Unseen Damage: Auto Insurance Adjusters And The Hunt For Hidden Structural Issues

If you've been in a car accident, you'll need to file a claim with your insurance company. An insurance adjuster will then be assigned to your case and will ask you for information about the accident, including any relevant reports, photos, and medical records. They may also contact the other driver and any witnesses, and they may visit the scene of the accident. The adjuster will then inspect your vehicle to estimate the extent of the damage and decide whether it's worth paying for repairs. If the repairs are more than 70% of the car's actual cash value, the car will likely be declared a total loss. The adjuster will then determine the amount the insurance company should pay, and you'll be offered a settlement. It's important to note that adjusters work for the insurance company and may try to convince you to accept less money than your claim is worth. To ensure a fair settlement, you can document the damage yourself, get repair estimates from multiple auto body shops, and stay with the adjuster during their assessment to point out any damage they miss.

The adjuster will check for signs of fraud or intentional damage

An auto insurance adjuster will check for signs of fraud or intentional damage. This is because insurance companies are for-profit businesses, and their goal is to make money, not pay out more money than they need to. The adjuster will inspect the damage to verify that it is legitimate. They will check for signs of wear and tear, fraud, or deliberate damage, for example. The insurer might also check for other damage around the property.

There are several warning signs that fraud is being perpetrated. These include people who suddenly appear at an accident scene and try to direct you to specific doctors and attorneys—these so-called “runners” are usually part of the criminal scheme as well. Another sign is physicians who insist you file a personal injury claim after an accident, especially if you are not hurt. Tow trucks that arrive on the scene without anyone having called them are another warning sign. These tow trucks might be working in concert with unscrupulous medical or legal providers.

Fraudulent automobile accidents occur more frequently in urban areas, where there is a greater number of vehicles, and in wealthier communities because drivers are perceived to have better insurance coverage. Criminals often target new, rental, or commercial vehicles because they are typically well insured. Furthermore, criminals tend to prey on women driving alone and senior citizens since they are perceived to cause fewer problems and are less likely to be confrontational at accident scenes.

There are two distinct categories of fraud: soft fraud and hard fraud. Soft fraud is the more common form and is associated with less severe consequences, like fines and legal fees. Examples include exaggerating a legitimate claim or lying during the application process to get a lower rate. Hard fraud is less common and leads to more severe punishment, including jail time. Examples include planning or inventing a loss for claim payout, such as staged auto accidents or theft.

Insurance adjusters have specific guidelines and resources to help them determine whether damage is the result of fraud or intentional damage. They will consider the vehicle’s age, make, model, mileage, condition, prior damage, and market value. They may also take into account regional pricing trends and the availability of similar vehicles in the market. By assessing these factors, adjusters can derive a fair value for the vehicle and determine whether the damage is legitimate.

They will inspect the damage to verify its legitimacy

An insurance adjuster is an insurance professional who investigates claims and determines how much an insurance company should pay. They will be your contact throughout the claim process. The amount of contact you have with the adjuster will depend on the claim; for a minor claim, you may only speak over the phone, while serious claims might involve more frequent and in-person contact.

When you report an accident to your insurance provider, it is standard practice for them to investigate the loss. This is to ensure that the policy covers the reported loss and to determine who is owed and how much they should be paid.

The adjuster will inspect the damage to verify its legitimacy. They will look for signs of wear and tear, fraud, or deliberate damage, for example. They will also check for other damage around the property. Based on the damage and the limits of your policy, the adjuster will decide on your payout.

The adjuster will conduct a full inspection of the damaged property and items. They will verify that the damage is legitimate and occurred during the incident in question, rather than being pre-existing damage. They will also ask for a list or inventory of damaged items, as well as any relevant receipts.

The adjuster will also check for structural damage on and around your property. They will look for structural damage to your home, pool, garage, shed, and any other buildings.

The adjuster will determine the repair estimate

If the cost of repairs exceeds 70% of the ACV, the car will likely be declared a total loss. In this case, the insurance company will pay the ACV of the car rather than the cost of repairs.

The adjuster's goal is to analyse the damage, determine a fair repair estimate, and pay out the minimum amount required by the insurance policy. It is important to remember that insurance companies are for-profit businesses and will aim to minimise their payouts.

To ensure a fair assessment, it is recommended to obtain multiple repair estimates from independent auto shops. This will help verify the accuracy of the adjuster's estimate and prevent low-ball offers from insurance companies.

Additionally, it is essential to document all conversations and interactions with the adjuster. Keeping a detailed record of communications can be crucial in case of disputes or delays in the claim process.

They will decide on the insurance payout

An insurance adjuster, also known as a claims adjuster, is a person who investigates an insurance claim to determine if the insurer should pay for damage or injuries, and if so, how much they should pay.

Reviewing Claim Details and Policies

The adjuster assigned to a claim will first review the details of the accident or loss submitted with the claim. They will also review the claimant's policy to determine which coverages may apply to the claim. This step helps them understand the extent of the damage and whether it is covered by the insurance policy.

Interviewing Involved Parties

The adjuster will collect statements from people involved in the incident, such as drivers, passengers, and witnesses. They may also review the scene of the accident, police reports, video footage, and other relevant information. This step allows them to gather different perspectives and evidence to make an informed decision.

Assessing Damage and Repairs

If the adjuster determines that the damage is covered, they will discuss options with the claimant. The claimant can choose to move forward with repairs or get an inspection to estimate repair costs first. The adjuster will coordinate the inspection and create a repair estimate. This step helps in deciding whether the vehicle can be repaired or needs to be declared a total loss.

Calculating Payout Amount

If the vehicle is repairable, the adjuster will help set up repairs. If the vehicle is totaled, the insurer will pay the claimant the actual cash value of the vehicle, minus any deductible. The actual cash value is based on the car's fair market value, make, model, year, pre-loss condition, mileage, and sales value of similar cars in the region.

Negotiating the Settlement

The claimant can negotiate the initial claim amount proposed by the insurance company to get a higher claim payout. The claimant can provide additional features of the car, estimated retail value, and comparable sales data to support their case. The adjuster will consider this information and make the final decision on the settlement amount.

The adjuster will inspect the damage to the vehicle

The adjuster will look for signs of wear and tear, fraud, or deliberate damage. They will also check for other damage around the property, including structural damage to the home, pool, garage, shed, and any other buildings. They will also review police reports, speak to witnesses, and talk to property owners.

Based on their inspection, the adjuster will then determine the amount of the insurance company's potential liability to its insured. They will use a computer program to determine the cost of fixing any accident-related damage, providing an estimate for repairs. If there are any questions about the damage or repairs, they may consult a mechanic or auto body repair expert.

The adjuster's goal is to analyze the property damage, determine a repair estimate, and pay the amount legally required for the insurance claim, based on the insurance policy. It is important to remember that adjusters work for the insurance company and are not there to represent the interests of the claimant.

Frequently asked questions