What does an insurance adjuster do?

What does an insurance adjuster do? 

An adjuster is an insurance professional who investigates claims and determines how much an insurance company should pay. 

But there are different types of adjusters for different types of claims. A single adjuster may handle only car accidents, home insurance claims, or even commercial liability or medical malpractice claims. For this article, we are mostly going to concentrate on auto insurance claims. 

When you report an accident to your insurance provider, it is a standard insurance-industry process to investigate the loss. This is to ensure that the policy covers the reported loss and to determine who is owed and the proper amount of payment. Insurance adjusters, sometimes referred to as claim adjusters or claim examiners, carry out that process. 

To put it more simply, insurance is a promise. As an insured person, you pay a fee up front in exchange for the promise that the company will pay a large loss if it happens. The main role of the insurance adjuster is to deliver on that promise. 

How does the claim process work? 

The basic elements of claim handling are coverage, liability, and damages. When you report a claim, these three things must be addressed before any claim payout. 

To investigate coverage, an adjuster must make sure the type of loss is covered by your insurance policy. In simple cases this is easy. They confirm who was driving, which car was involved, and what type of accident happened. 

In some cases, this can be more complicated. Claims involving unlisted drivers, borrowed vehicles, or suspicious circumstances get a much closer look. This may mean gathering statements and closely examining the policy language before confirming insurance coverage. 

To investigate liability, an adjuster must examine all available evidence to determine if their insured person owes anyone else due to their negligence. This is the part most people think of when they think of investigating an accident. 

Liability adjusters typically start with gathering statements from all involved drivers. They may also talk to witnesses and passengers. They will review the police report, photos of the accident scene, and photos of the vehicle damage. They will decide who is at fault, and whether their insured legally owes anyone else’s damages. 

Investigating damages means examining what is being claimed and determining how much money to pay for it.

This could mean inspecting a damaged vehicle and writing a repair estimate. This could mean reviewing medical records in an injury claim. This could even mean reviewing towing and rental car bills. Anything that is part of the claim payout must be examined. 

What is the difference between an insurance agent and an insurance adjuster?

An insurance agent is the person who sells you the insurance policy. They recommend the best products and coverages for you, review discounts, and make sure you are properly protected before an accident happens. 

Agents also provide customer service on the front end -- before a claim. If you need to add a driver or change your deductible, you call your agent. 

Agents can be exclusive or independent. An exclusive, or captive, agent is one who only sells policies for a single insurance company. An independent agent is not tied to a specific company, and may offer policies with multiple companies. 

An insurance adjuster handles claims. They only get involved after an accident happens. They usually don't have access to pricing, and they can't change the type of coverage you have. They can only work within the policy you paid for. 

Adjusters provide service on the back end, after a claim is reported. If you need to request a rental car or have a medical bill paid, you call your adjuster. 

Adjusters often specialize 

Even within auto claims, there are adjusters who specialize. 

Depending on the type of claim, you may be contacted by many different adjusters. There could be one person who investigates liability. And there may be a specialist to decide coverage in strange situations. 

There will almost certainly be an adjuster who handles vehicle damage. That person needs to see and document all damage, determine the cost of repairs, and sometimes negotiate with the body shop. This requires a very different skill set than, say, handling medical bills. 

When dealing with a claim, it helps to keep track of who is dealing with what part of your claim. The person who set up your rental, for example, may not be able to answer your question about a total loss payment. 

What's the difference between first-party and third-party claims?

When you make a claim on your own insurance policy, that is a first-party claim. You are the insured person, and you are asking your insurance company to pay. 

First-party claims are dependent on coverage. If you pay for collision coverage, and you are in a collision (subject to the terms of your policy), your insurance will cover you. It doesn't matter if you are at fault or not. 

When you make a claim with someone else's insurance company, that is a third-party claim. You are the third party to the other driver and their insurance. 

A third-party claim is always dependent on liability. An insurance company’s adjuster will need to be sure their insured is covered for this loss, and that they are at fault. Insurance companies do not pay third party claims until after liability is determined. 

Adjusters work both individually and in groups. 

Each insurance company differs slightly in structure. Some companies lean more toward working in teams, while others lean toward single adjusters handling each claim. But most companies use some element of teamwork. 

Adjusters are always working with a balance of individual authority and group decision making. The more complicated your claim is, the more likely it has been reviewed by multiple claims professionals.

What are independent or public adjusters? 

An independent adjuster is someone who does not work for a specific insurance company but may be contracted by various companies. 

Insurance companies do this most often when they have catastrophe claims. When something like a hurricane hits, they suddenly have more work than they can handle, and they need to hire independent adjusters for temporary help. 

Another common use of independent adjusters is in unstaffed areas. In less populated areas, a single company may not have many policies in force, and it is hard to justify maintaining full time field staff. An independent adjuster may specialize in a specific area, and handle claims for multiple companies. 

A public adjuster, on the other hand, is not hired by an insurance company. They are hired by an insured person to handle their claim for them. They act as an advocate for whomever hires them. 

A public adjuster is not authorized by the company, so the insured who hires them must pay them. They may work for a flat fee, or for a percentage of the claim payout. Since they usually assess property damage, this obviously cuts into the amount available to repair or replace damaged property. 

Public adjusters mostly work major loss property claims, such as house fires or business losses. You are not likely to encounter public adjusters on an auto claim. 

What are the requirements for being an adjuster? 

Prerequisites for the job will vary by company and position. Most major companies prefer a college degree, but may accept a high school diploma with related experience. 

In addition, many states require licensing for adjusters.  This usually entails mandated training and/or testing. 

Insurance companies value service highly in their adjusters. If a company wants to keep its customers, it is important the adjusters they hire deliver outstanding customer service. 

Bryon Bromley

Bryon Bromley is a blogger, a former insurance adjuster and a lifelong auto enthusiast. His latest project is Adjust Your Drive, where he explains accidents, insurance, liability, and driving safety. He is based in Beaverton, Ore. For more insider information on dealing with car accidents, you can visit his site at: www.adjustyourdrive.com.