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What Does an Insurance Adjuster Do? | Nolo

How does insurance adjuster work

Video How does insurance adjuster work

Insurance claims adjusters come with different job titles (claims specialist, claims representative, independent claims analyst), but they all do the same job. Understanding who claims adjusters are and how they resolve a personal injury case allows you to see that they have no real advantage over you in the settlement negotiation process. in fact, by having a good understanding of the facts of your own claim, you may be at an advantage.

the role of the insurance adjuster

When you have filed a claim against someone you believe was at fault for your accident, typically the negotiation process will be with a claims adjuster from that person’s liability insurance company.

Occasionally, a claim is not handled by an insurance company’s own adjuster, but is referred to a firm of independent insurance adjusters. insurance companies often do this if they don’t have a local claims office in a particular area.

Independent loss adjusters who represent an insurance company operate in the same manner as in-house loss adjusters. the only difference is that they may have a lower limit of authority within which to resolve a case and therefore must have any settlement approved by a claims supervisor. however, the personal injury claim settlement negotiation process is exactly the same.

Public entities such as state governments or large cities that receive many claims often have their own claims adjustment offices. The negotiation process with these government loss adjusters works the same as with private insurance adjusters. The only notable difference in negotiating with a government claims adjuster is that if a claim ultimately ends up in court, judges and juries tend not to be overly generous in awarding damages with public money. for this reason, government entity adjusters tend to be more strict with settlement money than private insurance adjusters. If you have a claim against a public entity, expect your settlement to be 10% to 25% lower than if it were against a private entity. (Get details on injury claims against your state government.)

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Sometimes it happens that even though you have not filed a personal injury claim, an attorney (not a claims adjuster) negotiates with you on your claim. self-insured corporations and some insurance companies without a local claims office sometimes use their own attorney or a local attorney as a claims adjuster. and government entities sometimes have assistant city, county, or state attorneys who handle accident claims directly before they even go to court.

If an attorney is handling your claim instead of a claims adjuster, don’t panic. In the claims settlement process, an attorney cannot do anything different than a non-attorney claims adjuster. An attorney may brag a bit more than a claims adjuster about the law regarding negligence and liability, but there are easy techniques to call that kind of bragging.

If you file a claim under your own auto collision, uninsured or underinsured motorist coverage, you do not negotiate a settlement with your own insurance agent. all an agent can do is refer your claim to the claims department, and then it’s completely out of the agent’s hands. then you will negotiate an injury settlement with a claims adjuster who will act as the company’s representative, not yours. learn more about negotiating with your own insurer after an accident.

how adjusters settle claims

Insurance adjusters’ job performance is judged not only by how much insurance company money they spend on settlements, but also how quickly they settle claims. most adjusters get between 50 and 100 new claims per month on their desks. they have to settle that number of claims, known as “clearing” or “closing” a claim file, every month just to keep up. their performance is also evaluated on how many claims they can resolve personally without having to involve insurance company supervisors or attorneys. once an adjuster knows that you understand the range of how much your claim is worth, the adjuster will generally not stop your claim.

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During the negotiations, you will discover that you know much more about your claim than the adjuster. Except for those assigned to the largest cases, insurance claims adjusters have no special legal or medical training. and most don’t have the time or resources to investigate or review your claim very carefully.

The result is that while an adjuster will know more about the claims business in general than you do, they won’t know your particular claim as well as you do. you were there during the accident. you know what your wounds are, how much and where they hurt, and how long they have taken to heal. has taken the time to understand how the accident occurred and to demonstrate through photographs, medical records, and other documents what your damages were. The insurance adjuster, on the other hand, only has a couple of minutes a week to review your file. As long as you are organized and understand the process, you are the one with the negotiating advantage. (Get tips on your first conversations with an insurance adjuster.)

The adjuster has the authority to reach an agreement with you over the phone on what the final settlement amount should be. once you and the adjuster agree on an amount, the adjuster simply sends you the paperwork to finalize the agreement. but the adjusters’ authority to settle claims on your own is restricted to certain dollar limits. the limits depend on the experience of the adjuster. for less experienced adjusters, the limit may be between $5,000 and $15,000. for more experienced adjusters, the limit could be between $15,000 and $30,000.

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An adjuster will not reveal the limits of his authority unless he obtains an offer above that authority. If so, the adjuster will need to seek approval from a superior, usually called a claims supervisor or claims administrator. this is not unusual or difficult. but if the adjuster needs to consult with a supervisor about his settlement offer, get him a date by which he will hear back from either of them and then send the adjuster a letter confirming that date.

For more details on how to negotiate an insurance claim, including sample letters to insurance companies, tips for handling negotiations, and strategies for dealing with an insurance company that refuses to make a good offer, see how win your personal injury claim, al jose l. matthew (nolo).

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