The Life Of An Insurance Adjuster: A Day In The Shoes Of Dad

An insurance adjuster, also known as a claims adjuster, is responsible for handling and investigating insurance claims. They determine whether an insurance company must pay a claim and if so, how much. This involves investigating the incident that led to the claim, examining the physical damages, calculating a payout, and settling the claim.

There are three main types of insurance claims adjusters: public adjusters, independent adjusters, and staff adjusters. Public adjusters work for the claimant and advocate for them to ensure they receive what they are entitled to. Independent adjusters represent the insurance carrier as a third-party consultant and are often brought in if the insurance company is overloaded with claims. Staff adjusters work exclusively for one insurance company and often work on one line of insurance.

The role of an insurance adjuster can be complex and stressful, especially during difficult times such as natural disasters. They need to have strong investigative and negotiating skills, as well as empathy and good listening skills.

Insurance adjusters investigate claims to determine if the insurer should pay for damage or injuries

An insurance adjuster, also known as a claims adjuster, investigates insurance claims to determine whether the insurer should pay for damage or injuries, and if so, how much. They are responsible for handling and investigating insurance claims and settling them.

There are three main types of insurance claims adjusters: public adjusters, independent adjusters, and staff adjusters. Public adjusters work directly for the claimant (the policyholder making the claim) and advocate for them to ensure they receive what they are entitled to within their policy. They are paid a percentage of the settled claim, typically 10-20% of the total payout. Independent adjusters, on the other hand, represent the insurance carrier as a third-party consultant and are hired if the insurance company is overloaded with claims or dealing with a specialised claim. Staff adjusters (also called company adjusters) work exclusively for one insurance company and often work on one line of insurance. Both independent and staff adjusters are responsible for ensuring that the insurance company does not give a claimant too much money.

The process of investigating insurance claims is similar to other types of investigations. It involves gathering documentation, interviewing witnesses, taking statements, inspecting the accident scene, and conducting surveillance. Once a claim is filed, a claims adjuster is assigned to the case and they review the claim details and the insurance policy. They then interview those involved, including drivers, passengers, and witnesses, and review any relevant reports, video footage, or other information related to the loss. If the damage is covered, the adjuster will go over the claimant's options with them, which may include repairs or an inspection to determine repair costs.

Adjusters are tasked with settling insurance claims, which involves reviewing the incident, inspecting the damage, calculating a payout, and resolving the claim. They determine whether the insurance policy covers the loss claimed, how much the insurance company should pay, and whether claims are fraudulent. Adjusters may consult with other professionals, such as accountants, architects, construction workers, engineers, lawyers, and physicians, to obtain a more expert evaluation of a claim. They gather information, including photographs and statements, and put together a report for claims examiners to review. When the examiner approves the claim, the adjuster negotiates with the policyholder and settles the claim.

They assess many types of claims, including those resulting from car accidents

An insurance adjuster, also known as a claims adjuster, is a person who investigates an insurance claim to determine whether the insurer should pay for damage or injuries, and if so, how much they should pay. They assess many types of claims, including those resulting from car accidents.

The claims adjusting process

When an insurance claim is filed, a claims adjuster is called in to take over the process. They gather information and details to establish what happened in the incident and find a fair settlement price.

Claims adjusters take the following steps when investigating a car insurance claim:

• Review claim details and policy: The adjuster assigned to the claim will first review the details of the accident/loss submitted with the claim. They will also review the policy to determine which coverages may apply to the claim.
• Interview those involved: The adjuster will collect recorded statements from people involved in the loss, such as drivers, passengers, and witnesses. They may also review the scene of the accident, police reports, or video footage of the loss, along with any other relevant information.
• Go over options with the claimant: If the adjuster determines that the damage is covered, they will discuss the available options with the claimant. Typically, the claimant can decide to move forward with repairs or get an inspection first to determine the repair costs. For an inspection, the adjuster will coordinate the inspection of the vehicle and write up a repair estimate.

Types of insurance claims

There are three main types of insurance claims adjusters: public adjusters, independent adjusters, and staff adjusters.

• Public adjusters work for the claimant (the policyholder making the claim) and advocate for them to ensure they receive what they are entitled to within their policy. They are paid a percentage of the settled claim, usually 10% to 20% of the total payout.
• Independent adjusters represent the insurance carrier as a third-party consultant. They are often brought in if the insurance company is overloaded with claims or dealing with a specialized claim. They are sometimes called "catastrophe claims adjusters" as they are the ones on the ground after major weather events and emergencies.
• Staff adjusters (also called company adjusters) work exclusively for one insurance company and are usually salaried employees. They often work on one line of insurance, such as condo claim adjusting or auto claim adjusting.

Benefits of being a claims adjuster

Being an insurance claims adjuster has several benefits. The median annual salary for an insurance claims adjuster is around $65,000, and adjusters can earn more as they gain experience. The role also offers job security as people will always need insurance and will always experience losses. Additionally, insurance claims adjusters get to help people in times of crisis, ensuring they are fairly compensated so they can recover and move forward.

