What step should an adjuster take before denying a claim related to potential fraud or arson?

The appropriate step for an adjuster to take before denying a claim related to potential fraud or arson is to send the claim to the special investigation unit (SIU). The SIU is specifically trained to handle cases that involve suspected fraud, including arson. They use expertise in investigation techniques and have access to resources that can thoroughly assess the legitimacy of the claim.

Involving the SIU before making any final decisions allows for a more comprehensive investigation into the circumstances of the claim, ensuring that any conclusions drawn are based on detailed scrutiny rather than speculation. This process also helps protect the insurance company from potential liability issues that could arise from incorrectly denying a claim based on insufficient evidence.

Contacting the policyholder directly, requesting additional documentation, or submitting a report to law enforcement could be initial steps in the process but do not provide the specialized focus that the SIU brings to cases of suspected fraud or arson. Engaging the SIU ensures that the matter is handled appropriately, following established protocols for investigations in these sensitive and complex situations.