An insurance claim refers to the request of an individual made to his or her insurance provider for coverage based on the agreed terms of an established policy and contractual agreement. Insurance claim expert witnesses are experienced with the reasons as to why the provider may challenge the claim, which may result in a potential court case if there is a discrepancy or disagreement over the terms of the insurance policy, or if the insurance provider deems the claim as being invalid.
Whether it’s casualty insurance, workers compensation, property insurance, life insurance, auto insurance, or any other type of coverage, the insurance company may reject an insurance claim. Insurance claim expert witnesses are experienced with bad faith, insurance fraud, due diligence, regulatory compliance, risk assessment, and valuation, since an issue with any of these subjects may factor into the reasoning behind a rejected insurance claim. The insurer may also hire an independent claims adjuster to assess the claim to determine if it is based on valid information, in which case the insured would be entitled to the proposed claim.
Insurance claims expert witnesses might have backgrounds in commercial litigation, risk management, actuary consulting, alternative risk finance, forensic accounting, and insurance law. Such experts are also licensed and/or certified as adjusters, property and casualty underwriters, accountants, insurance agents, and brokers, among other similar professions related to insurance.
Contact ForensisGroup today or submit an expert request form for further information on retaining the right insurance claim expert witness for your case.
I have over 30 years experience as an insurance claims specialist with expertise in medical and dental malpractice, health care/nursing home claims, both personal and commercial automobile liability and property damage, as well as general liability, construction defect, products liability, life science and public entity claims. I have also spent over 15 years as an insurance claims specialist expert witness with courtroom testimony, consultations, and deposition.
I have spent over 50 years working in Insurance Regulatory Matters with a focus in global regulatory standards, ComFrame, reinsurance standards, capital standards, life insurance regulation, property/casualty reinsurance, title, mortgage guaranty and financial guaranty. I have also offered my services for more than 50 years as an insurance regulatory matters expert witness by providing deposition, consultations, and courtroom testimony.
I have over 20 years experience in workers’ compensation claims administration with expertise in including identification and analysis of loss exposures; quantification of accident trends and historical loss data and daily interface with the third party claims administrators; ensures that all facilities and properties are inspected to identity potential safety issues and to monitor compliance with safety laws and regulations; and fulfills OSHA reporting requirements.
I have more than 30 years experience in the healthcare/health insurance industry. My experience includes, but is not limited to, sales, sales management, sales distribution channels (including internal sales and outside broker/agents/consultants, operations (billing, claims, customer service), underwriting, product, compensation plans, and profit and loss management. My indirect responsibilities included, but not limited to, actuarial, finance, network development and contracting, compliance, and marketing. My experience includes Individual and Group products/business in commercial and government (Medicare) lines of business. I am offering my services as a healthcare expert witness.
I have over 40 years experience in Insurance with a focus in property management insurance, underwriting, casualty insurance, inland marine property insurance, risk management, D & O, Worker's compensation, and claims management. My background is in property coverage under builder’s risk (a type of Inland Marine insurance) and what is known as Completed Civil Works, such as operational bridges, tunnels, and dams. I have also worked as an insurance expert witness in New York for more than 30 years by offering consultations, deposition, and courtroom testimony.
The Eighth Circuit Court of Appeals recently heard an appeal from a district court's denial of a motion for new trial on the basis of excluded expert evidence.A jury awarded an insured under a commercial-property insurance policy $76,000 for covered hail and wind damage to the exterior of two properties, but it found that the policy didn’t cover the water damage to the interiors.A hail storm damaged Appellant’s properties, and she sought coverage replacing the damaged portions of the homes. Insurance Company disputed the claims, and they went to trial on two of the properties. The parties didn’t dispute that hail and wind damage to the properties' exteriors constituted a covered loss under the policy. However, they disagreed on the amount of coverage and whether the policy covered water damage to the properties' interiors. Appellant claimed that damage to the roofs and windows let water seep inside and that the resulting interior water damage was a covered loss. Insurance Company said that water leaked into the properties because of deferred maintenance, not hail damage. As such, it refused to cover the interior damage.Appellant enlisted a public adjuster and a roofing consultant to assess the damage. The insurance expert inspected the properties and issued a written expert report, which described hail and wind damage to both properties' exteriors, particularly the roofs. The insurance expert observed interior water damage at both properties, and based on its location and its appearance shortly after the storm, he opined that it was from water entering the homes through the external damage. He also said that the roofs and other items at both properties should be replaced. Appellant’s roofing expert issued an expert report based solely on his review of the insurance expert's and Insurance Company's reports and photographs of the properties. In that report, he opined regarding on property that "[w]ater intrusion within the home may be the result of defects within the . . . roof caused by wind and hail impact." The report didn’t mention water damage to one of the property's interior but did