Insurance Claims Expert Witness Found Qualified to Testify

In Lucas v. Texas International Life Insurance Company the U.S. District Court for the Eastern District of Oklahoma has ruled that an insurance claims expert witness is qualified to testify on claims under a cancer/dread disease policy or standards for bad faith in Oklahoma.  The court reasoned:

Defendant has also objected to the testimony of Mr. Jim Schratz arguing he does not have sufficient credentials or background to offer an expert opinion on claims under a cancer/dread disease policy or standards for bad faith in Oklahoma. Defendant argues his background is in reviewing attorney fee bills and unrelated claims opinions. Defendant contends he does not appear to have any medical insurance claims handling expertise in Oklahoma. Defendant also objects to his testimony stating that his reliance on other expert opinions make his opinion unreliable. Further, defendant argues Mr. Schratz has not reviewed all necessary evidence to render opinions in this case.[fn1]

Mr. Schratz was the Vice-President of Major Claims for the Fireman’s Fund Insurance Company from July 1990 to December 31, 1993. In this job, he was responsible for case management of all cases throughout the world with a potential exposure of $3 million or more. While in this position he dealt closely with claims handling and the claims department of Fireman’s Fund. While there, he also supervised litigation against Fireman’s Fund. He reviewed hundreds of claims files from across the country to evaluate on behalf of Fireman’s Fund whether those claims had been properly investigated or met or exceeded industry standards. In fact, Mr. Schratz had a long career of working internally for Fireman’s Fund. Now, Mr. Schratz does expert work where seventy to eighty percent of his work is devoted to claims handling practices.

Defendant has objected to Mr. Schratz testimony stating that he has no experience reviewing medical claims specifically cancer/dread disease policies. Mr. Schratz testified claims handling policies are the same regardless of the line of insurance. Mr. Schratz testified at the hearing that no matter what line of insurance all claims handling standards are the same. Defendant has offered no evidence to refute this testimony. Mr. Schratz will testify to an insider’s view of what it is like to process a claim and how the process should work based on his opinion.

The court finds Mr. Schratz is qualified to testify to claims handling issues based on his knowledge, skill, training and education. Mr. Schratz has extensive experience working with a major insurance carrier in all areas of claims handling. He has also worked extensively in this area as an expert witness. Accordingly, the court overrules the defendant’s objection to his testimony. At 5-7


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