Insurance

Claims Adjusters: Roles, Duties and Interests

Reviewed by David Goguen, J.D., University of San Francisco School of Law
Your interaction with an insurance company will most likely be limited to contact with a "claims adjuster," so it's important to understand the critical role these individuals play in the claim process.

We purchase insurance policies to protect us against unexpected events and losses such as accidents, fire, and theft. When you make a claim with your insurance company, it is assigned to a "claims adjuster" who makes a number of crucial determinations: Does your policy provide coverage for your claimed loss? And if so, how much will be paid on your claim? It's easy to see why the role of an insurance claims adjuster is an important one to understand.

What Does an Adjuster Do?

A claims adjuster plans and carries out most of the work required to process an insurance claim. The very first task an adjuster undertakes when receiving a claim is to determine whether or not your policy covers the loss.

If coverage is found, it may include both your direct losses and associated losses or expenses. For example, if your home is damaged by a fire, your homeowners' insurance policy may pay for your hotel or rental house during the time it takes to repair the property.

Once the adjuster has determined that your policy applies, they will investigate the details of your claim. The adjuster will also be your contact with the insurance company until the claim is settled.

The role of claims adjuster can include all of the following:

  • Assessing the claimed damage and deciding who is responsible for the loss. For example, the adjuster will likely inspect the damaged property, take photographs, and gather other evidence. In some instances, as with a rear-end car collision, it’s relatively clear that the tailing driver is responsible for the accident. In other circumstances, it's not as easy to assess liability. For example, your condominium suffers water damage during a storm. The building had recently had roof repairs done. It may take some time and investigation to determine if the water damage is related to a faulty roof repair, improper window installation, or even a neighbor with a leaky toilet.
  • Investigating the claim by interviewing the people involved and any witnesses, obtaining police reports and hospital records, and inspecting the vehicle(s) or property and photographing any claimed property damage. Adjusters may also consult with other professionals, such as accountants, architects, construction workers, engineers, lawyers, and physicians, who can offer a more expert evaluation of a claim.
  • Drafting a damage report so that financial losses can be determined. Adjusters often have specialized software they use to determine the value of specific damages.
  • Working with any specialists needed to repair or rebuild, such as contractors, roofers, and auto repair shops.
  • Negotiating settlement and payment of the claim.

When Will the Claims Adjuster Visit Me?

Claims adjusters typically do not work 9-to-5 hours in one location. They may work out of an office or remotely, and cover a wide geographical area.

The adjuster will contact you and make an appointment to inspect the damaged property. If there has been a natural disaster, such as a tornado or hurricane, the adjuster may be visiting many, many properties in the area. In such circumstances the adjuster may temporarily relocate in the area to handle the numerous claims.

Are all Adjusters the Same?

No. There are several different types of insurance claim adjusters. For a small personal claim for your automobile or home, you will usually have a “staff adjuster.” This is an adjuster who is employed full-time by the insurance company.

Particularly with large or complicated claims, the insurance company will hire an “independent adjuster.” Make no mistake about it though, the “independent” adjuster still works for the insurance company.

Finally, there are “public adjusters” who are employed by you, the policyholder. Typically a public adjuster isn’t needed for your run-of-the-mill auto claim or home burglary. However, if you have a bigger loss, like a house destroyed by fire, or extensive storm damage, and the insurance company adjuster and you cannot agree on key aspects of your claim, it may be time to consult a public adjuster or an attorney. A public adjuster will perform the same tasks as the insurance company’s adjuster, but with your best interests in mind. A public adjuster usually works for a percentage of the eventual settlement with the insurance company (similar to a personal injury attorney's contingency fee).

Is an Adjuster a Type of Lawyer?

No, in fact it is illegal for an adjuster to engage in the practice of law. The adjuster takes the facts of your claim -- what happened, when, how -- and applies them to your policy. The adjuster should not give you (or the insurance company) legal advice of any kind.

How Do I Deal With the Adjuster?

It's important to be honest with your adjuster and cooperate, right from the beginning of the claims process. It's helpful to have a copy of your insurance policy handy, and to know what your duties are when you a file a claim.

Make sure you contact the insurance company promptly after a loss, and document everything. This may mean taking pictures, keeping receipts, getting medical records, obtaining estimates from contractors, and securing other vital information. The more information you provide the adjuster, the easier it is for the claim to move forward quickly.

However, remember that the adjuster’s job is to settle your claim fast, without paying any more than is necessary. Make sure the adjuster has all the information needed before you discuss settlement of your claim, even if the adjuster is in a hurry to settle. If you think the adjuster’s proposed resolution is unfair, or you're encountering other difficulties with your claim, it may be time to consult an attorney.

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