Understanding Insurance Adjusters: Whose Side Are They On?

When you file an insurance claim, you will typically work with a claims adjuster from the at-fault party's insurance company. However, it's important to remember that the adjuster works for the insurance company and is paid to calculate the lowest possible compensation on the insurer's behalf. They are not advocating for you. The adjuster's role involves reviewing what happened, estimating the claims payment, and determining the appropriate compensation. While most adjusters are employed or contracted by insurers, policyholders can also hire public adjusters to advocate for their interests. Public adjusters typically charge a percentage of the claim proceeds for their services. It is important to understand the role of the insurance adjuster and your options to ensure a smooth claims process.

The role of an insurance adjuster

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 responsible for reviewing what happened and estimating the claims payment.

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. Independent adjusters, on the other hand, represent the insurance carrier as a third-party consultant and are usually 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.

• Investigating the claim: The adjuster investigates the incident that led to the claim and determines if the claim is covered and who was at fault. They may inspect the property, review police reports, talk to witnesses, and ask for more information.
• Reviewing the damages: The adjuster examines the physical damages and assesses the extent of the damage. They may take pictures and make notes about the damage.
• Calculating a payout: Considering the evidence, the adjuster will then figure out how much it might cost to compensate the policyholder.
• Settling the claim: The adjuster resolves the claim based on the claimant's insurance policy and the insurance company's legal obligations. The policyholder receives the settlement, and the claim is closed.

It is important to note that adjusters work for the insurance company and aim to resolve claims as quickly and cheaply as possible. Therefore, it is recommended to hire an independent adjuster or a public adjuster who will advocate for your interests and help you get a fair settlement.

How to prepare for an insurance adjuster's visit

An insurance adjuster's job is to assess damage and determine a fair settlement. Here are some steps to prepare for an insurance adjuster's visit:

Document the damage

Take pictures of the damage and loss. Document the exact time and date of the incident and write down any other relevant details. If there was an illegal act, file a police report.

Collect documents

Gather witness statements and their contact information, photos or videos of the damage, and receipts or estimates for repairs or lost/damaged items.

Plan to be present during the visit

Although you don't have to be present for the visit, it's beneficial to be there to answer questions and ensure the adjuster doesn't overlook anything. Have some estimates ready to compare to the adjuster's findings.

Ask about next steps

Before the adjuster leaves, inquire about the expected timeline for receiving a response about your claim. Most states have a deadline for insurance companies to respond to claim filings.

Understand the adjuster's role

The adjuster works for the insurance company and their goal is to resolve claims as quickly and cheaply as possible. They are not advocating for you.

Be careful what you say

Avoid giving lots of details about the incident or taking blame. Be concise and don't offer information that might indicate partial fault. Focus on providing the facts and evidence.

Don't sign anything or give a recorded statement

Review any statements carefully before signing to ensure they are true and accurate. A recorded statement could impact your final insurance payout.

Don't settle for the first offer

Negotiate and make a counteroffer if the adjuster's initial settlement offer seems too low. Gather compelling evidence to support your claim. Remember that the adjuster also wants to settle the claim.

What to do after an insurance adjuster's visit

After an insurance adjuster's visit, there are several steps you can take to ensure your claim is processed smoothly. Here are some detailed instructions on what to do after an insurance adjuster's visit:

Submit Required Documents and Paperwork

The insurance adjuster may request additional documentation to support your claim. This could include receipts, repair estimates, medical records, or other relevant information. Provide this documentation promptly to avoid delays in the claim process.

Maintain Regular Communication

Keep an eye out for emails, phone calls, or other forms of communication from the insurance adjuster or the insurance company. Respond to their inquiries and stay in touch to show your engagement in the process.

Follow Up on the Claim Status

If you haven't heard back from the adjuster or the insurance company after a while, don't hesitate to follow up. Inquire about the status of your claim and whether they require any additional information from you.

Keep a Log of Interactions

Document all your interactions with the insurance adjuster. Note the dates, times, and key points discussed during meetings, phone calls, or emails. This will help you stay organised and refer back to important details if needed.

