A multibillion-dollar industry has developed around insurance company claims vendors. Engineering and consulting firms doing work for the insurance industry are now their own big-dollar industry. There is plenty of competition among these “consultants” willing to please and keep insurance company accounts. While the insurance adjusters and insurance companies are subject to regulation, most of these vendors answer to nobody other than the insurance claims departments. Those claims departments are now dependent upon them for reports and opinions about every aspect of a property insurance loss.

Continue Reading Can Policyholders Trust Insurance Company Retained Experts?

Today’s blog is not going to endear me to HAAG, Rimkus, JS Held, and other regularly retained forensic engineers working for insurance companies. These engineering and consulting firms are big business. So much so that Sedgwick, a large independent adjusting firm, has acquired a number of these engineering firms. I can imagine many of you wondering how an adjusting firm representing the insurance company’s interest can obtain an independent and honest opinion under such circumstances.
Continue Reading The Plague of Wrong and Insurer Worded Engineering Reports by Insurance Company Retained Engineers

The California Appellate Court recently ruled in a published opinion that an insurer cannot escape liability for a breach of the implied covenant of good faith and fair dealing claim (bad faith), because its coverage position was based an outside consultant’s findings. In the case, Fadeeff v. State Farm General Insurance Company,1 the court considered State Farm’s bold contention that an insurer should automatically be considered to have acted in good faith if its claim decision is based on an independent expert’s conclusions.
Continue Reading Can an Insurer Avoid Bad Faith Liability by Claiming it Relied on the Opinion of an Outside Consultant?

I read Law360 five days a week for insurance law, class action matters, and California cases. One article, Insurer Says Condo’s Engineer Padded $30M Hurricane Claim,1 caused me to ask our Merlin Law Group Knowledge Manager, Ruck DeMinico, to get me more of the pleadings and reports from the case since it involved an engineering report which was allegedly changed in a wrongful manner to support a policyholder’s position rather than an insurance company’s position.
Continue Reading Proper and Ethical Peer Review of Engineering Reports Is Important—But Wrongfully Changed Outcome Oriented Reports Are Never Right

Drew Houghton heads up Merlin Law Group operations in our Oklahoma City office. I was speaking with him just before our holiday party about the American Policyholder Association combating fraudulent engineering reports harming policyholders as noted in, American Policyholder Association Makes Resonating Comments About Insurance Fraud Against Policyholders. Drew then told me about a recently filed Oklahoma class action where engineers were accused of sham reports to help prevent earthquake claims payments.
Continue Reading Engineers Accused of Sham Reports in Class Action

Hail prone areas may result in multiple storms which damage a roof. Not too many policyholders are climbing up on their roofs to measure exactly how much hail damage is done after a hail storm occurs. But their insurance companies must be expecting them to do so based on a recent case involving Berkshire Hathaway Insurance Company.1
Continue Reading Which Hailstorm Damaged Your Roof? The Time of Hail Damage Is Often Disputed

After a fire loss you would expect your insurance company to complete a full and fair adjustment of the damages, right? So did the Normans, however, as admitted by a corporate representative of State Farm, “had State Farm not received additional information [from an industrial hygienist], the payments made in July 2012 would have been the settlement of the Normans’ claim” stemming from smoke and soot damage to their home as a result of the infamous Waldo Canyon fire of 2012 in Colorado.1 Eventually State Farm did pay a lot more in covered damages in May of 2013.
Continue Reading After A Fire, You May Need An Industrial Hygienist

Generally, in Florida, when there is a difference of opinions between each party’s expert, the jury gets to decide who’s right, not the judge. But there has been a trend by insurance companies in the first-party property context of taking their expert’s report before the judge and arguing, in essence, “our expert’s right, the insured’s is wrong, so find in favor of the insurance company as a matter of law.”
Continue Reading Appellate Court Reverses Summary Judgment Where Battle of Experts Created a Jury Question

Fraud is generally defined as an act done with the intent to deceive or misrepresent others in order to attain or secure some unlawful gain or deprive a victim of a legal right. Different courts, states, and bodies of law throughout our country have their own unique causes of action based in fraud, or where fraud is the primary allegation.
Continue Reading Insurance Fraud – It’s a Widespread Industry Problem

A recent case filed in the Western District of Texas highlights the importance of retaining experts to assist in evaluating the cause of loss early in the claim process. In White Lodging Services Corporation et al v. Liberty Mutual Fire Insurance Company,1 a hotel development and management company filed suit against Liberty Mutual over a collapse claim that arose during the construction of a hotel. The policyholder had a builders’ risk insurance policy issued by Liberty Mutual.
Continue Reading Collapse Claim Highlights the Importance of Retaining Experts Early in the Claim Process