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The Role of an Insurance Adjuster

August 11, 2013 Posted By Vanguard Attorneys

An insurance adjuster, also referred to as a claims adjuster, typically represents the insurance company. Claims adjusters apply their knowledge and training to determine whether a party claiming a loss is owed payment under the terms of an insurance policy, and what that payment should be.

Adjusters are used for all types of losses, including property damage and bodily injury. The majority of insurance adjusters work directly for major insurance companies. Other adjusters may work as independent contractors who represent claimants.

The Specific Duties of an Insurance Adjuster

A claims adjuster’s job begins once a claim is filed against an insurance policy. The adjuster’s responsibilities often play out as follows:

  1. After verifying that insurance coverage applies to the loss, the adjuster notifies the insurer of a covered loss under policy terms.
  2. Claims evaluation must begin in a timely manner. Most insurance companies require that claims evaluations be initiated within mandatory timeframes, depending on the type of loss involved.
  3. The adjuster files any necessary paperwork, communicates with the claimant, and investigates the assignment of liability. For example, in a case of a rear-end collision, the claimant who was struck from behind will likely hold 0% liability.
  4. Damages are physically inspected and assessed. An adjuster may travel to a repair shop to inspect a damaged vehicle, or to a hospital to verify medical records and patient information (in cases of bodily injury claims).
  5. The adjuster then researches market values and average replacement costs associated with each aspect of the claim to account for property damage, loss of personal items, or any extra expenses claimed as a result of the loss.
  6. A detailed damages report is then provided by the adjuster to the insurance company.
  7. An adjuster may also simultaneously negotiate with vendors or repair shops on cost and time needed for repair/replacement in order to coincide with a settlement offer for the claimant.
  8. If the claimant disagrees with a settlement offer, an adjuster may go back to reassess any new information or evidence that could substantiate a change to the offer.
  9. At all times, the adjuster is responsible for protecting the interest of the insurance company. An adjuster’s main focus is to prevent an overpayment or any payment on an exaggerated or otherwise illegitimate claim.

Three Types of Claims Adjusters

Corporate/Traditional Claims Adjusters: Typically employed by a single insurance company. These adjusters may focus on handling only property damage claims (buildings, vehicles) or liability claims (personal injury, third-party). Adjusters may also handle multiple areas of claims; they are known as “Multi-Line” or “All-Lines” adjusters.

Public Adjusters: They represent policyholders, or the individual filing the claim. Personal injury attorneys may hire a public adjuster to provide an objective evaluation of an injury claim as a safeguard against a low-ball settlement offer from the opposing insurance company. A public adjuster can also be called upon to present industry-recognized findings on behalf of the claimant in cases of litigation.

Independent Adjusters: These individuals work as consultants or contractors, and they may service multiple insurance companies. They are often brought in to supplement large field claim efforts, including times following large natural disasters like hurricanes or flooding. State licensed independent adjusters tend to be revered within the industry as high-level loss experts in their preferred line of adjustment.

Categories: Personal Injury
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