Insurance Coverage Expert Witness Not Allowed to Opine on the Specific Costs He Identified in his Estimate
Posted on September 17, 2024 by Expert Witness Profiler
In March 2019, Zeqa, the Plaintiff bought a two-story home on 3 acres in Lincoln Park, New Jersey, for $310,000. Before the purchase, an inspection revealed pre-existing water damage, which remained unaddressed after Zeqa took ownership. Hanover, the Defendant insured the property under a homeowner’s policy, covering the dwelling, personal property, and living expenses, with specific coverage limits. The policy took effect on March 29, 2019.
On October 2, 2019, the property experienced water damage from ruptured supply lines connected to bidet attachments. The increased water pressure was caused by the Water Authority’s seasonal fire hydrant flushing. Zeqa promptly notified Hanover, who hired ServPro for remediation. However, ServPro was released due to electrical issues before completing any work. Zeqa then hired Quality Air Care (QAC) for remediation without Hanover’s explicit authorization.
The parties disagreed on the damage extent and necessary repairs. Hanover argued that QAC’s work was excessive and unauthorized, while Zeqa claimed it was essential to mitigate damage under the policy. Hanover paid Zeqa a total of $100,280.55 for various damages and offered additional amounts for emergency water mitigation and replacement costs. The dispute centered on the scope of covered losses and the necessity of QAC’s extensive remediation work. Zeqa contended that Hanover’s payments were insufficient and that additional funds should have been released. Furthermore, Hanover argued that Kevin Kaufmann, Zeqa’s public adjuster expert, should be excluded under Federal Rule of Evidence 702, challenging his qualifications to opine on causation and coverage.
Insurance Coverage Expert Witness
Kevin Kaufmann is a seasoned expert in property adjustment with extensive experience in the field. He completed his Bachelor of Business Administration (B.B.A.) from Temple University in 1987, following his Associate’s degree in Liberal Arts from Bucks County Community College.
Kaufmann has been serving as the President of Property Adjustment Corporation since November 1989, where he has been instrumental in leading the company’s operations and providing expert property adjustment services.
Discussion By the Court
1. Qualifications of the Expert
The Court addressed Hanover’s argument that Zeqa’s public adjuster expert, Kevin Kaufmann, was not qualified to opine on causation or coverage. It disagreed, noting that the “specialized knowledge” required for an expert could encompass a broad range of knowledge, skills, and training in the subject matter. The Court found Kaufmann to possess such qualifications. Specifically, it highlighted that Kaufmann had worked as a licensed public adjuster since 1990 and as a claims adjuster for two insurance companies from 1987 to 1989. The Court recognized that Kaufmann had investigated hundreds of water damage claims to determine the cause of damage and coverage under insurance policies. It also noted his significant education and training, including courses in building damage restoration and property claims.
The Court dismissed Hanover’s argument that Kaufmann should be excluded because he was not an engineer. It cited the standard that an expert need only have “skill or knowledge greater than the average layman” to opine on the issues in his report. The Court found that Kaufmann easily met this standard. It also addressed Hanover’s reference to the Balu v. Cincinnati Ins. Co. case, finding it unpersuasive. The Court distinguished Balu, noting that unlike the expert in that case, Kaufmann did have expertise in identifying the cause of damage.
Furthermore, the Court rejected Hanover’s unsupported claim that Kaufmann’s expertise was limited to evaluating repair costs rather than determining how property was damaged. It noted that Kaufmann’s own statements contradicted this assertion. Lastly, the Court dismissed Hanover’s argument about Kaufmann’s use of the phrase “sudden and accidental,” stating that this went to credibility rather than qualifications and could be addressed through cross-examination.
2. Reliability of Causation Analysis
Despite finding Kaufmann qualified, the Court agreed with Hanover that his causation analysis was unreliable and would not assist the trier of fact. The Court identified a significant flaw in Kaufmann’s methodology. It noted that Kaufmann had inspected the property after remediation work had started and the house had been “gutted.” In his deposition, Kaufmann admitted he could not confirm if all the gutted areas had been damaged and needed repair due to water intrusion. Despite this uncertainty, Kaufmann included all these repairs in his estimate and opined that they all related to the Incident.
Based on this admission, the Court found that Kaufmann had no reliable basis to opine that all the repair work included in his estimate related to the Incident. The Court concluded that Kaufmann’s opinion on causation was unreliable and would not be helpful to the jury. Consequently, it ruled that Kaufmann could not testify about whether all the repair work in his estimate was caused by the water intrusion.
3. Opinion on Policy Coverage
The Court’s analysis of Kaufmann’s opinions on policy coverage was nuanced. It disagreed with Hanover’s argument that Kaufmann should be precluded from testifying that the loss he identified was covered by the Policy because it constituted an inadmissible legal conclusion. The Court noted that while Rule 704 prohibits experts from opining about ultimate legal conclusions or legal standards, Kaufmann’s opinions did not cross this line. His statements about policy coverage did not invade the Court’s role in instructing the jury on the law.
However, the Court did find that Kaufmann’s opinion on whether the specific costs he identified were covered under the Policy was inadmissible under Rule 702. The Court made several distinctions in its ruling. It determined that Kaufmann could testify about his observations and findings from his review and inspection of the Property. He could discuss the types of losses covered under the Policy and opine on whether damage caused by the Incident qualifies as a covered loss in general terms. However, Kaufmann could not testify about what specific damage was caused by the Incident, nor could he opine on whether the specific costs he identified in his estimate were covered under the Policy.
Held
The Court found Kaufmann qualified to testify as an expert based on his experience as a public adjuster but excluded parts of his testimony. It ruled his causation analysis unreliable since he inspected the property after remediation work started, making it difficult to confirm damage from the Incident. Kaufmann was allowed to testify on general policy coverage but barred from discussing specific damage or costs due to his inadmissible causation opinion. The Court limited his testimony to ensure reliability and usefulness to the jury.
Key Takeaways:
- Pre-existing property damage can heavily impact insurance claims and disputes.
- Expert testimony may be limited if deemed unreliable, even with qualified experts.
- Inspections after remediation work can compromise the ability to assess original damage.
- Clear communication between insurers and policyholders about repairs is crucial.
- Differentiating incident-related damage from pre-existing issues is vital in insurance claims.
Case Details:
| Case Caption: | Zeqa V. The Hanover Insurance Company |
| Docket Number: | 2:21cv10066 |
| Court: | United States District Court for the District of New Jersey |
| Order Date: | September 9, 2024 |
