Every fraud investigator or lawyer advising an insurer on a potentially fraudulent claim is faced, at the end of an investigation, with the need to determine whether there is sufficient grounds to deny the claim. It is not enough to believe that the insured has committed fraud. It is necessary that sufficient evidence exist to establish, beyond a preponderance of the evidence, that fraud occurred.
Two grounds upon which a denial may be effective are misrepresentation or concealment of a material fact, and false swearing.
Misrepresentation
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