The Hired Gun
When you suspect a biased forensic engineer is helping an insurance company wrongfully deny a claim, you should scrutinize the engineer’s credentials, the procedures they used, the specific language in their report, and their professional history.
Here are the key red flags and areas to investigate:
1. Report Language and “Peer Review” Alterations
- Policy-Mirroring Language: Check if the wording of the engineering report inextricably dovetails with the insurance company’s specific exclusionary or limiting policy language. This often indicates an outcome-oriented report designed specifically to trigger a denial.
- “Peer Review” Changes: Be aware that some reports are altered during a “peer review” process. There are documented instances where an engineering firm’s account manager or reviewer changed the original engineer’s conclusions to favor the insurance company client and lower the payout.
- Exclusivity Clauses: Look for small print stating that the report is only for the benefit and use of the insurance company.
- Invalid Disclaimers: Watch for boilerplate disclaimers refusing to certify printed or electronic copies (e.g., claiming the report is invalid without a “wet stamp”). Under state laws like Missouri’s, an engineer must seal all final technical submissions, and properly sealed electronic copies are legally valid; refusing to certify them is a violation.
2. Licensing and Expertise Discrepancies
- Mismatched Expertise: Look up the engineer’s license at the state level to verify their specific area of expertise. For example, ensure a computer or electrical engineer is not making structural engineering opinions. Engineers are ethically and legally mandated to perform services only in areas where they are qualified by education, training, and experience.
- Corporate Authorization: Check if the engineer is actually authorized to work for the company whose name is stamped on the report. If they are not authorized by the state to operate under that firm, it can invalidate the entire report. Additionally, check if the firm has listed its required Corporate Certificate of Authority (COA) number on the title block or signature line.
- Out-of-State Seals: Ensure the engineer used a valid seal for the state where the property is located, rather than applying an out-of-state seal.
3. Lack of “Immediate Personal Supervision” Investigate who actually performed the physical inspection. A major red flag is when an unlicensed assistant, field technician, or “home inspector” conducts the site visit, evaluates the damage, and takes notes, while the licensed engineer merely signs the final report from a desk. State regulations strictly require engineers to provide “immediate personal supervision,” meaning they must personally direct, oversee, inspect, and observe the work to maintain control over the decisions and conclusions being sealed.
4. Contradictions and Falsified Data
- The “Red Pen” Test: Go through the report and mark patently false statements, comparing them against your own photographic evidence or scientific documentation (such as thermal imaging or ruler measurements). If you find numerous false claims (e.g., claiming “no damage” next to a photo showing obvious damage), it strongly suggests the professional is intentionally misleading for the insurer’s benefit.
- Drastically Downgraded Estimates: Look for extreme discrepancies between repair estimates, such as a contractor’s $60,000 estimate being downgraded to $3,000 by the insurer’s vendor.
- Shifting Standards: Compare the engineer’s past reports, if possible. You may find instances where an engineer contradicts their own standards (e.g., stating in one report that hail spatter evidence lasts 1-2 years, but claiming it lasts 2-3 years in another report to justify denying a claim).
5. The Engineer’s History and Financial Pressures
- Financial Bias: Forensic engineering is a highly lucrative business tied to the insurance industry. Experts who jump sides to provide honest opinions that force insurers to pay more often find themselves removed from the “approved” lists in claims offices. Because they rely on repeat business from insurers, there is immense mercantile pressure to provide incomplete, biased, or untrue testimony that advances the insurer’s interests.
- Litigation and Disciplinary History: Research the expert’s background. Have they been challenged in court frequently? Have judges refused to allow their testimony? Obtain their prior depositions to look for patterns of bias. Furthermore, check the state engineering board’s records for disciplinary actions. For example, firms have been placed on probation by state boards for issuing reports to insurance companies that failed to meet professional standards and violated professional trust.
What You Can Do: If you uncover these red flags, document the true conditions thoroughly. Engineers are bound by a Code of Professional Conduct to protect the public welfare, and this duty cannot be compromised by the self-interest of their client. You can file a formal complaint with the state’s engineering licensing board, which has the authority to discipline or revoke licenses for fraud, deceit, or incompetence. Additionally, policyholders and their attorneys are increasingly filing lawsuits directly against offending forensic engineers for fraud, defamation, and abuse of legal process to combat this egregiously mercantile use of the engineering profession.
For more information about how to move your insurance claim forward, contact a licensed public adjuster.
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