expect and your rights

If your adjuster says the claim has gone to the special investigations unit, a team that checks claims for misrepresentation and fraud is now reading your file. That is not a finding against you, and it does not cancel what the policy owes you if the claim is genuine. It does mean the usual pace changes: expect more document requests, possibly an interview, and a longer wait, with state deadlines that bend but do not disappear.

This article is for the person sitting in that wait. It explains why claims get referred, which clocks still apply, what you can be asked to do, what to write down, and when to bring in the state insurance department or a lawyer. Claim rules differ by state, so the examples here come from the NAIC model rules and from California, Texas and New York texts that could be read in full in November 2026. For your own state, use the state car insurance requirements lookup tool and the insurance department's site.

What the SIU is, and why your claim was sent there

A special investigations unit is the part of an insurer that investigates suspected fraud. Many states require insurers to have one or to hire outside investigators, and the rules about how they work are public. California, for instance, requires an insurer to maintain written procedures that list red flags for detecting suspected fraud, specific to each line of insurance, and to investigate every credible referral that includes a red flag, including referrals generated automatically by a system (10 CCR 2698.36).

Two points follow from that. First, a referral can start with software or a checklist rather than with anyone doubting you personally. Second, the specific red flags are the insurer's internal list, so nobody outside can tell you exactly which one your claim tripped.

What tends to prompt a second look, in general terms, are facts that do not fit together. The Insurance Information Institute (Triple-I) describes the common auto frauds as padding a claim, misrepresenting facts on an application, claiming injury or damage that never occurred, and staging accidents. A review can start from the opposite side too: an ordinary claim that happens to share features with those patterns. Examples that commonly lead to questions:

• A loss soon after the policy began or the coverage went up (see filing a claim shortly after a policy starts: what insurers check).
• A story that differs between the first call, the police report and the repair estimate.
• Several people claiming injuries from a low-speed collision, or several claims treated at the same clinic.
• Missing records that would normally exist, such as a police report or towing receipt.
• A vehicle, address or driver on the claim that does not match the application.

None of those proves anything. A software flag that delays an ordinary claim is its own topic; see when an automated fraud flag delays your claim.

Does the clock still run?

Yes, with exceptions. State rules set deadlines for accepting or denying a first-party claim, and fraud suspicion modifies them rather than switching them off.

The sources are the NAIC's model claims regulation, California's 10 CCR 2695.7, Texas's Insurance Code 542.056, and New York's 65-3.5 and 65-3.8. Notice what the table implies. In California, the insurer is not required to tell you why it needs more time if the reason would alert you to a fraud investigation, because the regulation says nothing in it requires an insurer to disclose information that could reasonably alert a claimant that the claim is being investigated as a suspected fraudulent claim. A vague "we need more time" letter is not itself a violation.

One more California rule is worth knowing. If the insurer sends the Fraud Division information on a claim and has no evidence that its own insured is involved in the fraud, Insurance Code 1872.4(e) says it must take all necessary steps so no surcharge is added to the insured's premium because of the claim. Other states may or may not have a similar protection.

What you may be asked to do

An SIU review usually adds requests to the ordinary claim process. Here are the common ones, with what the standard policy form says about them.

Documents. Receipts, repair estimates, photographs, the title, maintenance records, phone records showing when you called for help. The standard Insurance Services Office personal auto policy form, as reprinted by PropertyCasualty360 (December 2014 edition), requires an insured to authorize the insurer to obtain medical reports and other pertinent records and to submit a proof of loss when required. Policies vary, so read yours.

A recorded statement. The insurer asks questions and records the answers. This is usually voluntary in the sense that no court is compelling it, but refusing every request can be treated as a failure to cooperate. Read recorded statements: when to give one and when to wait before agreeing.

An examination under oath (EUO). A formal, sworn question session, often with a court reporter, that the policy can require. The same ISO form lists examination under oath among the insured's duties. New York's no-fault regulation sets guardrails: when an insurer requires an EUO to establish proof of claim, the requirement must rest on objective standards giving specific objective justification; the exam must be at a place and time reasonably convenient to the applicant; and the insurer must tell you when scheduling that you will be reimbursed for lost earnings and reasonable transportation costs. the cooperation clause: records, interviews and exams under oath covers this in detail.

