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Expert testimony is needed to prove the insurance agent's duty of care



While Omar Alabassi was covered by an insurance policy obtained by T.I.B. Insurance broker ("TIB"), he was involved in a hit-and-run collision with another driver who fled the scene. Alabassi brought an action for negligence against TIB, claiming that TIB did not meet its standard of care by (1) providing him with adequate insurance cover and (2) preparing and filing his insurance application. The district court granted a summary judgment in favor of TIB because Alabassi failed to present expert testimony that TIB violated its duty of care. Omar Alabassi v. T.I.B. Insurance Brokers, Inc. ., No. 19-1183, U.S. Court of Appeals for the Tenth Circuit (September 17, 2020), the Tenth Circuit was asked to determine an expert was not necessary.

FACTS

At the time of the accident, Alabassi owned his own limousine service but drove his personal vehicle to pick up a customer at Denver International Airport. Prior to the accident, TIB Alabassi sold a commercial car insurance policy issued by Columbia Insurance that covered both Alabassi and his limousine business. TIB informed Alabassi of the insurance to be purchased and then assisted Alabassi in preparing and submitting his insurance application.

The insurance application contained a Colorado Coverage Selection Form, which enables the insured to choose how much uninsured car insurance is to be covered. through his policies. Alabassi chose the minimum coverage required by Colorado law, but he also marked a $ 50,000 single coverage box. Alabassi claims that these two alternatives are contradictory.

After the accident, Alabassi claimed that he suffered more than $ 86,000 in medical expenses, but Columbia Insurance offered him only $ 55,000. Alabassi claimed in his complaint that TIB was negligent in (1) providing him with adequate insurance cover and (2) preparing and submitting his insurance application.

At the trial, the TIB brought for a summary judgment on the grounds that Alabassi failed to offer expert testimony establishing substantial elements of his negligence. The district court issued a summary judgment for TIB and approved that expert opinions were required to prove Alabassi's claim that TIB had violated its duty of care. the defendant has violated an obligation owed to the plaintiff and thereby caused the plaintiff's damages. When a claim for negligence is based on an allegation that a professional was negligent, the plaintiff must show that the practitioner's conduct fell below the standard of care associated with that profession. For those who practice a profession that involves specialized knowledge or skill, reasonable care requires that the actor has a standard minimum of special knowledge and ability that is consistent with members of the profession with a good reputation. In such cases of professional negligence, expert opinions are usually necessary to help the fact-seeker determine the applicable standard of care, as such standards are in most cases not within the reach of ordinary people.

A defendant's standard of care must be determined by an expert when the applicable standard is outside the general knowledge and experience of ordinary persons. The standard of care in Alabassi's suit was based on TIB's determination of the correct insurance for Alabassi – a decision that requires knowledge of conditions and practices that are specific to the insurance industry. For example, Alabassi's complaint claimed that TIB did not meet its standard of care for Alabassi adequate insurance for the following reasons:

  1. TIB failed to offer uninsured motorist limits equal to the personal injury limits included in Alabassi's policy.
  2. TIB failed to provide accurate information and guidance by failing to advise, provide and evaluate the plaintiff's needs; and
  3. TIB failed to obtain insurance policies that would cover any hired, borrowed or temporary prudent insurance broker that would determine the appropriate policy for a client or whether TIB's conduct was consistent with those practices.

Consequently, the district court did not err in finding that an expert opinion was necessary to determine whether TIB did not fulfill its obligation to provide Alabassi with adequate insurance cover. In response, Alabassi seems to argue that expert opinion is never needed to prove that an insurance company violates its duty of care because insurers have an obligation to act with only "reasonable care" towards their insured.

Expert testimony was necessary to prove Alabassis' claim that TIB did not use reasonable care in preparing and submitting Alabassi's insurance application. Alabassi argued that expert opinion was not needed to submit an application with inconsistent answers is a mistake that does not require special knowledge or knowledge to understand. His argument failed, however, because the current selection form contains conditions that are specific to the insurance industry that are beyond the knowledge of ordinary people.

Because Alabassi's allegations that TIB was negligent were based on an understanding of conditions and practices beyond common knowledge and experience of ordinary people. Therefore, the USCA concluded that the district court did not make a mistake by deciding that an expert opinion was required and confirmed the trial court. ordinary people, the decision of the tenth circle is reasonable. In order to try to hold an insurance agent responsible for failure to advise on the proper limits to acquire from an insurance company and the type of restrictions to be acquired, it should always be necessary to call an expert witness to explain the insurance agents' practice and practice in the state and explain why, or why not, the agent violated the duty of care against the insured's damages.


© 2020 – Barry Zalma. He also acts as an arbitrator or mediator for insurance-related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims lawyer and more than 52 years in the insurance industry. He is available at http://www.zalma.com and zalma@zalma.com.

Mr. Zalma is the first recipient of the first annual Claims Magazine / ACE Legend Award.

For the past 52 years, Barry Zalma has devoted his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to enable insurers and their claims staff to become professionals in insurance claims.

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