They interview those involved, including witnesses, and review the scene of the incident

Interviewing those involved in an incident, including witnesses, and reviewing the scene are crucial steps in an insurance adjuster's investigation process. This allows them to gather firsthand information and create a clear picture of what happened. Here's a detailed breakdown of these steps:

Interviewing Those Involved and Witnesses:

• Obtaining Recorded Statements: Insurance adjusters collect recorded statements from individuals involved in the incident, such as drivers, passengers, and witnesses. They ask open-ended questions to gain a comprehensive understanding of the incident from different perspectives.
• Fact-Finding and Clarity: During these interviews, adjusters seek to clarify the facts and details surrounding the incident. They ask about what happened, where it occurred, the vehicles involved, and the identities of those involved. This helps them piece together the sequence of events.
• Separating Emotions: When dealing with upset individuals, adjusters maintain a calm and empathetic demeanour. They focus on answering questions, explaining decisions, and keeping communication channels open.
• Handling Disputes: In cases of disputes or conflicting testimonies, adjusters carefully consider all information. They may re-evaluate their findings or consult additional sources to make informed decisions.

Reviewing the Scene of the Incident:

• Physical Inspection: Insurance adjusters may visit the scene of the incident, especially if fault is unclear or the accident is severe. They examine the location to better understand how the incident occurred and to gather any additional evidence or insights.
• Gathering Evidence: During their visit, adjusters take photographs, videos, and notes about the scene. They compare these with statements and official records to identify any discrepancies or important details that may impact the claim.
• Recreating the Incident: By reviewing the scene, adjusters can better visualise what took place. This helps them in their investigation, allowing them to form a more accurate understanding of the incident and make more informed decisions.

These steps enable insurance adjusters to thoroughly investigate claims, determine liability, and calculate appropriate compensation. Their work is essential in ensuring fair settlements for all parties involved while also preventing insurance fraud.

They work with the claimant to get their vehicle inspected or set up repairs

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. They work for the insurance company paying the claim and are the people claimants will deal with most often.

When it comes to vehicle damage, the adjuster will first review the details of the accident and the claimant's policy to determine which coverages may apply. They will then interview those involved, including the claimant, other drivers, and witnesses, and review police reports, photos, and other documents to understand the circumstances of the accident and determine fault.

The adjuster will then work with the claimant to get their vehicle inspected or set up repairs. They may visually inspect the vehicle themselves to assess the damage and ensure it matches the accident description and report. They will also check for any pre-existing damage to the vehicle that should be excluded from the claim. The adjuster will take pictures of the vehicle, including the license plate, VIN number, and odometer reading. They will then use this information to compile a detailed estimate of the repair costs.

If the adjuster determines that the damage is covered, they will present the claimant with options. The claimant can choose to move forward with repairs or get an inspection first to determine the repair costs. If the claimant chooses to get an inspection first, the adjuster will coordinate this and write up a repair estimate. The claimant can then decide to have the adjuster set up the repairs or take the claim payout and set up the repairs themselves.

It is important to note that the adjuster works for the insurance company and has the company's best interests at heart. Claimants should be vigilant regarding their claim to ensure their settlement meets their needs.

They calculate a payout and settle the claim

An insurance adjuster is an employee of an insurance company who investigates what happened during an accident and calculates the claim's worth. They consider factors such as actual expenses, lost income, and pain and suffering when determining the claim value. The adjuster works for the insurance company and aims to keep any payout as low as possible to increase the company's profitability.

Investigation and Documentation

Insurance adjusters investigate the accident or incident by gathering evidence, reviewing reports, and interviewing witnesses. They also request documentation related to the claim, such as medical bills, proof of earnings, tax returns, and property damage estimates. A thorough investigation helps them understand the facts of the case and assess the validity of the claim.

Evaluating the Claimant

In personal injury cases, insurance adjusters review the claimant's background and claims history. They may conduct a background check and hire investigators to ensure the legitimacy of the claim. This includes verifying that the claimant's injuries align with their claimed limitations and are not contradicted by their activities.

Determining Settlement Value

When determining the settlement value, insurance adjusters consider the claimant's potential for winning a personal injury lawsuit and the potential jury award. They assess damages capable of exact calculation, such as medical bills and lost earnings, and those not capable of exact calculation, such as pain and suffering. Adjusters may use specialised software to assign a value to pain and suffering claims.

Initial Settlement Offer

After evaluating the claim, the insurance adjuster will make an initial settlement offer, which is typically a percentage of what they believe is the final value of the case. This offer may be lower if the claimant is unrepresented by a lawyer. It is important to remember that the initial payment is usually not final, and claimants can reopen the claim if they discover additional damage.

Multiple Checks and Payments

In cases where both the structure of a home and personal belongings are damaged, claimants may receive multiple checks from the insurance company. These checks may be for separate categories of damage, additional living expenses (ALE), or flood insurance if applicable. The insurance company may also pay the contractor directly if requested by the claimant.

Lender or Management Company Involvement

If the claimant has a mortgage on their house, the insurance payment for repairs is typically made out to both the claimant and the mortgage lender. Lenders usually require this as a condition of granting a mortgage to ensure they have a financial interest in the property. Similarly, in the case of cooperatives or condominiums, the management company may require being named as co-insured.

Replacement Value vs. Actual Cash Value

When it comes to personal belongings, insurance companies typically calculate the initial payment based on the actual cash value of the items, considering their age and depreciation. To receive the replacement value for items, claimants must purchase replacements and provide proof of purchase. The insurance company will then pay the difference between the initial cash value and the cost of replacement.

Frequently asked questions