A medical examination. If the claim involves injury, the policy may require you to be examined by physicians the insurer selects, at its expense. The ISO analysis notes this applies to the person making a claim under the policy, such as medical payments or uninsured motorist coverage, and that a third-party claimant has no obligation to submit to any kind of examination except voluntarily as part of a settlement.

A polygraph. The NAIC model claims regulation says no insurer shall request or require an insured to submit to a polygraph unless authorized under the policy and state law. Ask which provision they rely on before agreeing.

If you are asked for something that seems unrelated to your claim, ask the adjuster in writing why it is needed. California's regulation says an insurer must pursue a thorough, fair and objective investigation and "shall not persist in seeking information not reasonably required for or material to the resolution of a claim dispute."

Your duties and your protections

The two lists sit side by side, and it helps to see them as a pair.

Two details deserve emphasis.

Cooperation duties usually have a limit. The ISO form states that the insurer has no duty to provide coverage if the failure to comply with the listed duties is prejudicial to it. In plain terms, a refusal that actually harms the insurer's ability to investigate carries more risk than a technical lapse that harms nothing. Do not count on that; cooperate with every reasonable request and object in writing to the unreasonable ones.

Denials come in writing with reasons. Under the NAIC regulation, a denial on the basis of a specific provision, condition or exclusion must refer to it and be in writing, and after a rejection the insurer must tell a claimant who objects that the matter can be reviewed by the state insurance department. California adds that the written denial must list all bases and the factual and legal reasons then within the insurer's knowledge, and must include the department's address and telephone number for claim reviews. Texas requires a rejection notice to state the reasons.

Keep your own file

The insurer's claim file is thorough. Yours should be too, because memory fades and adjusters change. keeping a claim diary to protect yourself goes deeper; the essentials follow.

1. Log every contact. Date, time, name, title, phone number, what was said and promised. Send a confirming email afterward: "Thank you for speaking with me today. To confirm, you said..."
2. Do everything in writing when you can, and keep sent items. If someone calls, follow up in writing.
3. Number your documents. When you send paperwork, list each item in your cover note and keep a copy of exactly what was sent, including the date and method.
4. Save the originals of photos, texts and receipts, with metadata intact.
5. Calendar the deadlines. Note the insurer's stated decision date, the next required status letter, and any suit-limitation period in your policy.
6. Ask for your claim number (claim number) on every communication and quote it.

A short log might look like this:

A worked example

This is a hypothetical timeline with invented numbers.

Say your parked car is damaged in a hit-and-run on a Monday, and your repair estimate is $7,400. On day 9 the adjuster calls to say the claim needs "additional review" and asks for a recorded statement and the phone records for that night.

• Day 9. You ask what is needed and why, in writing. You tell the adjuster you will provide documents that relate to the claim and ask which policy provision requires the phone records.
• Day 10. You send the police report number, your photos and your estimate, and log the date.
• Day 16. You give the recorded statement. You ask for a copy of the recording or transcript.
• Around day 50 (in a California-style state). The 40-day deadline to accept or deny, counted from proof of claim, passes unless the insurer has sent written notice that it needs more time. If you got nothing, you send a dated email: "I have not received a decision or a written explanation of the delay. Please send both."
• Day 55. Still nothing. You file a complaint with the department of insurance and attach your log.
• Day 70. The insurer accepts the claim and pays within the payment window. In a California-style state that window is 30 calendar days after acceptance.

The claim was delayed, not denied. The log made the complaint easy to document.

When to bring in the department or a lawyer

The insurance department handles claims-practice disputes. A fraud allegation or criminal exposure is a different matter and calls for a lawyer. These are the triggers:

Contact the department when the insurer misses a deadline, will not explain what it needs, or sends no written status notices. The process is in how to file a complaint against a car insurance company and after you file a department of insurance complaint: what to expect.