Understand Your Policy's Exclusions

Be aware of what your insurance policy covers and what it excludes. This is crucial when discussing your property damage with the adjuster. Misrepresenting the nature of the damage could inadvertently invalidate your coverage.

Consider Hiring a Public Adjuster

If you disagree with the insurance adjuster's assessment or feel that your claim is not being handled fairly, you may want to consult a public adjuster. A public adjuster works on your behalf and can help negotiate a higher settlement or resolve disputes. However, they typically charge a percentage of the claim payout as their fee.

Be Honest and Avoid Accepting Blame

When discussing your loss or damage, always be honest and refrain from making statements that suggest you are to blame for the incident. While honesty is essential, avoid providing recorded statements or signing documents without thoroughly reviewing and understanding their content.

Seek Legal Advice if Necessary

If you encounter significant issues with the insurance adjuster or feel that your rights are not being protected, consider seeking legal advice from an attorney or a lawyer. They can guide you through the process and ensure your interests are represented fairly.

The different types of insurance adjusters

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

Staff Adjuster

Staff adjusters work directly for insurance companies as full-time employees. They are usually hired as full-time employees that get standard employee benefits such as health insurance, paid holiday and vacation time, and sick leave. They handle claims only for the insurance company they work for, and usually work primarily on car accident cases.

Independent Adjuster

Independent adjusters are self-employed and work as contractors for multiple insurance companies. They are hired by insurance companies on a contract basis, but they are not direct employees of the insurance company. They are typically hired when there is a high demand and a limited number of staff, or when a specialized adjuster is needed. They often work with catastrophe claims and must travel to the area after a major weather event or emergency. They do similar work to staff adjusters, but on a freelance or contract basis, and handle claims from insurers who have no nearby office or adjuster, or who have too many claims to handle—often in the case of a natural disaster.

Public Adjuster

Public adjusters are hired by the claimant or policyholder, and work on their behalf to ensure they receive a fair settlement from the insurance company. They are usually self-employed and work as independent contractors, typically taking a percentage of the claim amount as a commission. They perform many of the same duties as company or independent adjusters, such as inspecting medical and police reports, examining damaged property, and reviewing the language of a policy. However, they do this with the objective of representing their client's interests. Most states require public adjusters to be licensed to ensure they operate honestly.

Tips for communicating with an insurance adjuster

When you file an insurance claim, you'll likely have to work with an insurance adjuster from your insurance company. The adjuster evaluates your property, collects evidence on the extent of the damage, and rules on your claim. Here are some tips for communicating with an insurance adjuster:

• Understand their role: The adjuster works for the insurance company paying the claim and will review what happened and estimate the claims payment. They are not advocating for you but calculating the lowest possible compensation on your insurer's behalf.
• Be present during the inspection: Try to be there when the adjuster inspects the damage to your property. Make sure they don't miss anything.
• Ask questions: Find out when you should expect the insurance company's offer and get the adjuster's contact information.
• Document and log conversations: Record and log all conversations with the adjuster. Take notes during conversations and ask for copies of any reports or statements made by the adjuster.
• Be honest: Always be honest about your loss. Making false statements will negatively affect your claim and may result in a lawsuit for insurance fraud.
• Understand your policy: Know what your policy covers and its exclusions to avoid having your claim denied.
• Avoid suggesting blame: While being honest, avoid statements that suggest you are to blame for the damage or loss.
• Don't give too many details: Avoid giving lots of details about the accident, your injuries, or your material damages. Wait for a proper medical diagnosis, as the adjuster will take it more seriously than a self-diagnosis.
• Don't sign anything or give a recorded statement: Don't sign any documents or give recorded statements until you've had a chance to review them and consult with a lawyer if necessary.
• Don't settle on the first offer: Negotiate and make a counteroffer if the adjuster's settlement offer is too low.
• Get legal help: Consult with a lawyer if you're unsure or uncomfortable with the process. A lawyer can guide you through the process and protect your interests.

Frequently asked questions