Tag: claim

  • The Insurance Expert’s Testimony on Claims Handling Contained Deficiencies

    The Insurance Expert’s Testimony on Claims Handling Contained Deficiencies

    This is an insurance coverage dispute arising from a car accident between Plaintiffs, in which Plaintiffs seek to enforce a liability insurance policy issued by Defendant to Plaintiff Anita Myers that was later assigned to Plaintiff Sarah Montalvan.

    Defendant sought to exclude the testimony of Peter Knowe, Plaintiffs’ designated insurance claims handling expert while Plaintiffs sought to exclude the opinions of GailAnn Stargardter, Defendants’ designated insurance claims-handling expert.

    Insurance Expert Witness

    Peter Knowe has specialized qualifications and experience in adjusting, investigating, and evaluating insurance claims. During his career in the insurance industry spanning 26 years, he was trained in evaluating and responding to policy limit demands and time-limited demands.

    Want to know more about the challenges Peter Knowe has faced? Get the full details with our Challenge Study report.

    Law And Legal Expert Witness

    GailAnn Y. Stargardter is a practicing attorney specializing in “insurance coverage and bad faith,” and has been practicing in Washington since 1988, and California since 2007.

    Stargardter’s practice is limited to insurance coverage and bad faith. Stargardter was previously employed as a claim attorney for an insurance company, where she reviewed files to “determine whether claims were being handled consistent with state and company requirements.” She also provides training to insurance clients regarding the California state settlement regulations, is a “co-author of California Insurance Law (The Recorder (2015)),” and previously testified as an expert witness.

    Discover more cases with GailAnn Stargardter as an expert witness by ordering her comprehensive Expert Witness Profile report.

    Discussion by the Court

    A. Defendant’s Motion to Exclude the Expert Testimony of Peter Knowe

    1. Qualifications

    Based on Knowe’s description of his experience and attached curriculum vitae, the Court found that Knowe is qualified to provide expert testimony in this case.

    Therefore, the Court denied the Knowe motion insofar as it sought to exclude, on the ground of Knowe’s lack of qualifications, his testimony regarding industry customs and practices in handling insurance claims.

    2. Reliability and Methodology

    Plaintiffs offered Knowe as an expert on the topic of whether Defendant “complied with the practices and standards of the insurance industry in its handling of the liability claim brought by Sarah Montalvan against Anita Myers.”

    Based on Knowe’s review of various materials, including Defendant’s claim file, the deposition transcript of Starla Tuck, Defendant’s claims adjuster, and other case specific documents, Knowe opined that Defendant’s claim handling “fell below the insurance industry standard of care” in twelve different ways.

    Based on the Court’s review of the Knowe Report, the Court agreed with Defendant that the Report (1) did not sufficiently articulate the bases for Knowe’s proffered “industry standards,” and (2) lacked a described nexus between the described industry standards and Knowe’s opinions.

    Analysis

    In his Report, Knowe listed sixteen standards “for claims handling,” which are “national in scope and apply in all states.” However, the Knowe Report did not identify the specific source for each standard.

    Other than to cite his training and experience, the Knowe Report did not explain how Knowe derived his sixteen standards from the above-referenced insurance industry texts and articles.

    In addition, as articulated by Defendant during the hearing on the motions, it is unclear whether each of the sixteen standards Knowe describes in his report were applicable when Defendant evaluated Plaintiffs’ claim in 2018. Further, even if the Knowe Report were to describe the basis for the standards described therein, it is unclear how Knowe “applied the principles and methods reliably to the facts of the case.”

    Nevertheless, the Court found that the above deficiencies may be curable. Based on Knowe’s described experience with insurance claims handling as a senior technical representative, manager of California-based field offices at a nationwide insurance company, and experience as an expert witness in other proceedings, the Court is inclined to give Knowe the opportunity to explain how he derived the 16 standards, whether those standards existed at the time of the claim, and how he applied the principles and methods reliably to the facts of this case.

    B. Plaintiffs’ Motion to Exclude GailAnn Stargardter

    1. Qualifications

    Plaintiffs presented no argument that Stargardter is unqualified. Based on Stargardter’s described experience, the Court found that she possesses sufficient “knowledge, skill, experience, training, or education” to provide expert testimony regarding insurance claim handling.

