MY INSURANCE CLAIM WAS DENIED

INSURANCE COMPANY HIRING ENGINEER WAS THE FIRST RED FLAG

Professional Engineering Opinions are Often Used to Deny Valid Claims    

While sometimes mandated by statute or policy, an insurance carrier’s unrequired association of an engineering firm to investigate an insurance claim is, many times, a red flag that the claim will be denied. 

Insurance companies do not generally seek to voluntarily spend extra money in the hiring of professionals to help you prove covered damages. If an insurance company’s field adjuster can easily make a determination that a claim is covered, payment usually comes without delay. However, if that same field adjuster, who has been to claims school and likely seen hundreds of claims similar to yours, makes a determination that the loss should not be covered and the loss is somewhat sizeable, an insurance company will often call upon an engineer to support the field adjuster’s conclusion. That is, the insurance company wants to add some heft to their claim decision, in hopes that it will give you peace of mind that they’ve done everything they can to investigate the loss and deter you from challenging a coverage denial or deficient claim payment. 

The initial conversation with the insurance company along these lines often appears reasonable, “We would like to have an engineer inspect your claim to determine the cause of your loss”. Again, this can be insurance speak for, “our adjuster doesn’t think this claim, or certain aspects of the claim, should be covered and we would like an outside opinion to support our denial”.  Requests of this type are an attempt to shift the burden of a claim decision from the adjuster or carrier management to a third party. If an insurance company has elected to make an engineering evaluation part of your claim prior to any payment being issued, it is highly probable that part, if not all, of your claim will be denied.

Following such an engineering evaluation, you may expect to receive correspondence from the insurance company in some form of the following: “We retained XYZ engineering to inspect and determine the cause of your (fill in the blank) loss. Based on their evaluation of your residence, your damages aren’t covered under the policy”. The denial would likely then quote policy exclusion language that is purportedly supported by the engineer’s findings, without providing much in the way of explanation of how the two are connected. The denial normally concludes with sing song language to make it appear that they aren’t the bad guys for denying your claim. The letter may read something like: “Unfortunately, the policy does not cover the cause of loss identified by our engineer, and we regret that we cannot advise you more favorably in this matter and trust you will understand our position as an insurer is to honor only those losses covered by your policy.” Do you really believe the insurance carrier regrets to inform you, the policyholder, that they will not be issuing payment or that they find your circumstances in having to repair the loss on your own dime unfortunate? A carrier taking this position after first hiring unecessary engineers has a clear message, “We are claims professionals that associated a professional engineering company, which we have worked with numerous times in the past and who’s opinions we can generally anticipate before making an assignment, to come up with what we will hold out to be a legitimate basis for taking your policy premium and not offering you payment when you needed us.” 

In circumstances like those described above, the insurance company is rolling the dice and hoping you, the policyholder, see what appears to be insurmountable odds that lead you to accept the denial and abandon the claim. Fortunately, an insurance company’s engineer is not the final word on whether or not a loss should be covered. Bennett Legal represents policyholders against claim denials like these and can help you evaluate whether and how to proceed in pursuit of policy benefits. If your claim has been denied, contact Bennett Legal for a free, no cost legal consultation. You may have a great deal to gain. 

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