While pills on white background representing pharmaceutical claims

Practical Guide to Evaluating and Eliminating Biased Insurance Experts

Critically examining and applying the Demer framework

About

  • Promoting fairness in the insurance claims and litigation process
  • Pushing for legislation that mandates transparency in expert selection and testimony
  • Advocating for stricter regulations to prevent insurer fraud
  • Empowering policyholders with knowledge and legal strategies to combat biased claim denials
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. Insureds lose most bad-faith cases because they fail to recognize and argue expert bias.

What factors determine bias?

The most cited factors supporting an inference of bias 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 claims are affected by bias?

Every claim and context imaginable, especially when the expert’s opinions are based on experiential knowledge or subjective factors relating to the cause and scope of the loss, any treatment for the loss, or the cost to repair the damages. That includes 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 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 and remediating expert bias and ensuring a fair claim investigation.

What resources are offered here?

• An evolving E-Treatise analyzing the law of biased experts
• An Expert Bias Toolkit with discovery requests, disclosures, and jury instructions
• Case studies of egregious insurer misconduct
• A database of biased expert cases and analysis
• News reports and blog insights on insurer abuses
• Educational videos (coming soon)

What inspired this site?

This site evolved from a disputed insurance claim that spawned two cases in Los Angeles Superior Court (Nos. BC627381 and 20STCP01687), multiple hearings in an insurer’s conservatorship in San Francisco Superior Court (No. CPF16515183), and an eight-year odyssey by this site’s principal. The E-Treatise and Expert Bias Toolkit evolved from research conducted for this claim.

What legal recourse exists?

Policyholders can use evidence of bias to challenge the insured’s breach of contract and “fairly debatable” defenses, and bring claims against insurers for breach of the duty of good faith and fair dealing and for unfair business practices under the unfair competition law.

Why this site now?

For more than 3 decades, insurers have retained biased experts to provide opinions to support denial or underpayment of claims. It’s an illegal practice that prays on vulnerable people. The major national and state treatises lack any meaningful discussion of expert bias issues, providing, at best, apocryphal law. The regulators and courts have remained silent as well. This site was created to fill that void, offering a comprehensive legal foundation and practical resources.

Why offer the resources for free?

The practice harms individuals and businesses when they’re most vulnerable. It’s illegal. And it’s destroyed individuals and businesses for decades. The resources are offered free to raise awareness and end this predatory practice.