Kiwanis Presentation

On Wednesday, May 6, R.J. Hill was the guest speaker for the Kiwanis Club of Murfreesboro. Mr. Hill’s presentation was on performing forensic investigations. Specifically, Mr. Hill spoke about why an engineer was needed to investigate insurance claims and what most people don’t know about those investigations.

Educating the public…

In the course of conducting forensic engineering investigations over many years, there is one thing that keeps coming up. That is, people will ask me why their carrier would send an engineer to investigate. It immediately became obvious (early in my forensic career) that policy holders were poorly educated about subrogation. Questions like “do they suspect me of doing something wrong?” and “are they trying to get out of paying the claim?” frequently arise. First let me say that we are engaged because of the way we have been educated and trained to think. In short, we are problem solvers which makes us ideal for figuring out how property damage and personal injuries might have occurred. Second and more importantly, engineers are looking for evidence of a defect in a product, regardless of whether that product is mechanical, electrical, or structural. The reason is because most policies have a clause in the contract that allows the insurance carrier to take possession of whatever evidence is available and litigate against a manufacturer in the name of the insured policy holder. The purpose of doing so is to recover whatever damages have been paid to the insured party. In most homeowners as well as auto and business policies, the carrier’s rights are “subrogated” to the insured’s rights meaning that if the carrier accepts a claim and pays for damages, their rights to recovery are behind the insured’s if the insured recovers anything. For example, let’s say that an insured property owner sues another party for damaging his home and the property owner’s carrier pays to have the house fixed. If the property owner sues and is awarded a judgment for a specified amount, his insurance carrier has a right to that judgment amount as stated in the subrogation clause of the insurance contact. However, defective products are not the only things that can trigger subrogation suits. Faulty work can also cause property damage and personal injury. If a mechanic performing an oil change on someone’s vehicle leaves the oil plug loose causing the new oil to drain and subsequently ruin the engine, he and the company he works for can be sued and held liable for the engine damage. Again, suit would be filed in the name of the auto policy holder and if awarded a judgment, the carrier would be entitled to the award if they spent money to have the engine repaired or replaced.

Having said all of the above, these are the reasons that the public needs to be educated on what prompts insurance carriers to engage engineers and why. The public needs to understand that part of the insurance business is holding those responsible for producing the faulty products and services that they sell.

I’m Not the Enemy!

Earlier this year, I was asked to investigate the cause of failure of a hot water line fitting in a commercial establishment.  As most of you know, I am an engineer who performs forensic analysis on failed products.  It so happens that the guy that installed the failed part was insured by the company that hired me.  As soon as I called him to find out what work he had done, he got very defensive saying that I was hired by the insurance company to deny the claim.  This isn’t the first time that this has happened to me.  In fact, this is more like “par for the course”.  I understand that when people submit a claim to their insurance company, they are worried about whether the claim will be covered.  And when a technical expert shows up, that scares them even more.  I have learned over the course of my forensic career to be patient with people.  Sometimes, all it takes is a little give-and-take for the insured to feel more at ease.  By that, I mean as the insured expresses their thoughts, I listen and then explain why I am involved and what I will be doing.  At other times, the insured isn’t willing to listen or just won’t cooperate.  It is in these instances that I am viewed as the “enemy” and I’m the one “out to get them”.  In reality, I am usually tasked to provide an explanation of what happened to cause the damage or injury that occurred.  Remember, insurance adjusters are not experts in everything and as a result, have to hire people with expertise in areas other than their own.  But, there are those that just don’t or refuse to understand.  I know that it can be scary to have a stranger come to your door and ask a lot of questions but, there really is a purpose to the method.  Unfortunately, there are those that will attempt to commit fraud and as a result, make it harder on everyone else who is trying to do things honestly.  As it turned out, the insured that I was dealing with appeared to have been doing work outside of the scope of his insurance policy.

Would you Hire an Expert to Help you Deal With an Insurance Company?

In my last post, I talked about how people sometimes get angry when they find out that their claim is about to be denied because some engineer doesn’t see things their way.  All of a sudden, the engineer becomes a target for some nasty comments.  I also mentioned that insurance companies aren’t the only ones that could hire an engineer or any other expert for that matter.  Individual policyholders can do the same thing.  However, the reason that most don’t is because of the expense, preferring instead, to allow the insurance company to hire the expert.  I’ve thought about this quite a bit and am wondering if this is really true.  How many policyholders would actually hire an engineer (or adjuster, appraiser, etc) to determine if they have a claim and then pursue it if there is merit?  After practicing forensic engineering for over 20 years, I’ve lost count of the number of times that people have told me how cheated they have felt when their claims were denied.  Some believe that paying premiums faithfully for years entitles them to an unquestionable settlement.  Others believe that an investigation by an engineer, private investigator, or other expert amounts to an invasion of privacy and is insulting at the very least.  Regardless of a consumer’s attitude, it is in their best interest to engage the appropriate expert (if affordable).  Imagine having somebody on your side when you enter into negotiations with your insurer. Or, imagine when, there is a disagreement between you and your insurer about how your property was damaged and, you have someone to speak on your behalf.  Remember that your expert is not your “mouthpiece”. In other words, you are not hiring someone to speak for you regardless of the facts.  If you hire an engineer, the evidence must support your contentions if that person is to be able to present your case and DEFEND it.  If the facts don’t support your position, your engineer (or any other expert) is obligated to advise you.  In other words, the engineer has to make an unbiased call based on the evidence.  If the claim goes to court, the last thing you need is to have your expert’s testimony disqualified because of bias. 

So, having said all of the above, would you hire an expert to review your claim and help you deal with your insurance company?

Be Careful How You Treat Your Engineering Investigator!

Consider the following incident involving a vehicular impact and damage to the vehicle’s transmission. Assume that the driver hit an object in the road and claimed that the object caused damage to the transmission’s oil pan.  In short, fluid leaked out and the transmission was ruined.  On the surface, this seems like a plausible scenario and it would be reasonable to conclude that the failure of the transmission could occur after being hit by flying debris from the object that was struck.  However, what if evidence was found to indicate that things were not  as they appeared?  Needles to say, the final conclusions went against the owner’s claim.  Understandably, the owner would be upset and most likely not open to an alternative explanation.  If you are trying to get your insurance company to pay off on a claim, the last thing you want to do is insult the investigator.  The investigator has no interest in the outcome of the settlement between you and your insurer.  As a result, if you accuse the investigator of acting improperly with no evidence to support your accusation, neither the investigator or your insurer is going to feel inclined to help you in any way.  Not many people know this but, whenever a claim arises, the policyholder can hire their own engineer, appraiser, adjuster, attorney and anyone else they need to help prove their claim.  However, professional help does cost which is why insurers are seldom opposed in the claims process.  So, when you are faced with talking to an engineer, adjuster, appraiser or anyone else hired by and insurance company, be as polite and honest as you can be.  If you disagree with something, you can ask questions but, don’t insult or accuse the inverstigator of taking a “kickback”.  Instead, the time for an appeal ccomes after the initital decision is made by the insurer.  After that, appeals can be made directly to the insurer.  If there is  no satisfaction, then file a complaint with your state consumers affairs department or the office that regulates insurance companies.