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What Is An Insurance Adjuster?

When people get into some kind of incident where harm or property damage is involved, then one of the questions that need to be addressed in the near future is insurance coverage. If people have accident or damage insurance of some kind, then one of the big concerns; paying for medical treatment, or for repairs, is addressed by insurance coverage.

In other words, if a person was prudent enough to get an insurance policy for the event that befalls them, then those years of paying money to the insurance company every month will now be rewarded with the insurance company stepping in to cover costs. The exact amounts depend on the specifics of the insurance policy.

However, an insurance policy will only pay out in this way if the insurance company determines that the events that befell a policyholder actually do fall under the conditions laid out by an insurance company. Life insurance, for example, will never pay out to a recipient if the intended recipient murdered the policyholder.

One of the first lines of defense for an insurance company is a position known as an insurance adjuster or claims adjuster. But who is this person, and what do they do?

Financial Detectives

In one sense, an insurance or claims adjuster can be thought of like a detective. They go by other names in other parts of the world, such as “loss adjuster” in the United Kingdom and Australia. Regardless of title, their job is the same; they handle insurance claims, but, more importantly, they investigate the validity of these claims.

Just like private investigators, insurance adjusters are not lawyers, nor are they law enforcement officers, so they do not have the same legal authority as these positions. However, because of the unique flexibility of their position, they are allowed to go where many others can’t, such as dealing with the police and getting access to their information about a car accident, or interviewing people at an industrial site when an accident occurs.

Company People Or Hired Guns

One of the more unpredictable aspects of an insurance adjuster is whether or not they are on “your side,” the “enemy’s side,” or no one’s at all. Insurance adjusters may work for an insurance company directly, they may work for a group of different insurance companies, or they may be “public adjusters” that work for the policyholder, or they may be an independent adjuster who works for whoever is hiring.

This means that not all agendas for an insurance adjuster will be the same. For example, if you get into a car accident, and you are interviewed by an insurance adjuster that works for the insurance company of the other driver, exercise caution. It’s normal in these cases for a full-time insurance adjuster with a specific insurer to work strictly in favor of that company, attempting to come to any terms that would be favorable for the company.

On the other hand, if a building a company has invested in collapses, and the company wants to know whether this is due to poor work practices on the construction site, or some fault in the architectural plans, they might hire an independent adjuster. That adjuster will really only be interested in getting down to the truth of the matter and presenting the information as honestly as possible as about whether the claims being made will be honored by the insurance policy or not.

Many Different Hats

In some ways, the insurance adjuster has to play many different roles throughout a request for an insurance payout. First, insurance adjusters must verify that a legitimate policy even exists and that the claims being made fall under the policy that has been taken out. Some people, for example, may not realize that the life insurance policy for a loved one does cover suicide, but not within the first two years of the policy being taken out.

An insurance adjuster is a liaison between the insurer and the policyholder, handling paperwork, assessing the damages, researching the claim, and reporting to both the policyholder and the insurer the findings. In this way, they need to have some people skills when it comes to dealing with policyholder clients. They need to have knowledge of the insurance policies themselves, so they have a clear understanding of when something falls under a policy, and when it is excluded.

But perhaps most important of all, they cultivate a broad range of investigatory skills. This can be something as specific and technical as understanding structural engineering to investigate a claim of faulty building practices. Or it may be having the patience to wait with a camera outside a gym, and snap a picture of someone claiming to have whiplash engaging in exercises no whiplash victim could to present that evidence to an auto accident insurance company of an attempt at fraud.

Insurance adjusters work hard at their job, but whether you view them as an ally or rival depends on the situation you’re in.

Michael J. Babboni's wide-ranging legal career is based on the strong belief that everyone should be treated fairly and have access to effective legal help. Michael began putting his beliefs in action by helping the people of St. Petersburg Florida get what they are owed in civil trials fighting to protect families by making corporations pay, and honor their obligations.

What Is An Insurance Adjuster?

Goldman Babboni Fernandez
Murphy & Walsh

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