Back in 2007, the insurance industry lobbied for the passage of an alternative dispute resolution mechanism for disputed sinkhole claims – a process which they cleverly entitled “Neutral Evaluation”.  The concept was that if there was a disagreement between a property owner and an insurance company as to any issue related to a sinkhole claim, either party could request that the matter be submitted to the neutral evaluation process.  Upon submission to neutral evaluation, a “neutral” third party expert would review all available reports and estimates and render an opinion as to the cause of the loss and/or the cost to repair.  (Please refer to my previous post re: Neutral Evaluators for a further explanation as to why I place the word “neutral” in quotation marks.)

The new wrinkle in this process is that Citizens is now electing to ignore the recommendations of the neutral evaluator – even when Citizens demanded that the property owner submit to the process!  The scenario we are seeing is that as soon as Citizens senses a dispute between its experts and the property owner, Citizens will immediately file for neutral evaluation in order to prohibit the property owner from filing a law suit.  BUT – if the neutral evaluator then decides that Citizens’ position on the claim is incorrect and that either coverage should be found or a better repair method is warranted, Citizens will then refuse to honor such decision and will mandate that the property owner agree to Citizens original position.

Clearly, Citizens’ current tactics are in direct contravention of the purpose of the neutral evaluation statute.  Citizens new stance on this process is especially shocking in light of the fact that the neutral evaluation process was a product of the insurance industry’s efforts to limit property owners rights with regard to sinkhole claims.  Clearly, it is now more important than ever to seek the advice of a qualified lawyer who specializes in sinkhole claims in order to best protect your rights against the insurance company.

If you’ve filed an insurance claim for sinkhole related damage in the past few years in Florida, you’ve most likely seen the term “neutral evaluation” in various correspondence or heard the term mentioned by an insurance adjuster.  A few years ago, the Florida Legislature enacted a law whereby if there is a disagreement as to whether sinkhole activity is present on the property or as to the appropriate method to repair the damage, either party to the claim can elect to submit the claim to the neutral evaluation process.  During the neutral evaluation process, a third-party expert chosen from a list maintained by the Department of Financial Services reviews all the investigative reports, inspects the property, and then renders a non-binding “third-party” opinion as to the issue in dispute.  Although the report issued by the neutral evaluator is non-binding, the law states that his report is automatically admissible in any legal proceeding relating to the claim.

Sounds pretty straight forward, right?  Perhaps not.  Exactly what standard does a neutral evaluator have meet in order to be considered “neutral”?  When the neutral evaluation process first began, the Florida Legislature (or perhaps, the insurance company lobbyists?) set forth that an expert would be deemed “neutral” if that expert received 90% or less of their income from insurance companies.  So, in light of this definition, an expert who received 89% of his livelihood from an insurance company would not be seen as being biased in favor of insurance companies.  Hmm – how odd.

Recently, the insurance company lobbyists – er, I mean, the Florida Legislature – further refined the definition as to what would be deemed “neutral”.  Currently, the only “neutral” qualification they must meet is that the expert be, “determined by the department (of financial services) to be impartial”.  Apparently, the Legislature believed that the 90% cut-off requirement was too restrictive and that experts who received in excess of  90% of their income from insurance companies should still be considered “neutral” for this process.  Who are we to question that logic!

Clearly, the use of the word “neutral” in the neutral evaluation process is subject to scrutiny.  Although this process may have been sold to the general public as a way to have sinkhole claim disputes resolved by an “impartial” third party, the reality may be that the “independent” expert may be very beholden to the insurance industry.