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

HAAG’s chief engineer and owner, Tim Marshall, made at least 25% of his personal income from State Farm and was designated as an "impartial" appraiser. If you were his mother, sister or relative, would you think somebody making 25% of their income from another party was "impartial?" Just apply the Golden Rule when thinking about these issues.Continue Reading Do Insurance Companies Hiring Haag Engineering Follow the Golden Rule? Come To The TAPIA Conference and Find Out!

One strategy insurance companies use to avoid bad faith liability is claiming that they reasonably relied on their experts’ reports to deny a claim. Texas law on bad faith states that an insurer breaches its duty of good faith when: (1) denies or delays payment of a claim for which liability is reasonably clear, and (2) the insurer knew or should have known that liability was reasonably clear. Therefore, insurance companies often argue that because their retained experts concluded that there was no valid insurance claim, liability was not reasonably clear and they should not be found liable for bad faith. Courts typically side with insurance companies on this issue, but sometimes the facts of a case require courts to doubt this argument, just as the Texas Supreme Court did in State Farm Lloyds v. Nicolau, 951 S.W.2d 444 (Tex. 1997).Continue Reading When Insurers Hide Behind their Experts in Texas

The inaugural First Party Claims Conference in Providence, Rhode Island, has been a success. Over 200 hundred registrants discussing various aspects of first party property insurance claims have made for a very educational adjusting and legal seminar. Since I have been involved in so many disputes involving damage to roofs following hurricanes and tornados, I thought it would be a good learning experience for me to teach a course on the topic, along with an engineer.Continue Reading The Science of Roof Damage Claims Caused by Wind

Yesterday’s post, Physical Damage is Needed to Collect for Loss of Warranty, may lead some to think that property insurance policies require “structural” or a “functional” destruction before coverage is not afforded. This simply is not true. Alterations to the physical appearance of a structure or personal property are covered so long as the cause is a covered peril.Continue Reading Cosmetic Damage is “Physical Damage” and Recoverable Under a Property Insurance Policy

An important evidentiary hearing concerning alleged wrongful claims practices is taking place in Mississippi. Since the allegations partially involve an insurance company obtaining altered or biased reports from experts, it should be studied by those with similar concerns in other areas of the country. The primary issue in this case is whether State Farm adjusted flood losses so that the Federal Government paid too much on those flood claims through the National Flood Program. The lawsuit contends that State Farm had a motive for doing so because it could minimize the amount owed under its own all risk insurance policies which exclude flood damage.
Continue Reading State Farm “Qui Tam” Hearing Raises Issues of Wrongful Adjustment

For those of you that read something and you think it is dead wrong, do your eyes squint and head start shaking? Mine did when I first read the internal TWIA roofing memo. As I read it, I was thinking:

"Does the TWIA claims executive who wrote this not understand the basic insurance principle of what constitutes a direct physical loss?"Continue Reading “Physical Direct Loss” Caselaw and TWIA’s Roofing Memo

The post from this morning, Internal Texas Windstorm Roofing Claims Memo Explains Damage is Not Covered, raised a number of interesting methods to research this coverage issue. Many risk managers and public adjusters will simply call me to get a quick opinion regarding many day to day coverage issues. I thought it might be interesting to see what adjusters may have in their basic training materials to answer the questions raised in the memo. I have no idea if the TWIA claims executives looked at any reference materials. I hope they authored the claims memo in ignorance, because the opposite poses a different set of problems.Continue Reading The TWIA Roof Damage Memo: Checking Basic References to Resolve Adjustment Questions

Our firm has friends in the insurance industry and other sources of information who have privately provided evidence of wrongdoing by insurance companies. On more than one occasion, documents evidencing wrongful insurance claims conduct have appeared on my front door or in unmarked mail with anonymous notes asking that the information be disseminated. Sometimes, the proof of the current secret claims warfare against policyholders is provided to us by the insurance industry itself. We received such proof last week in an email.Continue Reading Insurance Company Experts Are Often Biased And Outcome Oriented