Which Came First: the Accident or the Transmission Damage?

 

Recently, we were asked to evaluate a vehicle in order to determine if the damage to the transmission occurred before or after the vehicle was involved in an accident. This was a situation where the accident involved two vehicles, a Pontiac Sunfire and a Buick Enclave. The impact occurred such that the Sunfire sustained damage on the right front side while the Enclave’s left front side was damaged. The Enclave was repaired, returned to the owner and approximately 3100 miles put on the vehicle before the transmission failed. Specifically, the transmission began making a whining noise and when put in gear, would not “pull”. One of the ways to assess when damage occurred is to construct a timeline of events that leads to the damage. That is, establish the condition of the transmission before and after the collision. In this case, the service record of the Enclave was obtained from the owner’s service garage. The record showed that the owner had the vehicle in for an oil change approximately one month prior to the accident. The particular servicing agency also provided a 21 point inspection which included checking all fluid levels. It was then established that the transmission was in good condition prior to the accident. From that piece of information, and without being able to prove that something else (like a sudden fluid leak) caused the damage, the benefit of the doubt has to go to the owner. The insurance company for the owner of the Pontiac was therefore responsible for the repair of the transmission in the Enclave. However, it should be noted that if the condition of the transmission could not have been established, the alternative would have been to remove the transmission and make a determination from the damaged parts. This is a process whereby someone is going to incur some charges. It is usually beneficial to all parties if an arrangement is made beforehand. The arrangement is usually one where the insurance company will pay for the disassembly and repair if the damage is found to have been caused by the accident. If not, then the owner has to agree to pay for the disassembly and repairs.

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.

Hired Guns

Figure 1 Leaking shower valve

We recently investigated the cause of damage to a local residence involving a water leak.  You would think that a water leak would be obvious, and it was, but the cause of the water leak wasn’t.  The water was found to have  been coming from a bathroom shower valve.  It seems that water was leaking from the valve because of a broken plastic piece of the valve stem housing.  The valve is shown in figure 1.  The valve was later removed by the insurance company’s restoration contractor and turned over to an engineering firm for examination.  The engineering company later determined that the valve contained a manufacturer’s defect in the form of a poorly formed plastic component.  The report also stated that no indication of installation error was found.  It should be noted that there were only three modes of failure possible: installation error, manufacturing defect, or a freezing episode.  It should be further noted that this incident occurred in January when temperatures were cold enough to support a freezing scenario.  The expert’s engineering report did not mention a freezing scenario as a possibility of failure. Why?  If the report had mentioned the possibility of damage by freezing, then the insurance company’s case would have been severly weakened.  By not including the possibility of freezing in the report, the insurance company could file suit against the general and plumbing contractors and increased their chances to recover what it had to spend in order to repair the residence.  The expert’s report was clearly written in order to substantiate the insurance company’s position without consideration and explanation given to all possibilities of failure.  As a result, it became clear that the opposing expert was a “hired gun”, someone paid to testify on their client’s behalf regardless of the facts.  These are the kinds of people (and companies) that should be avoided at all costs.  They can be discredited easily because of their lack of consideration for all the facts.  The case was later settled out of court for a fraction of the plaintiff’s originally claimed damages.  

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.

Buyer Beware!

Recently, we were called to investigate damage to a residential air conditioning unit. The allegation was that the unit was destroyed by fire.  Upon examining the unit, no evidence of fire was found.  That is, there was no evidence that any wiring or controls were burned and the compressor and condenser were both undamaged (as far as fire was concerned). However, during the examination of the unit, the compressor was found to have blown a terminal and caused its destruction. Most HVAC technicians will recognize this scenario. The possibility of lightning causing the damage was also explored and eliminated because there was no lightning in the area at the time of the compressor failure.  Instead of replacing the compressor, the homeowner had the entire unit replaced with a unit of greater capacity.  In doing so, the homeowner assumed that the insurance company would pay for the new installation which amounted to more than $8000.00.  Without a covered loss, the insurance company denied the homeowner’s claim leaving the homeowner to  absorb the entire cost of the new installation.   The lesson to be learned here is that you do not want to commit to a major purchase unless you can handle the expenditure if your insurer denies your claim. In this case, the cost to replace the compressor and recharge the unit would have been in the neighborhood of $1200.00 to $1500.00, which is significant lower than the new unit.