In-House Insurance Adjusters: Walking The Legal Tightrope

An insurance adjuster is a professional who assesses and determines the extent of damage or loss covered by an insurance policy. They are responsible for investigating insurance claims and facilitating the claims process. While most adjusters are employed or contracted by insurance companies, homeowners can also hire public adjusters to advocate for their interests. In-house insurance adjusters, also known as company adjusters, are salaried employees of the insurance company and primarily focus on evaluating claims and calculating the lowest possible compensation on the insurer's behalf.

Although in-house insurance adjusters do not practice law, they play a crucial role in the insurance claims process by inspecting properties, evaluating damage, and determining the appropriate compensation. Their job involves understanding the intricacies of insurance policies, assessing damage, and making calculations to determine the financial responsibility of the insurance company. While they do not provide legal advice or representation, their decisions can have legal implications for the insurance company and the policyholder.

It is important to note that in-house insurance adjusters represent the interests of the insurance company and aim to protect their employer's bottom line. Policyholders can hire public adjusters or seek legal advice if they believe the insurance company is acting in bad faith or if they need assistance in negotiating a fair settlement.

In-house insurance adjusters are hired by insurance companies to assess damage and loss

The role of the adjuster is to inspect the property, evaluate the damage, and calculate the appropriate compensation or settlement that the insurance company should provide. They may use specialised software to do this, such as Xactimate, which analyses damages and provides an estimate.

The adjuster's findings will determine the compensation the policyholder receives. It is important to note that the adjuster does not advocate for the policyholder; they are paid to calculate the lowest possible compensation on the insurer's behalf.

Homeowners can also hire their own public adjuster to provide a second opinion or negotiate with the insurance company on their behalf.

They evaluate insurance claims and calculate compensation for policyholders

An insurance claim is a formal request by a policyholder to an insurance company for coverage or compensation for a covered loss or policy event. The insurance company validates the claim (or denies the claim). If it is approved, the insurance company will issue payment to the insured or an approved interested party on behalf of the insured.

The process of evaluating insurance claims and calculating compensation for policyholders typically involves the following steps:

Step 1: Claim Reporting

The policyholder initiates the claim process by contacting their insurance provider and providing relevant information about the incident. This can be done through various channels, such as online portals, phone calls, emails, or in-person visits to the insurance company's branch or office.

Step 2: Claim Processing

Once the claim is reported, a claims adjuster or specialist from the insurance company will assess the claim. They may request additional documentation or information from the policyholder to support their claim. The adjuster will investigate and evaluate the claim based on the terms and conditions of the insurance policy.

Step 3: Claim Settlement

After reviewing all the relevant information and completing the necessary assessments, the insurance company will make a decision on the claim. If the claim is approved, the adjuster will calculate the compensation amount based on the policy coverage and the extent of the loss. The insurance company will then issue the payment to the policyholder or the approved interested party.

It's important to note that insurance companies may have their own specific procedures and requirements for claim processing, and the timeline for settlement can vary depending on the complexity of the claim.

In some cases, insurance companies may deny a claim if it is determined that the incident is not covered by the policy or if there are discrepancies in the information provided. Policyholders have the right to dispute or appeal denied claims, and it is recommended to carefully review the terms and conditions of their insurance policy to understand their rights and responsibilities in the claims process.

Overall, the process of evaluating insurance claims and calculating compensation aims to provide financial protection to policyholders during difficult times, ensuring that they receive the benefits they are entitled to under the terms of their insurance policy.

Adjusters do not represent the policyholder and are not legally obligated to act in their best interests

It is important to understand the role of adjusters in the insurance claims process. Adjusters do not represent the policyholder and are not legally obligated to act in their best interests. Instead, they work on behalf of the insurance company and are tasked with investigating and negotiating insurance claims. This means that their primary goal is to protect the interests of the insurance company and minimize payouts. As such, it is generally not advisable to speak to an adjuster from the "at-fault" party, as they may use your statements against you to reduce or deny your claim.

When dealing with insurance adjusters, it is essential to protect your rights. You are not legally obligated to speak to them, and you have the right to consult an attorney at any time during the insurance investigations. It is recommended to seek legal advice before accepting any offers or signing any documents. Remember that you are under no obligation to provide sensitive information, such as medical records, without a valid reason.

If you choose to speak with an adjuster, it is crucial to remain calm and polite. Provide only the necessary information, such as your contact details, and refrain from discussing the accident, your injuries, or insurance-related matters. Be cautious of any attempts to record the conversation, as this could be used against you. Always prioritize your own interests and seek legal representation if needed.

Policyholders can hire public adjusters to act on their behalf and negotiate with insurers

Public adjusters are often more thorough in their damage analysis than company adjusters. This is because of their training and because their loyalties lie with the policyholder, not the insurance company. They can save policyholders time and money by ensuring the insurance company pays the full amount it is responsible for, based on the policyholder's coverage.

Public adjusters can help with the following:

• Evaluating damages and estimating the cost and time needed to repair or replace property or structures.
• Helping policyholders understand their insurance policy, track the claim, file documents, and meet deadlines.
• Acting as a liaison between the policyholder, the insurer, and any other third parties such as attorneys or witnesses.
• Negotiating with the insurance company to achieve a fair payout.

There are some circumstances in which hiring a public adjuster may be particularly beneficial:

• When filing a large claim for high-value, significant, or complex damage to property, such as fire damage.
• When the policyholder is not confident with the assessment performed by the insurer's adjuster.
• When the policyholder feels that the insurer's adjuster has underestimated their claim or that the payout is not fair.
• When the policyholder needs assistance with a complex claim or the claims process in general.

Public adjusters typically charge a percentage of the total claim payout, with fees ranging from 3% to 30% of the insurance settlement. However, they may also charge a flat or hourly rate. It is important to understand the fee structure before hiring a public adjuster.

Public adjusters are licensed professionals who charge a fee, typically a percentage of the final claim

Public adjusters are licensed professionals who help individuals with the often complex insurance claim process. They are trained insurance experts who work on behalf of policyholders to ensure their claim is settled in a fair and efficient manner. Unlike insurance company adjusters, public adjusters are independent and only advocate for the policyholder. They are not affiliated with the insurance company and are only there to benefit the policyholder.

Public adjusters will handle every detail of your case, from learning your policy scheme inside out to assessing the damage to your property and negotiating the highest legally possible payout for your claim. They will also help you understand your insurance policy, track the claim, file documents, and meet deadlines. They act as a liaison between you, the insurer, and any other third parties such as attorneys or witnesses.

Public adjusters charge a fee for their services, which is typically a percentage of the final claim payout. This fee can range from 3% to 30% of the total insurance settlement, depending on the size and complexity of the claim. The fee is usually negotiated and agreed upon before any work is undertaken, and it is added to the signed contract with the public adjuster. It is important to note that public adjuster fees are regulated at the state level, and there may be rules and restrictions on when, how much, and the methods allowed for their fees.

In addition to contingency fees, public adjusters may also charge a flat rate or an hourly rate for their services. A flat rate is typically charged for large and straightforward claims with clear outcomes. An hourly rate, while less common, depends on factors such as the state, the adjuster's experience, their operating costs, and the type of policy.

Public adjusters are a valuable resource for individuals struggling with the insurance claim process or those who feel they need assistance to get a fair payout. By hiring a public adjuster, policyholders can ensure they receive the full amount they are owed based on their coverage.

Frequently asked questions