Insurance loss adjusters, engineers & expert reports

Insurance claims are often decided through technical evidence prepared by loss adjusters, engineers, surveyors, medical reviewers or other specialists. The fact that a report was commissioned by the insurer does not make it wrong, but neither does it make every conclusion unchallengeable.

Your task is to understand what the expert actually observed, what assumptions were made and whether the conclusion answers the policy question the insurer is relying on.

Know who is doing what

Ask for the report or the material findings

If the insurer relies on technical evidence to reject or reduce a claim, ask for the report it relies upon. If it will not provide the document itself, ask for the relevant findings, observations, photographs and reasoning so that you can understand and answer the case being made.

The Financial Ombudsman tells financial businesses that, for many home-insurance complaints, it may expect policy documents, expert reports and photographs, claim notes, loss-adjuster notes and settlement breakdowns.

Test the report rather than attacking the author

• Does the report identify what was actually inspected?
• Does it distinguish observation from assumption?
• Does it explain why the stated cause follows from those observations?
• Does it address evidence that points the other way?
• Does it apply the wording in your policy year rather than a generic standard?
• Are photographs, tests or measurements available to support the conclusion?

Correct factual errors immediately

If a report states that a property was unoccupied, a service had not been carried out or damage existed before the event when that is wrong, identify the error precisely and provide the document that corrects it. Do not bury a factual correction inside a long complaint about fairness.

When independent evidence may be worth the cost

Independent evidence is most useful when there is a defined technical question capable of changing the outcome. Before commissioning a report, write down the insurer’s proposition and ask the expert to address that issue directly.

For a modest claim, a detailed statement from a competent local tradesperson may sometimes be more proportionate than a formal expert report. For high-value or technically complex disputes, specialist evidence may be justified.

A SAR is not the same as disclosure of the whole technical file

A subject access request gives you access to your personal information. It may capture call recordings, diary notes and other personal data within the claim process, but it does not automatically entitle you to every document merely because it sits in the claim file.

Use the ordinary claim or complaint process to ask for technical evidence relied on, and use data rights where the information you need is your personal data.

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