Insurance Experts and Expert evidence, Keys to Being Successful In a Claim

Before getting into the topic of insurance experts and expert evidence, let’s talk about who the Experts are and the importance they have acquired in insurance companies.

What is an Expert?

The expert is an expert professional who has knowledge on a certain subject, which offers information or founded opinion on the points that are the subject of his report. In relation to a judicial process, there are different types of judicial experts.

What are the different types of legal experts?

  • Medical experts
  • IT experts
  • Insurance experts
  • Calligraphic experts
  • Appraisers

The list could continue and could be very extensive, however, all the different types of experts that exist are required to have their formalized and approved training, as well as sufficient experience in the object of the expertise.

What is the insurance expert and expert evidence?

In the case of the Insurance Expert , they are persons appointed by the insurance companies to evaluate, verify, quantify and value a claim. They determine the guarantee of the coverage and the amount of the damages based on the conditions of the policies. To be more specific, this definition is found in Law 30/1995, of November 8, on the Regulation and Supervision of Private Insurance , where these professionals are referred to as, “ Insurance experts are those who rule on the causes of the claim, the valuation of the damages and the other circumstances that influence the determination of the compensation derived from an insurance contract and formulate the proposal for the liquid amount of the compensation ”.

Expert evidence

Now what is expert evidence? This consists of the presentation to the trial of an opinion or opinion on controversial facts in it, for whose proper appreciation special knowledge of some science or art is required, with this the expert report is made .

As we have indicated, an expert opinion is a study carried out by an expert person in the specific matter on which it evaluates, who based on the observation of the facts and objective evidence, establishes the causes, circumstances and consequences of the accident. In addition, the expert assesses material damage, injuries and other losses as a result of the accident. The expert report requires that the expert observe the facts, which is why in most cases their presence at the scene of the event is necessary. The expert report written by the expert can be key to the success of a claim.

To have more clarity on this point, we spoke with ReclamoSeguro partners and experts in this field, Rafael Escarpizo of risk consulting and claims CRSControl and Alberto platform

What advantages does an insured person have of defending their rights based on an expert report?

At, on some occasions, we turn to experts to refute the arguments of the insurance companies since they often use the fact that the client does not have knowledge of a matter and offer them compensation that many times are not correct. In this sense, the consulting firm CRS ControlHe commented, »The first and main advantage of the insured is to be advised by a professional, with an objective, technical and independent vision and who, in addition, has knowledge in insurance matters. And at the same time balancing the possible vision that the insurance company has taken on the facts and circumstances of the claim, which decides on another expert report issued by another technician. Both for an individual or a company, in general and under the criterion of seeking solutions, having an expert report that collects the facts and economic circumstances of the claim is always positive, as it facilitates understanding between the technicians and ultimately speeds up the management and decision-making in claims ”. On the other hand, the platformHe complemented that the «The expert report must be technical and precise, but at the same time be clear and understandable for those who are not experts, since its main purpose is to be read by those people and that they can understand it in the same way that it has been made the expert. Thus the parties or a judge can reach an agreement or a sentence.

It is expected that an insurance company will react to an expert report from an external expert, that is why we asked the consulting firm CRS Control about this issue and this was their response:

What is the reaction or response of an insurance company when a client submits his own expert report?

Reactions are disparate even though in recent times they tend to normalize and be accepted by insurance companies as something positive, which facilitates dialogue and the final solution of the claim. On the other hand, there is the positioning of the experts or technicians who work for the insurance companies who also begin to see positively the intervention and collaboration of an expert or a technician on the part of the insured. In any case, the reaction of the parties is always greatly influenced by the phase of the claim in which the intervention of the insured’s expert takes place, since it is not the same to intervene from the beginning of the claim or to do it when the insurer’s expert has delivered your report and this, you have already made a decision regarding your position in the incident.