note that the roof was damaged and that it required major repair or replacement.Appellant’s roofing expert wanted to take a core sample of the property's roof to determine how it was constructed, but snow and ice kept him from doing so at the time of his initial report. But he went to the property later to take the samples, which showed the presence of moisture both within a top roof layer and an older layer beneath it. The expert believed this indicated that the roof needed to be replaced rather than repaired. The parties deposed the roofing expert, and he mentioned these findings. However, Insurance Company’s counsel objected to his mentioning those findings without a supplemental report. Appellant’s roofing expert did draft a supplemental report, but Appellant didn’t disclose it at the time.The original deadline for Appellant to disclose expert witnesses and reports was postponed, largely on stipulation of the parties, six times, and the final amended progression order set the deadline. Appellant subsequently served Insurance Company with supplemental expert reports from both of her experts. The supplemental report from Appellant’s insurance expert included updated damages calculations for each property based both on updated pricing for materials and on the inclusion of interior water damage not presented in the insurance expert's original report. The supplemental report for Appellant’s roofing expert was the as-yet-undisclosed report her roofing expert drafted addressing the core-sampling results. At that time, jury trial was set, and the supplemental reports were thus untimely not only regarding the progression order but also under Federal Rule of Civil Procedure 26(a)(3)(B)'s requirement that such disclosures be made at least 30 days before trial. Subsequently, the trial was postponed because of Appellant's counsel's illness.Insurance Company moved to exclude the supplemental insurance and roofing experts’ reports. The district court noted that, although Appellant's disclosure was untimely under the federal rules at the time it was served, it wouldn’t exclude the reports based on this because Insurance Company had at least 30 days' notice due to the extension of the trial date. But the district court excluded any new items of damage in Appellant’s insurance expert's supplemental report, holding that it was “far too late for Appellant to raise new items of damage she has not previously claimed."The district court also excluded from the Appellant’s roofing expert’s report evidence concerning the moisture in the roof as a justification for her insistence that the roof be replaced. The district court observed that Appellant offered no credible excuse why she didn’t provide the supplemental report to Insurance Company at the time it was drafted. The lower court concluded that it would be prejudicial to Insurance Company to allow Appellant to raise a new theory on why replacement rather than repair was required because it didn’t have the opportunity to explore the moisture-in-the-roof theory of replacement during discovery. The trial judge also noted that, although the results of the roofing expert's core sample were discussed at his deposition, Insurance Company was not obligated to presume the issue of replacement due to roof moisture would be raised without a supplemental report.Appellant argued that she was so prejudiced by the incorrect exclusion of certain portions of the supplemental reports by her insurance and roofing expert that the district court should’ve granted her a new trial. Circuit Judge Clarence Beam wrote in his opinion that Federal Rule of Civil Procedure 16(f)(1)(C) allows a district court to "issue any just orders" to sanction parties for failure to follow a pretrial scheduling order and includes "prohibiting the disobedient party from . . . introducing designated matters in evidence" under Rule 37(b)(2)(A)(ii). Further, Judge Beam noted that in Patterson v. F.W. Woolworth Co. (8th Cir. 1986), the Court of Appeals stated that the factors that a court should consider in deciding whether to exclude the testimony of a witness not made known in a manner complying with a pretrial order include: (i) the reason for failing to name the witness; (ii) the importance of the witness's testimony; (iii) opposing party's required time to prepare for the testimony; and (iv) whether a continuance would be useful. These factors, the judge explained, have also been applied to supplemental expert reports disclosed later than provided for in a progression order.The Circuit Court held that the district court was within its discretion when it excluded certain portions of the supplemental expert reports and did consider the Patterson factors. As to the roofing expert’s supplemental report, the district court noted Appellant had no reason for the extreme delay of her disclosure—despite the fact that she had the report six months earlier; the lack of opportunity for Insurance Company to develop evidence and respond to the roof-moisture theory of replacement at the property; that she did not request a continuance; and that "[a] continuance at the eleventh hour was not appropriate." As to the supplemental report of her insurance expert, the district court again noted its "egregiously untimely disclosure" and observed that the new claimed damage was less than 5% of the total damages Appellant sought.Also, the Court held that Appellant wasn’t prejudiced by the exclusion of this evidence resulting in fundamental unfairness, as she could’ve called her roofing expert to support her interior-water-damage theory, which was included in both his original and supplemental reports. Appellant’s insurance expert's original report likewise presented similar opinions and even included the opinion that the roof of one of the properties needed to be replaced. The roofing expert's original report acknowledged that possibility.The Eighth Circuit agreed that the jury clearly rejected Appellant's claim to any interior damage whatsoever, and thus, the exclusion of the new items of interior damage didn’t prejudice that claim. The district court applied the law correctly under the federal rules and acted within the scope of its discretion in excluding certain portions from the supplemental expert reports. The decision was affirmed. Amplatz v. Country Mutual Insurance Company, No. 15-2645, 2016 U.S. App. LEXIS 9540 (Cir. 8 (Minn.) May 25, 2016).
