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What Is The Next Question Of Ethics?

You are asked by an attorney friend to review a claims coverage opinion received from an insurance representative. When you read the opinion, you believe that parts of it are seriously flawed and incorrect. You know the person who wrote the opinion and believe that he is, at least in part, opining outside his area of expertise. What are your ethical obligations to both the attorney and the person who wrote the report? Feel free to weigh in right here, and while there is no need to give your name, please include your role in the insurance business—agent, adjuster, risk manager?

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Comments (5)

It depends on how and why the attorney asked. If he hires a broker as a consultant or expert, then the expert or consultant is duty bound to provide his or her honest opinion.

If this is just a friendly call with no official requirement it is better to remain silent.

Free advice is worth the amount paid for it and should be avoided because wrong, or poorly thought out opinions, could cause the person giving the opinion serious problems--including a lawsuit.

Becky Sanders, Claims Manager:

This is really quite simple.

You call the adjuster or the claims manager and bring to their attention that there is a question as to whether the coverage opinion is correct.

Get clarification, bring up the points you think may be incorrect, and allow them the chance to correct you or correct their position.

You might just learn something and getting clarification or any mistakes worked out will make for a very happy client/insured.

Marc Dubois, Executive General Adjuster:

As a favor to the requesting attorney, I would offer my opinion. I would hesitate, however, to intervene in the relationship between the attorney and my acquaintance.

Offering an unsolicited opinion I think would be unprofessional and reflect poorly on my acquaintance.

Furthermore I would question the attorney's position, especially if he knew my relationship with the originating opinion author.

I know that I would certainly appreciate any attorney I deal with to keep our relationship on a professional level and not disseminate any of my work to anyone else, especially without my prior consent.

Maybe this attorney is unfamiliar with laws governing work product.

BJ:

Sam, I just have to say this...I have NO attorney friends!

In my career, of late as a private investigator, it has been my policy not to foster relationships as "friends' with those whom I may have to have contact with in court, either in an adverse or other manner.

Being aloof has its benefits in that I remain strictly professional and independent, and not thought of as leaning to one side or the other. Of course, it doesn't get me invited to many cocktail parties either!

Providing a professional opinion always leads to the possibility of legal trouble down the road, as well pointed out by the comments by Barry above.

If a person is hired to provide the opinion, then it's one thing. If it's just a "once over, drive-by" opinion, then it's not a legal opinion and shouldn't be relied upon in any case.

But sometimes it can come back to haunt the person during those nasty "he said/she said" legal battles.

If it's a question of plicy coverage, maybe it should be reviewed by a senior claims person, such as the manager as Becky suggests, for clarification, before the legal wrangle begins.

She's entirely correct that many times, simple communication can bring these situations into a win-win situation.

James P. Reilly:

Simple, down and dirty. Tell the attorney that you know the person who wrote the opinion, and that any involvement on your part would be a conflict of interest. Sorry I can't be of assistance.

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