    2. Ultimate Issue Testimony

    Plaintiffs argued that “the Stargardter Report is a legal brief masquerading as expert testimony” in that the Stargardter’s opinions are no more that impermissible conclusions and are one-sided, incomplete, and unreliable.

    Based on the Court’s review of the Stargardter Report and Stargardter Rebuttal, the Court concluded that the Stargardter Report and Stargardter Rebuttal provided legal opinions on ultimate issues of law, and such opinions should be excluded.

    Anlaysis

    Stargardter opined that Defendant’s handling of Plaintiffs’ claims “was within the standard of care, consistent with the standards, customs, and practices in the insurance industry, compliant with the CUCPA and the Regulations, and compliant with National General’s own internal guidelines.”

    In particular, according to Stargardter’s opinion, Defendant “conducted a full, fair, objective and timely investigation of Sarah Montalvan’s claim,” “fully, fairly, objectively, proactively, and timely evaluated Sarah Montalvan’s claim, and extended settlement offers commensurate with the claims as documented by her counsel.”

    This opinion, plainly, amounts to legal analysis. The Stargardter Report and Stargardter Rebuttal rely on legal authorities to assert that Defendant’s handling of Plaintiffs’ claims was “within the standard of care, consistent with the standards, customs, and practices in the insurance industry, compliant with the CUCPA and the Regulations, and compliant with National General’s own internal guidelines.”

    The only portion of Stargardter’s testimony that does not provide legal analysis is what Defendant characterize as “a detailed claim-file chronology tracking Defendant’s handling from the initial loss report on September 24, 2017, through the filing of the suit.”

    Based on the Court’s review of the Stargardter Report and the parties’ arguments at the hearing, both the Stargardter Report and Stargardter Rebuttal offered legal opinions that will not be helpful to the jury

    Held

    Having considered the parties’ submissions, oral arguments, the relevant law, and the record in this case, the Court ordered the parties’ respective experts to file supplemental expert reports that address the deficiencies and reserved ruling on the motions until after the supplemental reports are filed.

    Key Takeaway

    In describing the bases for her opinions, Stargardter does not reference her experience handling insurance claims or Defendant’s internal guidelines. Neither the Stargardter Report nor Stargardter Rebuttal describe whether Defendant’s conduct was reasonable based on industry practices and norms.

    Case Details:

    Case Caption: Montalvan V. National General Insurance Company
    Docket Number: 5:25cv441
    Court Name: United States District Court, California Central
    Order Date: July 07, 2026
  • Insurance Expert Was Allowed to Opine on Damage Causation

    Insurance Expert Was Allowed to Opine on Damage Causation

    This case involves allegations of underpayment and nonpayment under an insurance policy.

    Ategrity Specialty Insurance Company issued Policy No. 01-C-PK-P20064154-0 to 707 FWY Investments, LLC with effective dates of September 12, 2022, to September 12, 2023. Plaintiff leased out this structure to commercial tenants.

    The roof collapsed and then several severe rain and windstorms allowed water infiltration to the roof surfacing and sub-surfacing and the interior of the building. Plaintiff subsequently filed a claim under the policy.

    Defendant filed a motion to strike Plaintiff’s expert, Monty Stone, a public adjuster designated to testify on causation.

    Insurance Expert Witness

    Monty B. Stone has had many years of experience in the construction and roofing industry starting from July 2005 to January 2020 where he owned and operated his own construction company and installed all types of roofing systems, including the one at issue in this case.

    Stone has been a licensed Public Insurance Adjuster since 2018.

    Get the full story on challenges to Monty Stone’s expert opinions and testimony with an in-depth Challenge Study.

    Discussion by the Court

    Plaintiff designated Stone to testify as an expert in damages and causation. Defendant filed a motion to strike Stone’s opinions on causation—but not damages—arguing 1) he is not qualified, and 2) his testimony is not based on a reliable methodology.

