Claims Adjusters: Roles, Duties and Interests

It's a good to have some familiarity with what a claims adjuster does, how your loss is assessed and whose interests are represented. You'll be prepared to recover if you have a business or personal loss no matter what damage was done to your property.

Who Are Claims Adjusters?

Claims adjusters can be employed by insurance companies, or may be independent and can contract with insurers to provide services. A claims adjuster wears many hats; he has the duty, in good faith, to investigate and resolve claims for the insurer. This good faith duty applies no matter if you're making a claim under your insurance policy, or someone else's, such as the general liability policy of the contractor who caused your loss.

This involves interpreting the policy, investigating and a loss and deciding if the policy covers the loss and the amount to pay. Negotiation skills are vital.

Starting the Claims Process

A loss notice is the usual first step - this is the document reporting a loss. It's familiar step - when your car or property is damaged or stolen the first call is often to your insurance company or agent.

The loss notice gives the adjuster a wealth of basic information so the claim investigation can begin. This includes:

  • Loss details - time, date, location and loss types (property, bodily injury, etc.)
  • Insurance type
  • Contact information for claimants, insureds and their agents and attorneys
  • Witness information
  • Any special instructions for the investigation

Investigation and Claims Basic Steps

An adjuster's investigation covers many common-sense steps and stages. The adjuster conducts interviews of claimants, insureds and witnesses. Loss sites are visited, with documentation by photography and audiovisual recording.

Collecting and storing physical evidence may be needed, or finding out who has the evidence, the police for example. Records related to the loss, such as medical records, are gathered. Public authorities, such as the police or fire departments, may be contacted. The adjuster may consult with experts as part of an investigation

It's important to cooperate with a claims adjuster. It's fine to ask for copies of all investigation records, and request copies for your attorney. Not cooperating can slow down the claims process, and can raise suspicion about a claim's validity.

Finalize the Claim

Once claim is authorized, the adjuster makes payment promptly. The amount may reflect items such as deductibles or liens against property that must be paid.

If a claimant has an attorney, the attorney's name is noted on the check. Before a check is delivered, there is a general release to sign. The release acknowledges the payment, unless there's an alternate agreement with the insurer.

A release may also cover dismissal of existing lawsuits over the claim's subject, and prevent further lawsuits. Be sure to understand the meaning of the release before signing.

Questions for Your Attorney

  • If I suffered a loss due to someone else's action, can I use an independent claims adjuster to protect my interests as a claimant? Do you use independent adjusters?
  • I have a property damage loss due to someone else's actions, and they're insured. If you represent me, how will you protect my interests during the claim and settlement process?
  • I have a third-party claim for property damage and I disagree with the insured's claims adjuster. Can you help negotiate a settlement?
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