Insurance Claims Adjusters

how do insurance adjusters work

Who? What? Insurance Claims Adjuster? Too few people outside of the insurance industry understand what an insurance claims adjuster does. The insurance jargon discourages the average person from reading their policy. All of us outside of the insurance industry find insurance policies difficult to read and understand.

Our friends at the insurance companies may have more in-depth definitions of claims adjusters but we will focus on explanations that the average purchaser of insurance can comprehend.

We purchase insurance to protect against monetary losses. We usually do not look at the policy until a loss has occurred and we need to confirm our coverage to file a claim.

Let's start by defining an insurance claims adjuster and what he/she does. We will limit our discussion to property and casualty insurance coverage.

What is an Insurance Claims Adjuster?

The main role of the insurance claims adjuster is to investigate claims, negotiate settlements and authorize payments to claimants on behalf of insurance companies. They may be employees of an insurance company or work for an independent claims adjuster company.

Adjusters, appraisers, examiners, and investigators deal with claims. They work primarily for property and casualty insurance companies and handle a wide variety of claims including property damage, liability and bodily injury.

The adjuster determines liability by inspecting the loss, interviewing claimants and witnesses, reviewing police accident reports and looking at hospital records.

Some large insurance companies provide central claims offices and have specialized claims adjusters. The adjusters are grouped together according to their specialty.

Single vehicle accidents or hail damages to roofs require little investigation and are usually handled from a centralized claims office. Even multiple vehicle accidents with no injuries can be handled out of a centralized office.

Insurance Adjuster investigates the claim and determines the cost of the loss.

The property adjuster inspects the damage of vehicles involved in accidents. In a homeowner's property claim, he will inspect the damage to the home.

The insurance adjuster gets to the loss as soon as possible because damages need to be assessed quickly. In many cases, the insured's loss has forced the homeowner from their home or a vehicle accident has left the owner without a vehicle to drive.

Even though many claims are straight forward, i.e. hail damage to a roof, the need for a responsible person to make judgments is required in more complex claims. A hail damage claim is settled by determining that the storm event caused the damage and preparing an estimate of the cost to repair or replace the roof.

Vehicle accidents involving several vehicles with injuries are usually assigned to the local office in the area where the accident occurred. Field investigators

or appraisers inspect the vehicles to determine the damage and the cost to repair the damage or replacement cost of the vehicle.

Also, a personal injury specialist handles injury claims. They investigate and gather necessary documentation to support the claimant's injury. They evaluate the injury and its severity, the necessary treatment, the length of treatment, and how the injury impacts the claimant.

An estimated range of cost is assigned to the claim. Insurance claims adjusters determine the exposure of the insurance company. An auto claims adjuster advises the insurance company of the approximate amount the insurance company will likely have to pay out. Usually another claims adjuster will have the responsibility of advising the insurance company of the cost of personal injury to the claimant.

3 Types of Insurance Claims Adjusters

 There are basically three types of insurance claims adjusters.

  • Staff Adjusters work directly for the insurance company as year-round employees. They are sometimes called claim representatives. The insurance company maintains a staff of adjusters located in regional offices around the country. They handle administrative duties such as gathering proof of loss, cost estimates, witness information, and payment of claims.
  • Independent Adjusters are independent contractors and are not employees of the insurance company. They are hired by the insurance companies on an as-needed bases and are paid per claim or sometimes per diem.
  • Public Adjusters work for independently owned companies that handle services exclusively for the insured. They investigate the extent of the damage, determine what repairs are needed, assist the insured in the required paperwork and work with the insurance company to reach a settlement on behalf of the insured. Should experts be needed to assess the damage, such as a traffic accident reconstruction engineer, an appraiser or a contractor, they will oversee and direct those activities to get the proper information to the insurance company. Probably the most important function of the public adjuster is helping the insured understand coverage specified in their insurance policy. They understand the insurance language and can explain it to the insured in plain English. An insurance policy contains provisions and stipulations as well as riders which are difficult to understand. The policyholder can get overwhelmed just trying to read the policy. The public adjuster will wade through the jargon and determine the coverage of the policy

The average consumer is probably unaware of the fact that the burden of proof is on the consumer and not the insurance company. Chances are that at most as an ordinary consumer, you may have only had one or two claims during your adult life whereas insurance companies do this every day. The advantage is to the insurance claims adjuster and the insurance company.


Category: Insurance

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