In recent times, there has been an increase in private expert reports by clients , insurance companies have had to begin to accept this trend, and according to what Rafael Escarpizo from the risk and claims consultancy CRSControl commented,   “this is due to , mainly, that the insured as a client and user is more aware of their rights and aware of the springs that protect themand that the insurance sector has, such as the figure of the insured’s expert and by expanding the management process contained in article 38 of the Insurance Contract Law, which represents an opportunity and a guarantee for the defense of their interests. Additionally, it should be noted that there has also been an increase in the demand for expert reports to be provided in legal proceedings with or without insurance companies involved. “

Video Expertise

Currently, the technological ones allow many expert opinions to be carried out by means of video expertise, as we will see in this article. Once this is understood, we can talk about the new tools that enable the expert to carry out the expert opinion, among which is the Video Expertise.

What is the Video Expertise?

It is a tool that enables the expert to remotely perform ocular supervision. This is carried out with the help of a user located at the scene of the events using a mobile device, which allows the transfer of images and videos, in order to evaluate the scene, thing or person object of the professional performance without the professional must be present.

What are the advantages of the Video Expertise?

The video appraisal allows the insurance expert to verify and assess the damages in a remote manner from his computer or mobile phone by means of a remote connection to the telephone of the user or person in charge of the workshop, in addition to allowing him to assess the causes and consequences of the loss. In this way, you can set the amount to be compensated or transfer the corresponding instructions to the operators to repair the damaged property, or decline assistance under the circumstances of the insurance contract.

Another of its advantages is the verification of the repair operations carried out by the workers subcontracted by the insurers during the process of carrying out the tasks commissioned. In case of injury, the work of medical experts is another advantage that can be done using this technology, since remote medical visits can be made . As we explained in a previous article on our blog, the medical report is crucial when having a traffic accident since it is necessary for a medical report to diagnose the injuries when claiming your compensation.

According to , currently, video-expertise is spreading and standardizing more and more. For some years now, it has been surveying remotely (with photos, videos, documentation or video calls) and the COVD19 has caused the explosion and the need for this system to be able to reach and attend to all the expert’s needs quickly. It could be said that video expertise began to become popular with vehicles through workshops that sent photographs and estimates to experts to be assessed remotely. Little by little, this system adapted to expert opinions of all kinds.

Feasibility and technical restrictions of the Video Expertise

  • It is not required to install any application to perform the session
  • Take pictures at all times
  • Record the entire session or part of it when needed
  • Check that the user is in the agreed place
  • Works with 3G, 4G, 5G and Wifi
  • Sessions can be held anywhere in the world
  • There is no limit to the duration of the sessions
  • You only pay for it when you use it
  • Purchased sessions never expire

According to , the video-session must be carried out with a computer, normally a smartphone-type mobile terminal, which the person who is in the place of the property to be surveyed must have. The quality of the device and the internet connection determine that we can have a good image to make the video call. There are certain places, such as basements, where if they do not have a Wi-Fi signal, it is not possible to make this type of connection. In these cases it is possible to solve it with photographs.

Video expertise has transformed expert activity

With all this the importance of the expertise video apparent today and explains , “Because of the restrictions that are suffering with COVID19 the expertise video is becoming an indispensable tool to address many claims that otherwise it could be delayed indefinitely with the aggravation that this could entail. In addition, being able to act immediately without having to travel helps to adapt to the client’s or injured party’s schedule and to reach remote places. “

On the other hand, and complemented the above, the consulting firm CRS ControlHe commented that “the irruption of the expert video has meant the great transformation and evolution of the expert activity. Obviously, in-person intervention of the expert will continue to be necessary in certain claims, which, due to their economic amount, circumstances or complexity, require it, but it is evident that in most cases video expertise is the option that provides more efficiency and agility to the expert process. , shortening response times in customer service and obtaining the necessary information to make decisions on the part of those involved. And also, in the current situation, mainly for security, with restrictions derived from COVID, protection measures and social transformation towards the use of new technologies,

Regarding the value of the Video Expertise, these are in accordance with the sessions that are needed, they are standardized, unlike the normal expert opinion that, like any professional, can charge whatever they deem appropriate. For the same reason, it is recommended to ask for the price in advance.

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