Not All Expert Testimony must be Scientifically Reliable
Post number 5284
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In Church Mutual Insurance Company, S.I. v. Chabad Of New Mexico, No. 1:24-cv-00090-MIS-SCY, United States District Court, D. New Mexico (February 10, 2026) the USDC dealt with a declaratory judgment filed by Church Mutual that it owes no duty to cover Chabad’s claims because the property was “vacant” for more than sixty consecutive days before the acts of arson, and therefore no coverage is owed pursuant to the Policy’s “Vacancy” loss condition.
FACTUAL BACKGROUND
Church Mutual Insurance Company, S.I. (“Church Mutual”) renewed an insurance policy for Chabad of New Mexico (“Chabad”) covering real property in Rio Rancho, New Mexico. The policy included a “Vacancy” loss condition, stating that if the building was vacant for more than 60 consecutive days prior to a loss, Church Mutual would not pay for losses caused by certain events, including vandalism.
The claims adjuster assigned to investigate the fires stated that “while the building was not actively being used, there remained sufficient contents in the structure for the Insured to continue their normal operations.”
The interpretation and construction of an insurance policy is a question of law for the Court and one that the Court performed when it ruled on the Parties’ cross-motions for summary judgment on the issue of coverage concluding that Chabad’s building was not “vacant” under the unambiguous terms of the Policy and that therefore Chabad was entitled to summary judgment on the issue of coverage as to both fires. As such, the Court finds that this argument was moot.
Chabad sought to introduce expert testimony regarding insurance industry standards, customs and practices and about how Church Mutual Insurance Company deviated from those standards in its handling of the property damage claims of” Chabad. Chabad hired Stuart Setcavage who purports to be “an expert in the field of insurance industry claim handling, policy interpretation and coverage analysis.”
As to the Vacancy provision, Mr. Setcavage states: “Claim professionals are trained to know that the vacancy condition of the building combines suspension of coverage for certain perils with reduction in coverage for others . . . The approach . . . eliminates coverage only for the perils most affected by vacancy, and it reduces coverage for damage by other perils. ”
Church Mutual sought to exclude the expert testimony of S. Setcavage.
ANALYSIS/DISCUSSION:
The Court denied Church Mutual’s Corrected Motion to Exclude the testimony of S. Setcavage. The judge found that the motion did not warrant exclusion and permitted the testimony to be presented at trial.
Mr. Setcavage noted that “neither the perils of arson nor fire are specifically identified” in the Vacancy provision, and opines that “the intent of the policy was to reduce coverage by 15% for perils not specifically listed, not eliminate it altogether.” Mr. Setcavage further opined that Church Mutual is attempting to redefine ‘vacancy’ to include factors not set forth in the policy. Church Mutual now wants vacant to mean unused.
District courts evaluating the reliability of non-scientific expert testimony do not have to focus on whether the expert employed an objective standard or methodology and can instead focus on the reliability of the expert’s personal knowledge or experience.
Here, Mr. Setcavage has offered opinions that may assist the jury in deciding whether Church Mutual has engaged in bad faith insurance conduct. In fact, the claim handling or investigation is indicia of a pre-determination to deny payment for these claims. The Court was satisfied that Mr. Setcavage’s proposed expert testimony was both reliable and relevant, in that it will assist the trier of fact.
Church Mutual Insurance Company’s Corrected Motion to Exclude the Testimony of S. Setcavage, was denied.
ZALMA OPINION
Insurance claims handling expert witnesses are not scientists, do not deal with scientific or engineering realities but rather are presented to explain to a jury that actions of an insurer in dealing with a claim, were conducted within the custom and practice of the insurance industry and whether the insurer fulfilled or failed to fulfill the standards of the industry. For that reason, since the court had ruled that the insurer’s attempt to apply a vacancy condition to apply to perils not identified the court concluded the expert would help the jury understand whether the tort of bad faith was involved.
(c) 2026 Barry Zalma & ClaimSchool, Inc.
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Liability Insurance Provides no Coverage for Damage to Insured’s Property
Post number 5283
Read the full article at https://www.linkedin.com/pulse/certificate-liability-insurance-policy-barry-zalma-esq-cfe-mteoc, see the video at and at and https://zalma.com/blog plus more than 5250 posts.
