A simple yet very confusing issue has come up recently with the neutral evaluation process. When a neutral evaluator is assigned a new file he or she is provided with a one page standard form from the Department of Financial Services to complete when they are done. The form provides two boxes they can check: “sinkhole verified” or “sinkhole eliminated”. If the neutral evaluator is investigating a claim where the insurance company has denied the claim because of a lack of structural damage which box does the evaluator check? If the insurance company determined that no structural damage was found then that means no testing was ever done to determine whether a sinkhole existed. When the form only allows you to verify or eliminate a sinkhole what do you do? There is no evidence either way.

The other problem is these types of cases put the neutral evaluators in the precarious position of taking on the role of a judge or attorney because they have to make decisions as to whether they will let the insurance company deny the claim with no sinkhole investigation. The evaluators don’t want to make the decision to do the testing because that makes them a judge in a way, deciding how the claim has to be handled verses making a scientific decision on the objective data presented. I don’t know what the best solution is but it seems something needs to change as these cases become more popular. We just hope the evaluators have some understanding of the law and ruling such as Bay Farms and do the right thing based on that.

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