    Defendant’s argument that Stone is unqualified rests on the fact that he is not an engineer—he is a public adjuster—and “working closely” with engineers is an insufficient basis to make one an expert in engineering. Defendant also pointed to the fact that Stone was not certified as a roof consultant or a roof observer at the time of the loss. Plaintiff responded that 1) Stone has been upheld has an expert in the face of nearly identical challenges, and 2) Defendant’s quibble is better suited for cross-examination.

    While he is not currently licensed, he has been in the past and has extensive work experience and training with identifying damage causation, reasonable repairs, and reasonable costs. Stone was also formerly a HAAG Certified Roof Inspector—the same company for which Defendant’s causation expert works. Because Stone is not required to be an engineer to testify as to causation, Defendant’s arguments regarding Stone’s experience are better suited for cross-examination, rather than a challenge based on qualification.

    Defendant also objected to the reliability of Stone’s testimony, arguing that he provides only “general statements without concrete examples” which amounts to “ipse dixit.”

    Plaintiff argued that “Defendant offered no comparison to other methodologies” and that Defendant’s own engineer relied on the same methodology—visual inspection—and performed no testing.

    Defendant presented no other reason for the Court to believe Stone’s physical inspection is not a proper methodology. In light of this, the Court found no reason to think Stone’s methodology was unreliable.

    Held

    The Court denied Defendant’s motion to strike the testimony of Plaintiff’s expert Monty Stone.

    Key Takeaway

    Although Defendant makes an argument based on Stone’s lack of schooling, that is only one among many ways to be qualified. Under Federal Rule of Civil Procedure 702, a witness may be qualified as an expert by “knowledge, skill, experience, training, or education.”

    Case Details:

    Case Caption: 707 FWY Investments LLC V. Ategrity Specialty Insurance Company
    Docket Number: 4:25cv114
    Court Name: United States District Court, Texas Northern
    Order Date: January 09, 2026
  • Insurance Expert is Not Allowed to Opine on Structural Design

    Insurance Expert is Not Allowed to Opine on Structural Design

    Plaintiffs, Michael and Karen Green claimed that they had sustained loss as a result of hail and wind. Defendant Nationwide Mutual Insurance Company issued them a homeowner’s policy but when Plaintiffs filed a claim for loss under the policy, it gave rise to this dispute because Nationwide apparently failed to reimburse all covered losses under the Policy.

    Nationwide sought to exclude the testimony of Plaintiffs’ retained expert witness, James Taylor, a licensed public adjuster.

    Insurance Expert Witness

    James Taylor has extensive knowledge about restoration and common practices in adjusting and handling claims in the insurance industry. He is licensed public adjuster, insurance appraiser, and IICRC-certified restorer with significant experience in insurance claims handling, loss assessment, and industry-standard compliance.

    He has worked in field of remediation since 2000, and as an insurance adjustor and appraiser since 2019. Taylor’s professional background includes experience in water intrusion and hail damage assessments and structural loss analysis. He holds a public adjuster license with multi-state reciprocity, including Missouri, and maintains IICRC certification in restoration practices.

    Get the full story on challenges to James Taylor’s expert opinions and testimony with an in-depth Challenge Study.  

    Discussion by the Court

    Nationwide argued that Taylor lacked the qualifications to opine on the Nederveld engineering report or offer credibility opinions regarding third parties. Plaintiffs countered that Taylor’s testimony concerned insurance industry standards and claims handling practices, not legal conclusions, and agreed he would not testify on the legal standard for vexatious refusal to pay under Missouri law.

    The Court found Taylor qualified based on his extensive experience as a public adjuster, appraiser, and restorer. The Court ruled that Taylor will be permitted to testify regarding insurance industry practices and standards in general, proper claims handling, how certain information affects claims decisions, and whether Nationwide’s actions deviated from insurance industry customs and practices.

    As for the Nederveld engineering report, the Court allowed Taylor to testify on how the industry uses such reports and why, as an adjuster, he finds it reliable or not, but ruled he could not offer opinions on structural engineering defects. Similarly, while he could not give unfounded credibility opinions about third parties like SeekNow or Sedgwick Claims, the Court permitted him to testify if their services or practices were consistent with insurance industry standards.

    Held

    The Court granted in part and denied in part the Defendant’s motion to exclude the testimony of expert James Taylor.

