Why You Should Not Rely on Reports Prepared by an Insurance Company Experts

J.P. Gonzalez-Sirgo
Founder of J.P. Gonzalez-Sirgo, P.A.

While engineering issues are based on science and mathematical principles, the conclusions drawn by competing experts can differ dramatically.  While these discrepancies sometimes amount to nothing more than a legitimate difference of professional opinion, some so-called experts might produce disparate reports motivated by more nefarious motives.  If your home suffers damage caused by wind, rain, fire or other covered perils, you should always retain your own expert, rather than relying on conclusions from the insurance company’s so-called expert. 

The New Jersey post-Hurricane Sandy case of Raimey v. Wright National Flood Ins. Co. provides a cautionary tale regarding the peril of relying on reports prepared by insurance company experts.  The U.S. Magistrate Judge characterized the conduct of the expert for the insurer in this case as a pattern of rewriting reports to deny coverage without a legitimate basis as “reprehensible gamesmanship” by a professional engineering company that unfairly frustrated the claims of homeowners. 

In the case, the residence of the homeowners and many others in the area were damaged during Hurricane Sandy.  The insurance carrier refused to cover the claim after the insurance carrier hired U.S. Forensic, an engineering firm, to thwart reasonable evaluation of the claim by producing a “baseless report”.  The original report prepared by an expert employed by U.S. Forensic, who physically examined the property, concluded that the damage to the home was the result of flooding from Hurricane Sandy.  Further, the report indicated that the structural damage was too extensive to perform repairs.

The initial report referenced above was never provided during the discovery process in the subsequent lawsuit by the insurance company.  The insurer provided a re-written report that was changed in fundamental ways after a so-called “peer review” process.  These revisions were performed by a second engineer who only reviewed photographs from the original report rather than actually conducting an inspection of the property.

When the conclusions of the two reports are put side by side, the unethical nature of this “peer review” becomes apparent:

Excerpts from “Results and Conclusions” of Original Report

“1) The physical evidence observed at the property indicated that the subject building was structural [sic] damaged by hydrodynamic forces associated with the flood event of October 29, 2012.  The hydrodynamic forces appear to have caused the foundation walls around the south-west corner of the building to collapse.

2) The extent of the overall damages of the building, it needed scope of repair combined with the age of the building and its simple structure, lead us to conclude that a repair of the building is not economically viable.” (Emphasis added).

Excerpts from the Results and Conclusions Portion of Report Provided to the Homeowners in Litigation

“1) The physical structure observed at the property indicated that the subject building was not structurally damaged by hydrodynamic forces, hydrostatic forces, scour or erosion of the supporting soils, or buoyancy forces of the floodwaters associated with the subject flood event.

2) The physical evidence observed at the subject property indicated that the uneven roof slopes, leaning exterior walls and the uneven floor surfaces within the interior of the building, were the result of long-term differential movement of the building and foundation caused by long-term differential movement of the supporting soils at the sight and long-term deflection of the building framing.”

The court castigated the insurer for failing to disclose the initial report and ridiculed the efforts of the second expert to claim that his divergent conclusions based solely on reviewing photos of the prior report were more reliable than those of the expert who inspected the home.  The court found for the homeowners in this matter and expressed concern that this same engineering company had been used to evaluate this carrier’s claims involving dozens of houses damaged by Hurricane Sandy.

The bottom line is that the “expert” conclusions in a report might depend on who enlists the services of the expert.  If your home is damaged, it is never a good idea to rely on the inspector or expert report provided by your insurer. 

If you have questions about Miami-Dade homeowners claims, you are welcome to contact my Florida homeowners insurance claims dispute law firm.  My law firm represents policyholders in claims disputes in Miami and throughout Florida.  The Law Firm of J.P. Gonzalez-Sirgo, P.A. offers free consultations and case evaluations.  No Recovery, No Lawyer Fees.  Call 305-461-1095 or Toll Free 1-866-71-CLAIM.

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