Auto insurance claim adjusters work for insurance companies, and their job is to deal with claimants. If you have been in an accident, and are intending to file an insurance claim, it’s likely that you will be dealing with an auto insurance claim adjuster. The claim adjuster will be your main contact with the insurance company, investigate the claim details, and negotiate a settlement with you. To navigate the claims process effectively, it will help to understand the role of a claim adjuster.
Table of Contents
What Is an Auto Insurance Claim Adjuster?
An auto insurance claim adjuster is the person who is assigned to your insurance claim. He or she may have different titles, such as claims specialist, claims representative, loss adjuster, or independent claims analyst. If an insurance claim is made, the claims adjuster is assigned to handle the claim.
If you are filing a claim for a car accident, the insurance company will assign a claims adjuster who will investigate your claim. This is to determine if the insurance should pay for any damage or injuries that you have suffered, and if so, how much.
Usually, you will file an insurance claim with the at-fault party’s insurance company or your own insurance company, under either uninsured motorist coverage or else your own collision coverage. In this case, you will work with a claims adjuster employed by the insurance company. Sometimes, however, the claims adjuster may be a third party.
There are three types of insurance adjusters.
Company or Staff Adjuster
A company adjuster is an in-house insurance adjuster or one who is employed full-time by the insurance company. He or she works exclusively for that insurance company. This is the type of adjuster that you are most likely to be working with if you file an insurance claim. He or she will be assigned to your claim to represent the insurance company in investigating your claim and negotiating a settlement.
A public adjuster is a trained independent insurance professional that you can hire to settle the claim on your behalf. While a company adjuster is provided without charge, a public adjuster charges a fee, usually as a percentage of your claim. He or she represents you in the claims process, rather than the insurance company, to ensure a fair settlement. A public adjuster cannot get you more compensation than your policy allows for.
An independent adjuster is not employed by an insurance company but is hired by an insurance company when a claim is made on a contract basis. The functions are similar to that of a company adjuster. The independent adjuster provides greater objectivity as a third party and thus gives the impression of better fairness to people filing a claim. Independent adjusters are typically used when a company is overloaded with claims, when a claim is in a remote location if special expertise is needed, or if there has been a catastrophe.
What Role Does the Insurance Adjuster Play in an Accident Claim?
Auto insurance claim adjusters are employed primarily for investigating claims. They fact-check every aspect of a claim to determine who is at fault in a car accident, to measure the extent of the fault, and to prevent fraudulent claims. They also apply the limits of your policy to check the extent of your losses and damages that are covered and negotiate a settlement amount with you. An insurance claim adjuster’s duties fall into three main categories:
Investigate the Claim
An insurance adjuster is responsible for investigating the claim. He or she needs to determine what happened, how it happened, and who is at fault for causing it. To do this, the adjuster will collect information and evidence, including:
- Police accident reports in the case of a vehicle accident
- Witness statements
- Photos and video evidence of the scene
- Statements from the drivers involved in the accident
During this part of the investigation, the focus of the adjuster is determining who is liable. If the person who holds the insurance policy is liable, then the investigation will move to the next phase. The second stage investigates your injuries. Claims adjusters typically request you to sign a medical release form so that they can access your medical records. Your medical bills, property damage, and proof of lost earnings may be requested, and you may also be requested to undergo an independent medical examination.
The reason for requesting this information is so that the adjuster can determine the extent of your injuries and damages and ensure that they were sustained in the accident. At this stage, the adjuster will also likely determine whether the specific loss that you are claiming is covered under your policy.
Calculate the Value of the Claim
At the end of the investigation, the auto insurance claim adjuster will decide whether you are entitled to compensation under the insurance policy. If the claim adjuster decides that you are entitled to compensation, then he or she is responsible for calculating the value of the damages that you have suffered and the value of your claim.
To make this calculation, the insurance adjuster will consider a number of factors. These include expenses and losses that can be verified, how severe your injuries are, the impact of these injuries on your life, the strength of your case, and the limits of the insurance policy. Medical bills, as well as loss of income due to the inability to work, play a major role in this calculation.
Settle the Claim
Once the auto insurance adjuster has calculated what he or she thinks your claim is worth, then he or she will make you an offer of compensation on behalf of the insurance company. The adjuster will let you know how much money the insurance company is willing to pay you as compensation.
The insurance adjuster’s role in an accident claim is to represent the insurance company in getting the best settlement value. The first offer made by the adjuster is not likely to be the full value of the claim, and will probably be a percentage of what the claim is worth. The first offer may be lower than you expect. You do not have to accept the first offer. If you reject the initial offer, the claims adjuster can make a counteroffer. It’s best to have a car accident lawyer with you to help with negotiations at this point, to represent you in negotiating with the insurance adjuster, and to get you the best settlement offer possible.
If the auto insurance claim adjuster makes a final offer that you are not prepared to accept, then you can write a formal personal injury demand letter. This letter contains details on how the accident happened, why the insured driver is at fault, a description of your injuries, a summary of your medical treatment related to the accident, and an explanation of how the accident and resulting injuries have affected your daily life. You will also include an amount that you are prepared to accept as a settlement. After this, if you still cannot reach a settlement, then you can file a car accident lawsuit to claim the compensation to cover your losses and damages.