Yesterday afternoon, Jean Niven was presenting an in-house Merlin Law Group continuing legal education seminar about expert witnesses and the exacting standards for their allowance to testify in federal court. During the presentation, I thought about how a lost insurance coverage case1 could have ended differently if the policyholder’s expert witnesses had been allowed to testify about the damages. Jean is our firm’s expert witness authority. She works with our clients’ expert witnesses to make sure they are able to testify. Continue Reading Insurance Coverage Cases Can Be Won or Lost Based on Expert Witnesses and The Preparation of Their Reports and Testimony

The Florida Third District Court of Appeal recently found that when a policyholder failed to substantially comply with a post-loss obligation, the insurance company is presumed to have been prejudiced by the breach.1 The burden then shifts to the policyholder to show that the failure to comply with a post-loss obligation did not prejudice the insurance company. The question remains: What have courts found to satisfy a policyholder’s burden of showing that reporting a claim late did not prejudice the insurance company? Continue Reading Overcoming the Prejudice of Late Reporting

In my last blog post, I wrote about the Seventh Circuit Court of Appeal’s recent decision in Windridge of Naperville Condominium Association v. Philadelphia Indemnity Insurance Company.1 Continue Reading Does An Insurer Act In “Bad Faith” If It Denies Coverage For A Hail Loss Based On Its Retained Engineer Defining Hail Damage As Functional Damage?

Former director of Hi-Rise Engineering, Matthew Pappalardo was indicted on a 50-count indictment stemming from Hi-Rise’s role in altering their engineering reports to defraud policyholders from monies owed due to Superstorm Sandy damage. Contained within the indictment were 25 counts of Forgery in the second degree, in violation of Penal Law Sect. 170.10(1) and 25 counts of the Unauthorized Practice of a Profession in violation of Education Law Sect. 6512(1).

A person is guilty of forgery in the second degree when, with intent to defraud, deceive or injury another, he falsely makes, completes or alters a written instrument which is or purports to be, or which is calculated to become or to represent if completed. . . .[an] instrument which does or may evidence, create, transfer, terminate or otherwise affect a legal right, interest, obligation or status. . . .

A person violates Education Law Sect. 6512(1), while not being authorized to practice under said law, practiced or offered to practice or held himself out as being able to practice the profession of engineering, a profession in which a license was a prerequisite to the practice of the acts, or aided or abetted an unlicensed person to practice the profession of engineering. . . .

Continue Reading Former Director of Hi-Rise Engineering is Indicted in New York

Nicole Vinson‘s post State Farm Sued for Fraud for Katrina: More Altered Engineering Reports Alleged, a recent filing by my co-liaison counsel Steve Mostyn, and one by Javier Delgado, prompted me to write about how groups of people with power can dictate an unethical claims culture biased and driven to pre-determined outcomes. I strongly encourage those involved with this area of claims to read each of the linked materials.

Continue Reading Unethical Claims Cultures Promote Outcome Oriented Expert Reports

On Wednesday, February 18, 2015, the New York Attorney General’s office executed a search warrant at the offices of GEB HiRise Engineering in Uniondale, New York in a criminal probe over allegations of fraudulently changed engineering reports for Superstorm Sandy flood claims.

Continue Reading Authorities Raid New York Engineering Firm Over Superstorm Sandy Fraud

Catastrophes breed controversies. Superstorm Sandy has a raging one involving altered engineering reports. Yesterday, Jeff Moore, a flood insurance executive with one of the largest National Flood Insurance participating insurers, pleaded the Fifth Amendment when asked questions regarding those altered reports. As reported by Christie Smyth of Bloomberg:

In November, U.S. Magistrate Judge Gary Brown said he feared there may be conflicting reports in many other flood insurance cases, and hundreds of homeowners are now searching for evidence that similar tactics were used to deny their Sandy-related claims.

In court, Brown is weighing whether to penalize Wright Flood and a law firm that represented it and other insurers. Representatives from the Metairie, Louisiana-based firm, Nielsen Carter & Treas LLC, didn’t attend the hearing, and a phone call wasn’t immediately returned.

During the proceeding, Jeff Moore, who was Wright Flood’s vice president of claims when Ramey was disputing her claim, refused to answer questions posed by her lawyers, citing his Fifth Amendment right under the U.S. Constitution not to incriminate himself.

Continue Reading Insurance Executive Pleads Fifth Over Altered Reports During Superstorm Sandy Hearing

This is a question I was asked recently so I thought I would answer it here. In this case, the insured made a claim for hail damage done to the roof. The insurance company investigated the claim and hired an Engineer to inspect the property. The Engineer drafted a report and provided it to the insurance company. Based on that report, the insurance company denied the claim. When the insured and his public adjuster asked for a copy of the report, the insurance company would not produce it, saying it is privileged “work product.” So what is “work product?”

Continue Reading Can an Insurance Company Refuse to Provide a Copy of the Report Used to Deny Your Claim?