Part II - Practice of Falsifying Expert Reports to Deny Claims Appears Widespread

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

This is the second installment of our two-part blog post intended to shine a light on insurance company practices that include the manipulation of investigations, analysis of evidence and distortion of reports by experts to underpay and deny legitimate claims.  If you have questions about a homeowners claim after reading this two-part blog post, you should contract our Miami insurance claims law firm to schedule a free consultation.

Senators Condemn FEMA’s Failure to Protect Policyholders

The Raimey case has garnered harsh criticism from the aggrieved policyholders and members of Congress.  Senators Corey Booker and Robert Menendez sent a joint letter to FEMA reminding the federal agency that it bears ultimate responsibility for the conduct of insurance carriers participating in the WYO flood insurance program.  The letter expressly criticized the penalty structure imposed through the WYO program that imposes steep penalties if too much is paid out on flood damage claims but does not impose a penalty for underpayment of claims.  The senators condemned the Rainey decision and indicated that it constituted the “smoking gun of a pervasive and intentional effort to lowball disaster victims.”

The letter urged the federal agency to undertake a comprehensive investigation to determine the scope of the practice of hiding and manipulating engineering reports by WYO insurers.  The agency also was advised to formulate a plan to improve “transparency” and strategies to promote consumer protection.  The senators suggested that FEMA should implement the discovery parameters of the Raimey decision in terms of disclosure of expert reports.  Full disclosure would include not only producing all reports and supporting documents but also an explanation for any revisions of prior reports.

Court Decisions Suggest the Practice of Revising Engineering Reports Widespread

While the Raimey decision is the most egregious example of the practice of falsifying engineering reports in flood insurance claims cases, a wave of other cases suggest that the practice is widespread.  In Shlyonsky v. HiRise Eng’g, P.C., the policyholders alleged that Travelers Insurance Company modified an original engineering report’s conclusion to indicate that the property damage was preexisting.  The engineer that wrote the initial report was unaware that the report had been modified and did not sign off on the revised report.

HiRise Engineering also prepared the offending engineering report in Dweck v. Hartford Ins. Co. of the Midwest.  The first report was prepared by a validly licensed engineer who concluded that the property was severely damaged by flooding from Superstorm Sandy.  HiRise allegedly had another engineer who was not validly licensed in the jurisdiction revise the report to indicate the loss was the result of preexisting damage caused by soil consolidation.  The original engineer’s seal was placed on the altered report without the knowledge of the original engineer.  The first engineer ultimately repudiated the revised conclusions and affirmed his initial findings.  The lawsuit filed by the policyholder asserted a wide range of claims, including wire fraud, mail fraud and breach of contract.

In the wake of this pattern of court decisions and criticism from members of Congress, FEMA has indicated that it will reform the claims process.  The agency also has implored insurers under the WYO policy program to abide by the judge’s order in Raimey.  FEMA is reopening hundreds of denied appeals and has agreed to penalize underpayment as well as overpayment of claims.

Knowledgeable Insurance Claims Attorneys Can Seek Manipulated Expert Reports

The public disclosure of this practice of re-drafting and covering up inspection reports means that claimants who suffer property damage need an experienced insurance claims attorney.  The lawyer can conduct a thorough investigation and extensive discovery to ensure that opinions of experts and other claims professionals are not the product of fraudulent manipulation.  This means it is important to seek not only earlier versions of expert reports but also related notes, correspondence, pictures and supporting materials.   Experienced insurance claims lawyers can use discovery tools like depositions, document demands, requests for admission, interrogatories and related discovery requests to obtain evidence of inspections and analysis by insurance company experts.

If you have questions about Florida property insurance claims, you are welcome to contact my Miami 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 with an experienced Miami insurance claims lawyer.  No Recovery, No Lawyer Fees.  Call 305-461-1095 or Toll Free 1-866-71-CLAIM.

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