An adjuster is a professional employed by a property and casualty insurance company to manage and settle claims brought by insureds. This critical role involves evaluating the merits of each claim and making recommendations to the insurance company on how to proceed.
What is an Adjuster?
An adjuster, or claims adjuster, investigates insurance claims to determine the extent of the insuring company’s liability. They play a crucial role in ensuring that claims are settled fairly and promptly, balancing the interests of both the insured and the insurer.
Types of Adjusters
Staff Adjusters
Staff adjusters, also known as company adjusters, are employees of insurance companies. They handle claims directly on behalf of their employer.
Independent Adjusters
Independent adjusters are contractors hired by insurance companies when there is either an overflow of claims or a need for expertise outside the in-house staff’s areas.
Public Adjusters
Public adjusters are hired by policyholders (insureds) to represent their interests during the claim process, rather than the interests of the insurance company.
The Role and Responsibilities of an Adjuster
Evaluation of Claims
Adjusters are responsible for reviewing claims submitted by policyholders, including examining the extent of property damage or reviewing medical bills.
Investigation
They conduct thorough investigations which may involve interviewing witnesses, consulting police and hospital records, and inspecting property damage.
Reporting
Adjusters prepare detailed reports including evidence, interviews, and their recommendations regarding the settlement.
Negotiation
Negotiating settlements with claimants or their representatives is a key part of an adjuster’s job, ensuring claims are resolved fairly and within the policy terms.
Special Considerations
Conflict of Interest
To avoid conflicts of interest, it is essential that adjusters remain impartial and objective.
Regulatory Compliance
Adjusters need to comply with state-specific regulations, licensing requirements, and ethical standards which can vary significantly.
Examples
Property Damage Claim
If a policyholder’s house is damaged by a storm, a staff adjuster would inspect the damage, review repair estimates, and decide on the appropriate amount to settle the claim.
Injury Claim
In the case of an car accident injury, an adjuster might review medical records and consult with medical experts to determine the extent and validity of the claims.
Historical Context
The role of an adjuster has evolved significantly since insurance first became a structured industry. From rudimentary methods of claim verification to today’s sophisticated digital tracking and data analysis, the position requires a blend of traditional skills and modern technology.
Applicability in Modern Context
Today’s adjusters often use advanced software and tools to manage and investigate claims more efficiently. This includes aerial drones for property assessment and AI-driven analytics for pattern detection in fraudulent claims.
Related Terms
- Independent Adjuster: An independent adjuster is a consultant who can be engaged by insurance companies to assist with overflow claims or for their specialized expertise.
- Claims Examiner: A claims examiner reviews the adjuster’s findings to ensure the claim is handled correctly and compliant with the company’s policies and regulations.
FAQs
What qualifications are needed to become an adjuster?
How do adjusters differ from public adjusters?
Are adjusters involved in legal disputes?
References
- National Association of Insurance Commissioners. (2022). Public Adjusters Licensing Model Act.
- Insurance Information Institute. (2023). Understanding Your Insurance Claim.
Summary
Adjusters play a pivotal role in the insurance industry, ensuring claims are evaluated and settled in a fair and timely manner. Their work involves investigation, negotiation, and compliance with regulations, making them essential to the integrity and functioning of insurance processes. Understanding the different types of adjusters and their specific roles helps in navigating the complexities of insurance claims effectively.