    Key Takeaway

    Taylor is not an attorney offering a legal opinion as to whether Nationwide complied with Missouri law. He is a licensed public adjuster and former restorer, and he is an expert in insurance industry practices and standards. He is offering opinions as to whether Nationwide’s handling of Plaintiffs’ claim was in line with practices in the insurance industry, which goes to the issue of reasonableness and is admissible.

    Case Details

    Case Caption: Green v. Nationwide Mut. Ins. Co.
    Docket Number: 4:23 cv 156 
    Court Name: United States District Court for the Eastern District of Missouri, Eastern Division
    Order Date: May 12, 2025
  • Appraisal and Valuation Expert is Qualified to Testify about the Value of the Porsche

    Appraisal and Valuation Expert is Qualified to Testify about the Value of the Porsche

    Joseph Falasco bought a non-functioning 1974 Porsche 911S for $10,000 and put a significant amount of time and money into restoring it, including the installation of a new engine and transmission.

    Falasco later filed a claim regarding the non-collision fire that destroyed Plaintiff’s 1974 Porsche 911S (the “1974 Porsche”) and ended up suing USAA for breach of insurance contract, bad faith, and unfair claims
    settlement practices.

    Falasco filed a motion to exclude the testimony of two of USAA’s experts— Roy Da Silva and Mark McGillivray.

    Insurance Expert Witness

    Mark A McGillivray holds a bachelor’s degree in business administration with a concentration in Finance from the University of Puget Sound and a master’s degree in Business Administration with a concentration in Marketing from the University of Illinois at Chicago.

    He also holds the Chartered Property Casualty Underwriter (CPCU) designation from the American Institute for CPCU and the Insurance Institute of America (The Institutes).

    McGillivray has over 41 years of experience in the Insurance Industry, primarily in claims roles. He held various roles at Allstate Insurance Company for over 35 years, including Senior Vice President in claims.

    Since 2019, he has worked as a consultant in the industry, participated in expert networks, and been retained as an insurance expert. He is also on the Board of Directors of Hancock Claim Consultants.

    Get the full story on challenges to Mark A McGillivray’s expert opinions and testimony with an in-depth Challenge Study.  

    Appraisal and Valuation Expert Witness

    Roy Da Silva is an experienced appraiser who specializes in classic cars. He founded and developed Source One Services to provide specialized services
    to the collector car markets.

    Want to know more about the challenges Roy Da Silva has faced? Get the full details with our Challenge Study report.  

    Discussion by the Court

    Motion to exclude the Expert Testimony of Mark McGillivray

    Falasco filed a motion to exclude the expert testimony of Mark McGillivray. The Court ruled that this motion is denied without prejudice as moot.

    It appeared that USAA intended to offer McGillivray’s testimony solely in support of its defense on Falasco’s bad faith and unfair claims settlement practices claims.

    Since the Court had already granted summary judgment on those claims, McGillivray’s testimony was no longer relevant to the remaining issues in the case.

    Motion to exclude the Expert Testimony of Roy Da Silva

    Falasco argued for the exclusion of Roy Da Silva’s testimony, implying it would not offer adequate assistance to the trier of fact.

    The Court held that Da Silva is qualified to testify about the value of Falasco’s Porsche. In other words, Da Silva’s expertise will aid the jury due to the complexity of the classic car market. 

    While Falasco may dispute Da Silva’s valuation or methodology, the Court held that such challenges concerned the weight and credibility of his testimony. These concerns could be addressed through “vigorous cross-examination and presentation of contrary evidence” at trial, allowing the jury to evaluate its significance.

    Held

    • The Court denied without prejudice as moot the motion to exclude the testimony of Mark McGillivray.
    • The Court denied Falasco’s motion to exclude the testimony of Roy Da Silva.

    Key Takwaway:

    Classic car appraiser Roy Da Silva’s testimony was admitted because his expertise was essential for assisting the jury in understanding the complex classic car market.

    Case Details:

    Case Caption: Falasco v. USAA Cas. Ins. Co
    Docket Number: 4:23cv01054
    Court Name: United States District Court for the Eastern District of Arkansas, Central Division
    Order Date: May 2, 2025