In a time where expert reports are more the norm than the exception, it’s important to remember that a great expert report is only as good as the expert delivering it. Delivery here is being used in the sense of delivering a timely, well written report and verbally delivering a succinct explanation of the methodology used to reach the conclusions at a deposition.
As promised yesterday in Wildfire and Smoke Claims – A Case Burning With Issues That Public Adjusters Should Study, today’s post will be the first study from the recent decision in Falcon v. State Farm Lloyds.1 The initial question is how long has the expert has been doing what he is asked to do. The fire in Falcon involved a September 2011 wildfire in Texas.
Wildfire cases are unique and have many evidentiary issues. Public adjusters have been making claims for damage by fire, heat, and especially smoke. State Farm and its able trial counsel successfully appear to be fighting back in Falcon v State Farm Lloyds.1
Insurance companies and their attorneys bet they can beat me for a living – they are professional litigators and have a frequent motive to deny or underpay claims. My firm and I are in their way from profits and bad publicity for their manner of delay and denial way of life in the insurance claims business. It is a high stakes game and a very competitive forum where winning is everything – to prove who is “right.”
Continue Reading Rocco Calaci – Is Rocco the Best Meteorologist?
When suing to recoup roof replacement costs in the Lone Star State you need an expert to prove up damages. Texas courts won’t consider a homeowner’s testimony as competent evidence where a roof was replaced and there was a question of the reasonable and necessary cost of the replacement. In Wortham Brothers, Inc. v. Haffner,1 property owners sued their roofing contractor for negligent roof replacement for two of their properties. The trial court entered judgment in favor of owners and awarded treble damages. On appeal, the contractor prevailed when the court determined the necessity of complete roof replacements and reasonableness of replacement roof costs were matters of specialized and technical nature that had to be established by expert testimony.
Depending on the nature of the loss and damages to property involved in insurance claims, the damage investigation can be expert intensive. Engineers or other structural experts can play a necessary and vital role in proving the cause of some types of damage. Having a qualified expert to give an opinion as to cause and origin of damages in certain claims is a corner that cannot be shortcut on behalf of the policyholder to achieve the recovery they are entitled to. The insurance industry certainly does not cut that corner as a recent case demonstrates.1
Continue Reading The Importance Of Expert Witnesses To Support Damages In Insurance Claim Investigations
Hail storms across Texas have brought out the worst conduct in some insurance companies. We have found some, if not many, insurance adjusters making assessments of damage without closely inspecting for roof damage. It is hard to find subtle indicators of hail damage and water leaks on roofs without climbing up there and looking for those. In many instances, we find adjuster photos taken where no damage has occurred and no photos of where damage did occur. With some of those same adjusters testifying as experts on behalf of the carriers, it’s a wonder any claims for hail damaged and leaking roofs get paid.
Continue Reading Wind Driven Rain v. Hail Damage
In Colorado, insurance companies often deny claims based on exclusions for “wear and tear,” “repeated seepage and leakage,” or “failure to maintain.” Often insurance companies will hire experts to examine the property months or years after a loss, hoping the expert is willing to perform an outcome oriented examination—aimed at substantiating the insurance company’s denial based on “wear and tear” or the like. Insurers then attempt to designate these experts to give an opinion at trial—even if the expert never examined photos of the property before the loss, and failed to view the property relatively soon after the loss. These experts’ opinions may be based on speculation, and may be thrown out by the court based on a Shreck motion, described below.
Continue Reading Prevent Insurance Defense Counsel From Presenting Junk Science To The Jury
On November 16, 2012, the Court of Appeals for the Ninth Circuit reaffirmed the need for plaintiffs and their attorneys to not only ensure their experts are well qualified but also that they can prove it to the court’s satisfaction before heading to trial.1
Virtually every insurance company I have deposed or talked with (whether corporate representative, adjuster, or some other representative) has properly agreed with the following, non-exhaustive list of non-delegable claim handling standards (many of which are codified in states such as Florida, see, e.g., Fla. Stat. § 626.9541 and Fla. Admin. Code § 69B-220.201): (1) Insurers must adjust claims at their own expense; (2) The claims department is not the department through which insurers should strive to augment corporate profit (i.e., departments such as marketing, actuarial, and underwriting are where the money should be made); (3) Insurers must adopt and implement standards for the proper (prompt, thorough, fair, and et cetera) adjustment of claims; (4) Adjusters must assist claimants during the adjustment process; (5) Adjusters must give claimants the benefit of the doubt when considering information gathered during claim adjustment; (6) Adjusters must not ignore evidence supportive of claim approval, must objectively report facts, and must disclose all available coverages and contractual rights to claimants; (7) Adjusters must not use biased consultants to assist with claim adjustment and/or delegate claim payment decisions to such consultants.