Guide · Injury · Illinois

When Your Own Insurer Wants a Statement: Cooperation Clauses, UM Claims, and Examinations Under Oath

You can decline the other driver’s insurer. Your own policy may require cooperation. How to meet it without damaging your claim.

By Lincoln Square Law · 8-minute read

Most advice about recorded statements is about the other driver’s insurer: you are not required to give one, and you usually should not. The harder question comes when the request is from your own insurance company. Your policy is a contract, and most automobile policies require you to cooperate with the insurer’s investigation. If you are making a claim under your own uninsured or underinsured motorist coverage, your own insurer is effectively on the other side of that claim. This guide explains how statements to your own insurer differ from statements to the other side, what your policy may require, and how to meet those obligations without damaging your claim. Our companion article on the recorded statement trap covers calls from the other driver’s adjuster.

Two different relationships

When the other driver’s insurer calls, it has no contract with you. Its job is to minimize what it pays on a claim against its own customer. You generally have no obligation to talk to it.

Your own insurer is different. You bought a policy, and the policy includes duties you agreed to perform after a loss. Those usually include prompt notice of the accident, cooperation with the investigation, and, for some claims, submitting to a recorded statement, an examination under oath, or a medical examination. At the same time, when you claim uninsured motorist or underinsured motorist benefits, your insurer stands in the shoes of the at-fault driver, and its interests on the value of your injury claim are adverse to yours.

Start every call by confirming who is on the line. Ask for the caller’s name, the insurance company, whose policy the call concerns, and the claim number. Callers from different companies can sound alike, and after a crash involving several vehicles, you may hear from three or four insurers in the same week. Write down each call, and ask for any request in writing before you respond to it.

What the policy may require

Read the “Duties After an Accident or Loss” section of the policy. Common provisions require the insured to:

• Give prompt notice of the accident, including how, when, and where it happened, and the names of injured persons and witnesses.
• Cooperate with the insurer in the investigation, settlement, or defense of any claim.
• Send legal papers promptly if a lawsuit is filed.
• Submit to examinations by physicians chosen by the insurer, as often as reasonably required, for injury claims under the policy.
• Authorize access to medical records related to the claim.
• Submit to a statement or examination under oath when the policy provides for one.

The exact wording matters. Some policies require a statement under oath only for certain coverages. Some allow the insured to have counsel present. Some set time limits. A request that goes beyond what the policy requires can be declined or narrowed.

What happens if you do not cooperate

Illinois law has long protected insureds from losing coverage over technical failures to cooperate. In the liability context, the Illinois Supreme Court held that a breach of a cooperation clause is not a defense unless it substantially prejudices the insurer, and that the insurer must show it was actually hampered by the breach (M.F.A. Mutual Insurance Co. v. Cheek, 66 Ill. 2d 492 (1977)). How that principle applies to a particular first-party claim depends on the policy language and the facts. The practical lesson is that the right response to an overbroad request is usually to cooperate within the policy’s terms, in writing, rather than to refuse outright.

Uninsured and underinsured motorist claims

Illinois requires automobile liability policies to include uninsured motorist coverage and, for policies with limits above the statutory minimum, underinsured motorist coverage (215 ILCS 5/143a and 143a-2). These claims are often resolved by arbitration under the policy. Because your insurer is evaluating the value of your injury just as the at-fault driver’s insurer would, a statement given for an uninsured or underinsured motorist claim should be prepared for with the same care as a deposition.

• Ask for the request in writing. Identify what the insurer wants to know and under which policy provision.
• Ask for the policy. Request a complete certified copy of the policy, including endorsements.
• Prepare. Review the crash report, your notes, and your medical records before answering.
• Keep it factual. Describe what happened. Do not estimate speeds or distances you did not measure, and do not speculate about injuries your doctors have not yet evaluated.
• Have counsel present. Where the policy allows, your lawyer can attend and can object to questions outside the scope of the claim.
• Get a copy. Request a copy of the recording or transcript.

Examinations under oath

An examination under oath is more formal than a recorded statement. It is sworn testimony, usually taken by a lawyer for the insurer in front of a court reporter, and it can cover the accident, your injuries, your medical history, your finances, and your prior claims. Insurers most often request one when a claim is large, when facts are disputed, or when they suspect misrepresentation. If your policy provides for an examination under oath, the insurer may be able to insist on it within the policy’s terms. Treat it as you would a deposition: prepare with your lawyer, bring the documents you are asked to produce, answer only the question asked, and do not guess.

How disputes are resolved

Uninsured motorist coverage in Illinois provides for arbitration of disputes over coverage and the amount of damages (215 ILCS 5/143a), and many policies apply the same procedure to underinsured motorist claims. In arbitration, your statement, any examination under oath, and your medical records are the evidence the arbitrators will weigh. Anything you told your insurer early in the claim can be used to challenge your account later, which is another reason to keep every statement factual and consistent.

Property damage and medical payments claims

Claims for vehicle damage and medical payments coverage are usually simpler, and cooperation is straightforward: report the loss, allow inspection of the vehicle, and provide bills. Even so, the same statement may later be read in the injury claim. Keep descriptions of how the crash happened consistent and accurate, and avoid offhand comments about your injuries, such as saying you are “fine,” before you have been evaluated.

Medical authorizations

Insurers frequently send broad authorizations that would release your entire medical history. A policy that requires authorization for records related to the claim does not necessarily require a blanket release of unrelated records. Ask that the authorization be limited to the injuries and time period at issue, and keep a copy of what you sign.

Claim handling rules

Insurers doing business in Illinois are subject to standards for fair claims handling, and the Illinois Insurance Code prohibits improper claims practices (215 ILCS 5/154.6). Where an insurer’s delay or refusal to pay is vexatious and unreasonable, a court may award attorney fees and other amounts to the insured (215 ILCS 5/155). Those protections are not a reason to refuse reasonable cooperation, but they matter if an insurer uses a statement request to delay a claim without justification.

If you already gave a statement

Request a copy of the recording or transcript. Review it with your lawyer and correct inaccuracies in writing. Statements given in the first days after a crash are often incomplete, and a prompt, documented correction is far better than an inconsistency discovered later.

Cooperate as the policy requires and prepare as for a deposition

Your own insurer is entitled to cooperation under the policy, but not to more than the policy requires, and in an uninsured or underinsured motorist claim it is evaluating your injury as an opponent would. Read the policy, respond in writing, prepare for any statement as you would for a deposition, have counsel involved, and keep your account factual and consistent.