Main MenuIn today’s property insurance claims environment, there are numerous hurdles a claimant must overcome in order to recover the fair amounts owed to them under their policy after a loss occurs. In our opinion, none more troublesome than the outcome oriented and biased experts frequently utilized by insurance companies.
This claim investigation tactic is widely deployed by insurance carriers, whom utilize 3rd party consultants and experts, most commonly in the form of “forensic engineering firms”, producing inaccurate, slanted, biased and even fraudulent assessments of damages, in the pursuit of assisting insurance companies in arriving at assessments which are “favorable”. All at the expense of the insured, the consumer, business, homeowner’s association to whom the insurers owe a duty of good faith.
Many experts in this field have figured out that insurance companies are the faucet from which all claims flow; they can keep engineers, contractors and other consultants busy with projects, keeping their payrolls paid and families fed. And insurance companies know they are in a great position of power given they control the supply of claims. As a result, we have a situation where many engineering firms have created relationships in which they provide favorable claims assessments in exchange for continued stream of projects. What is a “favorable assessment”? This consistently and categorically is everything from denying damage exists, under reporting the extent or severity of damage, and asserting the cause of damages to have happened on another insurance carriers watch, all without the definitive evidence to support their position. Our firm has personally witnessed the same engineering firm make different representations of hail size, damages, and proper repairs to properties on the same street, just a few doors apart. We have seen the same engineer use conflicting logic in various reports to close the loop on positions that benefited their client, and many other forms of deceptive practices.
The key for policyholders in overcoming these outcome oriented engineer’s reports is to select the correct team of professionals to represent them in the claims process. Not all Public Adjusters are created equal, and choosing a public adjusting firm with the experience needed to break down and expose the flaws in the insurance carrier’s expert report is critical to arriving at fair and accurate claim conclusions.
Throughout the years we have had numerous clients whose insurance companies provided them a fancy report from these types of engineers and experts, to support their claims denials. In all of our cases to date we have been able to show the failures of the assessment to account for actual facts and evidence, resulting in our client’s claims being reevaluated and ultimately paid.
A qualified Public Adjuster will likely have encountered the same engineers and consultants on numerous cases, and will have seen their previous reports, tendencies, philosophies and asserted positions. This experience is paramount to conducting a proper investigation and arriving at neutral determinations based in fact…..not an outcome.
This is not always an easy process, but a qualified Public Adjuster will know when a position is being asserted without the necessary facts in support of the position, when a position directly contradicts the policy promises, or when it fails to meet the proper burden of proof to deny a claim or withhold coverage.
Our blog posted a story aired by 60 minutes called, “Insurance Company Lawyers Called “Dogs on a Leash”, this expose shed light on exactly this type of outcome oriented investigation practiced during Superstorm Sandy. It was well done and is worth the watch. You can access the link in the above blog post link.