For over 40 years, I have worked in the Property and Casualty Insurance Industry by serving clientele in various fields, such as OCIP/CCIP/Wrap-Ups; Manufacturers; Pharmaceuticals; Oil Jobbers; Truckers; Retailers; Banks; Engineers; Aviation; Wildlife Parks, etc. My expertise includes Standard of Care in Insurance Agent Broker Errors & Omissions; Insurance Bad Faith; and Claims Handling Custom & Practice; Case Assessment; Insurance Policy Construction; Carrier Claims Negotiation / Coverage Disputes, etc. I have been providing expert witness services for more than 10 years as an Insurance Expert Witness In Texas in the areas of Flood Insurance, Commercial Ocean Marine Insurance, Commercial Auto Insurance, Agent Errors and Omissions, Pollution / Environmental Liability Insurance, and Business Income / Extra Expense Insurance.
I have more than 30 years of experience as a Life Underwriter. I am the Founder and Principal of an audit, advisory, and actuarial firm focusing on the development of proprietary discovery, analysis, forward modeling and negotiating techniques associated with the employee benefits industry. I also founded a research foundation that focuses on researching healthcare delivery, financing and consumer issues to expand the utility and transparency of statistical and mathematical metric techniques required to accurately forecast future trends. I have prior expert witness experience with consultations and deposition.
I have more than 5 years of experience in the field of Vocational Rehabilitation, with a certification as a Rehabilitation Counselor. I have performed evaluations for purposes of civil litigation, insurance claims, and vocational rehabilitation as an aspect of economic damages and residual vocational potential. I have experience in earning capacity, lost earnings, cost of replacement labor and lost ability or time in performing household services. I have prior expert witness experience.
I have more than 15 years of experience in Civil and Criminal Investigations. Currently I manage and investigate complex criminal defense investigations such as homicide, aggravated robbery, cold cases, vehicular homicide, sexual assault, strangulation, and domestic violence. I serve as an investigative resource in civil matters to include family law, personal injury, insurance claims, dangerous animal allegations, permit violations, child custody, child endangerment, and runaways and missing persons. I have over 10 years of expert witness experience with consultations and courtroom testimony.
I have more than 45 years of experience as an Insurance Agent and Broker. My particular expertise is in insurance coverage analysis, and I am very familiar with all phases of the insurance industry, including consulting on bad faith, customs and practices, and standards of care. I have over 30 years of expert witness experience with consultations, deposition, and courtroom testimony.
I have more than 35 years of experience in insurance law and coverage, as well as in commercial litigation, contracts, disability, ERISA benefits, personal injury, and civil litigation generally. My insurance practice is principally for policyholders and claimants, but presently I am also national coverage counsel for one insurance company. My practice involves all types of insurance, including general liability, professional liability, directors and officers, excess and umbrella liability, auto, homeowners, commercial property, disability, life, health, and reinsurance. I handle policy claims, bad faith claims, declaratory judgment actions, rescissions, equitable contribution and equitable subrogation claims between insurers, and claims against agents and brokers. I have also negotiated and drafted policy language for insurers and policyholders, policy buybacks and commutations, and cost-sharing agreements among insurers and policyholders for mass torts. I frequently consult with other attorneys on insurance coverage issues, for example, construing the liability insurance of their clients or of their opponents. I have over 10 years of expert witness experience with consultation and deposition.
I have over 45 years of experience as a licensed life, health and property and casualty insurance agent, broker, and consultant. These licenses have been issued by examination with continuing education in the fields of life, health, disability, variable annuities, property and casualty insurance and mutual funds. I am an expert in forensic reconstruction of insurance transactions, specializing in policy interpretation of the rules, laws and regulations governing insurance and financial matters. I have over 40 years of expert witness experience with consultation, deposition, and courtroom testimony.
