A decade of original research on the insurance industry's use of biased experts to deny and underpay claims
The Problem
Insurance companies must thoroughly, fairly, and objectively investigate every claim. For more than three decades, they have routinely violated that duty by retaining biased experts — physicians, engineers, and other specialists — to provide opinions designed to minimize or deny coverage.
Two structural mechanisms drive this practice. Financial dependence bias: the expert earns a substantial portion of their income from insurer referrals, creating a systematic incentive to produce insurer-favorable opinions. Selection bias: insurers iteratively retain and re-retain experts who produce favorable outcomes, filtering out neutral voices over time. The available pool of insurer-retained experts is not independent — it is the product of decades of selection for the result the insurer wants.
These experts typically ground their opinions in experiential judgment rather than empirically tested methodology. Experientially-based opinions are difficult to challenge because they are not falsifiable. The insurer's expert says the claim isn't covered. The basis is "in my experience." The claim is pretextually denied.
Why It Matters
Although insurers must fully and fairly investigate claims, even an expert later found to be wrong ordinarily limits recovery to the damages covered by the policy. But when a claimant demonstrates that the expert was biased — through financial dependence, selection patterns, unreliable methodology, or the insurer's failure to take reasonable measures to ensure impartiality — the insurer's fairly debatable defense collapses.
The claimant can recover all damages, including amounts spent to obtain rightfully owed benefits. That is why exposing expert bias is not a peripheral issue in insurance litigation. It is often the central issue.
The Analytical Framework
In Demer v. IBM Corp. LTD Plan (9th Cir. 2016) 835 F.3d 893, the Ninth Circuit provided a framework of standards, factors, and presumptions for assessing and eliminating expert bias in insurance claims. When a claimant demonstrates an inference of bias — typically through relational and pattern metrics — the burden shifts to the insurer to establish the expert's neutrality and impartiality.
The four most-cited factors supporting an inference of bias:
The expert's past and expected financial benefits for providing opinions to the insurer — compensation amounts, retention frequency, and financial dependence on insurer referrals.
The expert's pattern of issuing opinions favorable to the insurer — outcome consistency across claims, carriers, and claim types.
The expert's failure to use reliable principles and methodologies — experientially-based opinions that deviate from professional standards or are not empirically verifiable.
The insurer's failure to take reasonable measures to safeguard expert impartiality and reliability — absence of vetting, disclosure, or periodic review.
This framework applies across every line of insurance — health, disability, life, auto, homeowner, cyber, CGL, D&O, E&O, fidelity, and surety — wherever the expert's opinions are grounded in experiential or subjective factors rather than empirically verifiable methodology.
The Research
This site is the public face of more than ten years of sustained original research — more than 1,000 reported decisions from state and federal courts, nearly 500 scholarly and practitioner articles, and a 14-chapter legal treatise analyzing the doctrinal, evidentiary, and regulatory dimensions of expert bias in insurance claims.
That research is published weekly in Expert Bias Report: Insurance Claims — a practitioner-focused publication covering case law, regulatory and legislative developments, and analytical tools for attorneys handling insurance bad faith, coverage, and ERISA benefit denial cases.
Free subscribers receive all legislative and regulatory content. Paid subscribers ($200/year) receive full access to the 14-chapter e-treatise and all practitioner tools.
Three bills currently before the California legislature — SB 354, AB 1680, and AB 1642/AB 1795 — would, if enacted, materially impair policyholders' ability to investigate and challenge the experts used against them. Detailed opposition letters on all three bills, going back to May 2025, are available free on the publication.