While pills on white background representing pharmaceutical claims

Practical Guide to Evaluating and Eliminating Biased Insurance Experts

Critically examining and applying the Demer framework

Unveiling Insurers’ Biased Expert Tactics

Insurance companies must act with complete honesty and candor toward their policyholders. They must thoroughly, fairly, and objectively investigate claims. Yet, for the past 30 years, insurers have routinely violated their fundamental duties and engaged biased experts to deny or underpay claims. Their reliance on biased experts is a predatory and unfair business practice. It undermines basic contract principles and deprives vulnerable claimants of needed benefits.

This comprehensive resource equips you with the knowledge and tools to challenge biased experts and hold insurers accountable. Explore in-depth legal analyses, case studies, and proven strategies to level the playing field against insurers rigging the system in their favor. Join the movement to uphold policyholder rights and restore integrity in the insurance industry!

Download the free E-Treatise and Expert Bias Toolkit

mobile home complex damage by a tornado, representing damage associated with a tornado claim

Homeowner Claims

disabled man sitting in a wheelchair, representing the injuries often associated with personal injury or disability insurance claims — Homeowner Claims

Why does exposing bias matter?

Although insurers must fully and fairly investigate claims, they use biased experts to deny, delay, or underpay claims, without any downside. Even if the expert is later found wrong, the insured can recover only the damages covered by the policy. However, by showing the expert is biased, the insured can recover all their damages, including the amounts spent to obtain the policy benefits.

How widespread is this abuse?

While precise data is limited, court cases and the media reveal a systemic national problem. Using biased experts to minimize claim payments may be the largest predatory business practice in the country’s history, affecting many, if not most, claims, including medical, disability, life, auto, homeowner, cyber, CGL, D&O, E&O, fidelity, and surety policies.

How is expert bias determined?

Bias is a tendency to favor a particular person, issue, or matter. It denotes a lack of fairness and impartiality—an inability to remain objective. Bias has no physical attributes; it exists solely as a state of mind. Bias is generally evaluated by considering circumstances that give rise to an inference of bias, such as the scope and magnitude of a relationship.

**What is the Demer paradigm?**

In Demer v. IBM Corp. LTD Plan (9th Cir. 2016) 835 F.3d 893, the court provided a framework of standards, factors, and presumptions to assess and eliminate expert bias. Under the framework, if a claimant demonstrates an inference of bias (often satisfied with relational metrics), the burden shifts to the insurer to show the expert’s neutrality and impartiality.

What factors determine bias?

The most cited factors indicating expert bias favoring insurers are the expert’s past and expected benefits for providing the opinions, the expert’s pattern of issuing opinions favorable to the insurer, the expert’s failure to use reliable principles and methodologies, and the insurer’s lack of reasonable measures to safeguard expert impartiality and reliability.

What factor is key to ending bias?

Insurers must take reasonable measures to ensure that any expert they use to investigate a claim is qualified, reliable, and impartial. They must vet the expert and periodically review their work. Uncovering the expert’s disclosures to the insurer—including relational and pattern metrics—is essential for identifying expert bias and ensuring a fair claim investigation.

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The Expert Bias Solution

From pleadings through appeal, applying the standards
factors, and presumptions to assess and eliminate biased insurance experts

Analytics ● Evaluations

Combine segmented relational and dispositional metrics with comprehensive analysis of expert’s principles, methodologies, tests, and facts

Discovery Plan ● Requests

Develop and implement a highly effective discovery plan, with requests targeting the bias factors and integrating with the pleadings and case-specific facts

Testimony ● Prep

Prepare and take effective depositions with outlines, scripts, and summaries narrowly focused on the critical expert reliability and neutrality issues

Motions ● Appeals

Draft, argue, and defend consistent motions to compel, motions for summary judgment and adjudication, motions in limine, jury instructions, and appeals