I have more than 30 years experience in the Insurance industry with experience as a public and independent adjuster. I am experienced in policy review and the adjustment of all lines of insurance claims, with specialization in homeowner, commercial fire and theft losses, and liability investigations for insurance carriers. I have over 30 years expert witness experience with consultation, deposition, and courtroom testimony.
I have more than 45 years experience in the field of Insurance Litigation with expertise in disputes involving agents’ and brokers’ errors and omissions, claims handling and bad faith, coverage issues and related customs and practices in property and casualty insurance. I have experience with various aspects of coverage. I have over 15 years expert witness experience with consultation, deposition, and courtroom testimony.
I have more than 25 years experience in the field of Law with expertise in equitable distribution and insurance coverage matters, third party liability defense, general commercial and civil litigation, and commercial matters. I have experience with the resolution of contract and commercial disputes, commercial and medical collection matters, travel insurance coverage and claims, and insurance defense. I also have experience with employment litigation, commercial transactions, real estate litigation and transactions, and personal injury litigation. I have over 10 years expert witness experience with consultation and courtroom testimony.
I have more than 35 years experience in the field of Risk Management and Public Accounting with expertise in advising commercial clients on property casualty insurance and self-insurance programs. I have experience with analyzing loss exposures and advising on insurance and non-insurance risk management alternatives, including contractual risk transfers, loss control and claims management, and providing due diligence. I have over 15 years expert witness experience with consultation and deposition.
I have more than 45 years of experience in providing analysis of construction defect exposures, including analysis of risk exposure coverage; Labor Code exposures, ADA compliance, including assisting with administration of prevailing wage in California; to assist with operational concerns, logistics, risk management, Workers Compensation underwriting and executive management. As a Claim and Litigation Manager my responsibilities included significant case handling for exposures in excess of client’s self-insured retention through various levels of the reinsurance in the United States and offshore venues. I have over 15 years of expert witness experience with consultation and deposition.
I have more than 45 years experience in the Insurance industry with expertise in Property Casualty for commercial policyholders. I have experience with management consulting for insurance agencies. I have over 10 years expert witness experience with consultations and deposition.
I have over 35 years of experience in Specialty Law Practice in insurance matters with emphasis on coverage issues. My expertise includes all personal and commercial liability lines and coverage (Commercial General Liability, Builders Risk, Course of Construction, Professional Errors and Omissions, Director and Officers, Contractors, Inland Marine, Surplus Lines, Specialty Lines, Excess and Umbrella, Employment Practices Liability, Personal Liability, Commercial and Personal Vehicle); and drafting liability insurance policy language (Commercial General Liability, Personal Liability and Environmental Policies). My experience involves Claims Handling; Duty to Investigate; Duty to Defend; Duty to Indemnify; Contribution among Insurers; Excess Insurer "Drop Down"; Rights and Duties of Primary/Excess Insurers, Bad Faith Issues, Professional Liability of Attorneys and Agents/Brokers Relating to Insurance Issues. I have more than 20 years expert witness experience with consultations, deposition, and courtroom testimony.
I have more than 30 years of experience in construction as a Licensed Insurance Adjuster, Real Estate Agent, and General Contractor. My expertise includes Construction Defects. I have experience with forensic damage assessment, wood repair, and replacement costs. My additional experience includes residential and commercial construction and consulting. I have over 15 years expert witness experience.
I have more than 30 years industry experience in claims management for personal, commercial, and specialty lines of business. I have extensive change management experience associated with mergers, acquisitions, sale of businesses, growth of new business and runoff business. I also have demonstrated success in the claims technical area with the development and implementation of best practices including the use of technology to support best practices; consistent and adequate case file reserving; process improvement; litigation management; file quality and claims payment accuracy; expense management; and, staff development. I have prior expert witness experience.
I have more than 20 years experience in the field of Risk Management with expertise in the provision of practical, technically oriented insurance operations assessment, business process engineering for insurers, self-insured and captives. I have experience with organization design and functional analysis of claim operations, independent case reserving valuation, cost management strategy, litigation management, claim operations design and implementation, and settlement strategy. I have additional experience with internal control assessment, fraud detection, regulatory financial examination analysis, merger/acquisition due diligence and post-acquisition integration, and claim benchmarking. I have prior expert witness experience with consultation, deposition, and courtroom testimony.
I have more than 35 years experience in the field Insurance with expertise in domestic and international insurance and reinsurance casualty claims. I have experience with all lines of property and casualty claims, with demonstrated expertise in professional liability, Architects and Engineers, Directors & Officers, general and product liability. I have a strong background experience in internal controls and compliance, internal compliance audits, insurance and reinsurance claims monitoring, auditing, cpcu, and counseling, as well as, management and supervision of legal and professional reinsurance staff. I have over 20 years expert witness experience with consultations, deposition, and court testimony.
