Becoming an insurance claims adjuster is a complex job that is frequently overlooked as a career in the insurance industry.
Insurance claims adjusters play an important role in the insurance industry, and the demand for adjusters has remained consistent over time as natural disasters and accidents occur on a daily basis.
Furthermore, knowing who insurance adjusters are and how they work can help find answers to the query “What does an insurance adjuster do” and also remove some of the mystery from the insurance injury claim process.
What is an Insurance Adjuster?
Insurance claims adjusters have various job titles, such as claims specialist, claims representative, and independent claims analyst, but they all do the same type of work.
The adjuster handles the resulting claim when an accident or other incident triggers insurance coverage.
Following a car accident, for example, an injured passenger may file an injury claim with the at-fault driver’s auto insurance company under the driver’s liability insurance coverage.
In that case, the injured passenger’s claim will be handled by an insurance adjuster for the driver’s car insurance company.
Types of Insurance Claims Adjusters
There are a few different kinds of insurance claims adjusters, and each would influence what the day-to-day work is like.
Company or Staff Adjuster
A Company or Staff adjuster works solely for one insurance adjuster firm.
In general, these jobs entail being salaried and receiving benefits from the company, such as a pension, life and health insurance, and continuing education training.
Company and staff adjusters handle claims for the same insurance company. These are frequently home and personal auto claims.
Independent adjusters work as independent contractors for various top insurance companies or third-party administrators. They frequently work with disaster claims and will travel to the affected areas following major weather events or emergencies.
Independent adjusters are also known as “catastrophe claims adjusters” because they are on the ground following major weather events and emergencies.
Public insurance adjusters represent policyholders directly. They assist businesses and individuals in filing insurance claims when a proposed settlement from an insurer appears unsuitable. Public adjusters are typically contract employees rather than salaried employees.
What Does an Insurance Adjuster Do?
When a passenger files a claim with the at-fault driver’s car insurance company, the adjuster will assign a claim number and gather some basic information such as the date of the incident and the claimant’s name, among other things.
The adjuster will also request permission from the claimant to obtain accident-related medical records.
At this moment, the adjuster will:
- Investigate the accident and how it occurred, including a review of any police reports.
- Examine the claimant’s medical records, income documentation, and other evidence of accident-related losses (“damages” in legal parlance).
- Assign a monetary value to the claimant’s damages, and manage the personal injury claim settlement negotiation process with the claimant (or the claimant’s attorney).
The insurance adjuster’s primary role is to resolve claims on behalf of the insurance company (always in service to the company’s bottom line).
That can include denying a claim or refusing to pay the claimant anything at all. However, most of the time, it means negotiating a settlement of the claim.
How Adjusters Settle Claims
Adjusters are in charge of “settling” insurance claims, which means they look over the incident and decide how much money the policyholder should receive. Here’s an overview of how they handle claims:
- Investigate the claim: The adjuster looks into the incident that led to the claim to see if it is covered and who was at fault.
- Examine the damage: The physical damages are examined by the adjuster. Depending on the circumstances, a field adjuster may inspect a home or vehicle in person to determine the extent of the damage.
- Determine a payout: The adjuster will then calculate how much it might cost to compensate the policyholder based on the evidence.
- Resolve the claim: The adjuster’s final step is to settle the claim based on the claimant’s insurance policy and the insurance company’s legal obligations. The settlement is delivered to the policyholder, and the claim is closed.
How to Communicate with an Insurance Adjuster
For filing an insurance claim, many insurance companies have an app or an online portal. Once the claim is filed, you may find yourself communicating with the adjuster primarily via email.
This is usually beneficial for everyone because there will be a written record of all correspondence and less of the on-the-spot anxiety that a phone call might cause.
Of course, you should always be cautious about what you say (or write) to an adjuster, especially when it comes to:
- How the accident occurred: Never provide information that suggests you were even partially to blame for the accident that resulted in your claim.
- The level of your injuries: Even if your injuries appear to be minor, don’t assume you’re completely healed. You should emphasize that you are taking a “wait and see” approach.
What if You Disagree With the Adjuster’s Settlement Offer?
If the adjuster’s settlement offer is unreasonably low, it could be a negotiating tactic or an attempt to determine whether you understand the true value of your claim.
At this point, it may be prudent to draft a formal personal injury demand letter that includes:
- the specifics of the accident and why the adjuster’s insured is at fault
- a detailed account of your injuries (including a diagnosis)
- a synopsis of your accident-related medical care
- a narrative relating how the accident and your injuries have affected your life (part of the “pain and suffering” component of your claim, and a counteroffer to settle your injury claim.
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To Wrap Up
We hope this article has been instrumental to your research on the duties of an insurance adjuster. Don’t forget to share with your friends and loved ones.