Evidence of Contract with Plaintiff There is No Insurance
In Erica T. Itzhak v. Briarwood Insurance Services Inc., Atlantic Casualty Insurance Co., 2026 NY Slip Op 00616, Appeal No. 5791, Index No. 651193/24, Case No. 2024-06530, Supreme Court of New York, First Department (February 10, 2026) Plaintiff Erica T. Itzhak alleged that her cooperative unit was damaged during a renovation. The complaint did not specify who caused the damage, nor did it clarify the relationships between the plaintiff, Atlantic Casualty Insurance Co., and Briarwood Insurance Services Inc., or provide details regarding which party was ...
UPCODING FRAUDSTER NEEDS TO PRODUCE DOCUMENTS DEMANDED
Post number 5282
Read the full article at https://www.linkedin.com/pulse/insurers-must-proactive-when-victims-fraud-barry-zalma-esq-cfe-07mpc, see the video at and at and at https://zalma.com/blog plus more than 5250 posts.
Insurance Fraud Can Be Stopped by Aggressive Insurers
In Unitedhealthcare Services, Inc., United Healthcare Insurance Co., and UMR, Inc. v. Team Health Holdings, Inc., Ameriteam Services, LLC, and HCFS Health Care Financial Services, Inc., No. 3:21-CV-364-DCLC-DCP, United States District Court, E.D. Tennessee, Knoxville (February 2, 2026) Plaintiffs are health insurance providers and claim administrators who process and pay approximately one million claims daily, relying on automated adjudication and truthful information from providers.
FACTUAL BACKGROUND
Defendants, including Team Health Holdings, Inc., Ameriteam Services, LLC,...
Pro Se Plaintiff Exceeds Logic & Sense
Post number 5281
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In Gordon Clark v. Hanover Insurance Group, et al., No. 3:24-CV-348 (SVN), United States District Court, D. Connecticut (January 30, 2026) the USDC dealt with a series of claims brought by a person representing himself resulting from an auto accident.
FACTUAL BACKGROUND
Plaintiff Gordon Clark, proceeding pro se, sued Olga L. Orengo and her insurer, The Hanover Insurance Group, Inc., following a motor vehicle collision in Windsor, Connecticut on July 22, 2023. Clark alleged that, despite Orengo being at fault, Hanover and Orengo refused to accept liability and instead filed an insurance claim asserting Clark was responsible for the accident.
LEGAL ISSUES
Clark’s Second Amended Complaint (SAC) included claims for negligence, negligent infliction of emotional distress, and ...
You Get What You Pay For – Less Coverage Means Lower Premium
Post number 5275
Posted on January 30, 2026 by Barry Zalma
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When Experts for Both Sides Agree That Two Causes Concur to Cause a Wall to Collapse Exclusion Applies
In Lido Hospitality, Inc. v. AIX Specialty Insurance Company, No. 1-24-1465, 2026 IL App (1st) 241465-U, Court of Appeals of Illinois (January 27, 2026) resolved the effect of an anti-concurrent cause exclusion to a loss with more than one cause.
Facts and Background
Lido Hospitality, Inc. operates the Lido Motel in Franklin Park, Illinois. In November 2020, a windstorm caused one of the motel’s brick veneer walls to collapse. At the time, Lido was insured under a policy issued by AIX Specialty Insurance Company which provided coverage for windstorm damage. However, the policy contained an exclusion for any loss or damage directly or indirectly resulting from ...
Declaratory Relief Available to an Insurer from USDC
Post number 5274
Read the full article at https://www.linkedin.com/pulse/resolution-coverage-issues-appropriate-under-federal-barry-wfpoc, see the video at and at and at https://zalma.com/blog plus more than 5250 posts.
Insurer Seeks Limitation of Liability of Child Killed by Foster Dogs
In the Cincinnati Specialty Underwriters Insurance Company, an Ohio corporation v. Dennis Murphy, as Personal Representative of the Wrongful Death Estate of Avery Colin Jackson-Dunphy, Deceased; Patrick Admiral Dunphy, an Individual; Danika Thompson, an Individual; and Animal Services Center Of The Messila Valley, a New Mexico limited Liability Company, No. CIV 24-1039 JB/JFR, United States District Court, D. New Mexico (January 23, 2026) resolved the issues raised about the court's jurisdiction.
Cincinnati Specialty Underwriters Insurance Company ...
Posted on January 26, 2026 by Barry Zalma
Insurance Fraud Should Not be a Retirement Plan
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Health Insurance Providers Are Attempting Insurance Fraud to Fund Retirement
Every insurer is required by its shareholders, members, state statutes and state regulations to do everything possible to deter and defeat attempts at insurance fraud. Most insurers, therefore, have a staff of fraud investigators working under their Special Investigative Unit (SIU) and the SIU works to train the claims handlers to recognize the indicators or red flags of fraud.
Much to the surprise of...