I have over 40 years experience as an Engineering Physicist, specializing in mechanical, structural and electrical engineering, as well as vehicle and fluid dynamics. I have experience in the failure analysis of products, such as structures, vehicles, mechanisms, control systems, fluid dynamics, and electromechanical systems. My expertise also includes accident reconstructions, business plans, and insurance claim evaluations. I have more than 40 years expert witness experience with consultations, deposition, and courtroom testimony.
I have more than 30 years experience in the field of Law with expertise in Employee Benefits. I have experience with benefits consulting, federal/state compliance, mergers & acquisitions, group benefits, employee communications and plan administration. I have additional experience with ERISA plans, fiduciary liability, wrongful termination, benefits loss, disability benefits, wellness programs, defined contribution plans, and benefits rights. I have prior expert witness experience with consultations and deposition.
I have more than 30 years of experience in the field of Property and Casualty Insurance with expertise in casualty reinsurance to commercial and personal insurance coverage. I have experience with insurance contracts, coverage, and insurance disputes; as well as knowledge of insurance company and broker relationships, cyber liability and risk, and real estate insurance.
I have more than 40 years experience in the fields of Risk Management and Alternative Risk Finance with expertise in insurance standard of care for agents and brokers, surplus lines brokers and underwriters. I have additional experience with industry custom and practice, insurance brokerage management and systems and procedures; as well as, property and business interruption, comprehensive liability – occurrence and claims made issues, workers compensation, excess liability, and Directors’ and Officers’ liability. I have over 5 years expert witness experience.
I have more than 20 years experience in the field of Insurance with expertise in commercial insurance program management, international general and professional liability exposures, pollution liability and remediation insurance coverage, privacy and cyber liability, and product liability claims management.
I have more than 30 years in the field of Insurance and Third-Party Administration. My expertise includes bad faith, coverage denial, adjuster standards-of-care, extracontractual liability, insurance disputes, benefit claims and appeals, claims and loss damages, assessment of insurance claim practices, insurance industry custom and practice, and claims-handling for policyholders and insurers. I have over 10 years expert witness experience with consultations, deposition, and courtroom testimony.
I have over 40 years experience in video, film, audio, audio visual equipment, video editing, film/video production, and post production. My expertise includes event production, video evidence, international live sports television production by satellite; union and non-union experience; estimating of residual value of industrial and broadcast new and used video, audio, staging and lighting equipment; facilities, production and post production equipment insurance damage claims; production and post production “negative” and “e and o” insurance claims; systems integration, sales and management; film, video and AV rentals and sub rentals; produced plays, audio evidence, concerts, promotional and arts events, etc. I have more than 40 years expert witness experience with consultations, deposition, and courtroom testimony.
I have more than 40 years experience in commercial litigation. My experience includes representation of banks and financial institutions in all aspects of litigation, with particular experience in insurance related matters and financial institution bond claims. I specialize in title insurance matters (including claims, litigation, bad faith, title issues), escrows, attorney malpractice, real estate matters and partnerships. I have represented title insurance companies in claims handling, defending title insurance companies in litigation and defending and prosecuting cases for title insurance company insureds. I have prior expert witness experience.
I have more than 25 years experience in Forensic Accounting. My expertise includes business interruption losses (loss of earnings) with aggregate claims exceeding $2 billion; financial evaluation of damage claims including 1st party property losses; 3rd party liability cases; commercial litigation damages; and fidelity matters. My industry experience includes claims and loss damages, oil and gas; petrochemical, utilities / cogeneration, mining, manufacturing; retail, services, and builders risk. I have over 25 years expert witness experience with consultations, deposition, and courtroom testimony.
I have more than 10 years in the field of Insurance with expertise in all types of insurance coverage. My experience includes Insurance Brokers/Agents Errors and Omissions issues, bad faith, analysis, research, insurance brokering, and underwriting. I have over 10 years expert witness experience with consultations, depositions, and courtroom testimony.
I have more than 50 years of experience with the insurance industry and claims handling. My experience includes working as a field adjuster, claim examiner, claim supervisor, and claim manager. I have additional experience as a corporate officer and as an independent insurance adjuster handling a variety of different types of claims. I organized and chaired a claim committee to review coverage issues, claims denials, insurance industry custom and practice, and evaluation of high value cases. I am able to evaluate the claims handling for compliance with manuals, the Fair Claims Practices Act, and acceptable industry standards. I have prior expert witness experience.