Consult a licensed attorney when:

• You are asked for an examination under oath, or told you are under investigation for fraud.
• A denial says you misrepresented something.
• The insurer asks you to sign a release, or to waive the time limit for suing, before it decides.
• You are told investigators outside the insurer, such as police or a fraud bureau, want to speak to you.
• The delay is eating into the suit-limitation period in your policy or state law.

On time limits: California requires an insurer to give written notice of any statute of limitations or other time requirement it may rely on to deny a claim at least 60 days before expiry for most claims, unless the claimant has counsel, and the NAIC regulation requires notice 30 days in advance for first-party claimants not legally represented. Do not assume your state is the same. A suit-limitation clause can keep running while the SIU works. See statute of limitations.

How to challenge a delay or a denial

Escalate in steps, keeping the log current:

1. Ask the adjuster for the specific basis of the delay or denial in writing.
2. Escalate inside the company to the claim supervisor or a complaints unit; escalating a problem inside your insurer before you complain explains how.
3. File a complaint with the insurance department, which can require a written response.
4. Use the policy's dispute tools where they apply, such as appraisal for amount-of-loss disputes or arbitration for some PIP claims (see arbitration and mediation in auto insurance disputes).
5. Consult an attorney about a lawsuit, including a claim of bad faith if the delay or denial lacks a reasonable basis. Bad-faith rules are state-specific; insurance bad faith explained gives the outline, and how to appeal a denied car insurance claim covers appeals.

What happens once a claim is cleared

Most often the result is simply payment. The NAIC regulation calls for tender within 30 days of affirming liability when the amount is determined and undisputed, and California's rule is payment within 30 calendar days of acceptance, when needed upon receipt of a signed release. Some things to do at this stage:

• Read the payment letter for what it covers and any release you are asked to sign. Does cashing a claim check end your claim? Releases explained explains the difference between a payment and a release.
• Ask for a written statement that the review is closed, if the insurer will give one.

If the insurer concludes there was a misrepresentation, the outcomes run from a partial denial to a full denial, cancellation or rescission of the policy, and, in some cases, a report to the state fraud bureau. A report is not a charge; prosecutors decide separately, as how an insurance fraud case is prosecuted from referral to sentence explains, and insurers who report are generally protected from suit absent malice (mandatory fraud reporting and immunity laws for insurers).

Common questions

Is the SIU the police?

No. The SIU works for the insurer and is not a law enforcement agency, though it can refer cases to police or a state fraud bureau. Its findings feed the insurer's decision to pay or deny. A criminal case requires a prosecutor.

Do they have to prove fraud to deny my claim?

An insurer denying a claim for misrepresentation has to be able to point to a policy provision and to facts. The proof required in a coverage dispute is lower than in a criminal trial, and the exact standard depends on the state. That is a reason to consult an attorney if you face an accusation, not a reason to assume the insurer is wrong or right.

Can I record my own conversations with the adjuster?

Whether you may record depends on state and federal recording-consent laws, which differ. Ask the other party to consent on the record, or take careful notes and confirm the conversation by email.

Will my premium go up because of the review?

Not necessarily. California bars a surcharge in the situation described above, where the insurer has no evidence its insured was involved in the fraud. In other states, the paid claim itself is what usually drives rating, not the review. If your premium changes, ask the insurer to explain, and see How a claim reaches your CLUE report and your renewal price.

Key takeaways

• An SIU referral is a review step, often triggered by software or a checklist; it is not a finding against you.
• Fraud suspicion extends claim deadlines in many states, as in California's 80-day limit, but insurers still owe a reasonable investigation, written reasons for a denial, and a path to the department of insurance.
• Respond to reasonable requests promptly, object in writing to unreasonable ones, and correct any mistakes you find in what you told the insurer.
• Keep a dated log, number the documents you send, and calendar every deadline, including the policy's time limit for suing.
• Call the department about missed deadlines and unexplained delays; call a licensed attorney when you are asked for an examination under oath, accused of misrepresentation, or contacted by investigators.