What is an insurance claims adjuster?

What does an insurance claims adjuster do?

An insurance claims adjuster’s role is to comprehensively review and inspect all of the details surrounding your claim. Their job is to not only help determine whether the claim is covered, but also which damages should be covered and to what extent.

Depending on the details surrounding your loss and the exact situation, an insurance claims adjuster is responsible for many steps along the way. Understanding what is a claims adjuster’s job can help you better understand the entire claims process. Depending on the claim, this can include things like:

• Gathering all of the details of your claim

• Reviewing your existing policy to determine any eligible coverages that might apply to your loss

• Collecting statements from you and anyone else involved in the claimed loss

• Reviewing any evidence related to the loss

• Inspecting damages and requesting additional information, if needed

• Determining which losses are covered and the value of your damages

• Communicating with you throughout the claims process and providing updates along the way

Insurance claims adjusters use a variety of resources to accomplish these tasks. This might include reviewing official police statements, photos, video footage, your own statement, statements from others involved in the loss or witnesses, receipts, and more.

Example

For instance, let’s say there’s a storm and a tree falls on your home, damaging the roof. You contact your insurance company to file a claim under your homeowners insurance policy for the repairs, and an insurance claims adjuster is assigned to your claim.

So, what does a claims adjuster do in this case?

They will likely visit your home to take photos of the fallen tree and any resulting damages. They will take notes and may request a statement from you; if the tree originally came from someone else’s property, they may even take a statement from that property owner or any witnesses.

Your insurance claims adjuster will then use this and other information to evaluate your claim, including determining coverage and settlement amount according to your policy coverage terms and limits. Once a determination of coverage is made, you’ll be notified and the adjuster will go over any repair options with you. If repairs have already been done to your property and your loss is covered, your adjuster may coordinate payment up to your coverage limits, minus any applicable deductible.

If you don’t agree with the adjuster’s determination, they can also help guide you through the steps of a dispute. In some cases, there may be an insurance adjustment, and your settlement offer may change. Other times, your claim might be escalated to another adjuster or department who will review it and make their own determination.

What is a public adjuster?

For homeowners claims, public insurance claims adjusters are professionals who can be hired directly by policyholders to help facilitate a claim, particularly if the policyholder and insurance company cannot agree on a claim settlement. Public adjusters may charge fees up to 20% of the settlement amount for their services.

When will I encounter an insurance claims adjuster?

An insurance claims adjuster is often an integral part of the claims process. If and when you file a claim under your insurance policy — whether it’s a homeowners policy or even auto insurance coverage — an insurance claims adjuster will almost always be assigned to your claim.

This individual is responsible for investigating the details of your claim, which could include inspecting damage to your property, gathering information, reviewing available coverage, and determining your settlement offer, if any. These professionals work for or on behalf of the insurance company and are almost always brought on as the primary point of contact throughout your claim process.

How to prepare for an insurance claims adjuster's visit?

You should expect to work with an adjuster any time you file a claim with your insurance company. For property damage claims, in most cases, this individual will come and inspect your property damage, take photos, ask questions, and even take a statement from you if one wasn’t already given. To make this visit easier for everyone (and better your chances of a smooth claims process), you should:

• Gather any relevant receipts or documents that could help with valuation, depreciation, or replacement costs.

• Take your own photos of the damage, especially if you need to make temporary repairs or move items before the adjuster arrives.

• Create a list of any lost or damaged items.

• Write down details related to the loss so you don't forget anything important.

• Prepare a list of questions to ask the adjuster while they're on-site.

• File a police report, if necessary (and have a copy of the report available for your adjuster).

Insurance claims adjusters and advances in technology

These days, available technology can make an insurance claims adjuster’s job easier. This technology can be utilized to help evaluate claims, manage information, identify data patterns, and determine loss values.

For example, adjusters may use technology such as drones to photograph damages to your home, such as viewing a high roof after a wind storm. Today’s insurance claims adjuster software can also help manage homeowners insurance claims faster and generate more accurate loss estimates. Some programs even use AI to facilitate claims processing around the clock.

Still have questions?

Want to know even more about the role of an adjuster in insurance claims and what exactly they do? Here are some frequently asked questions to note.

What does an insurance claims adjuster look for?

An insurance claims adjuster’s job is to gather information about a claim, document reports and evidence, analyze policy coverage, and calculate loss estimates to determine a policyholder’s settlement offer. In order to do this, claims adjusters will look at the actual damage, any related reports or statements, relevant receipts and records, and typical repair or replacement costs.

How much does an insurance claims adjuster cost?

Insurance claims adjusters who work for or on behalf of the insurance carrier are assigned to claims at no cost to policyholders. If you decide to hire a public adjuster to help navigate and negotiate a claim, however, their fee can be as much as 20% of the total settlement amount.

Can an insurance claims adjuster deny a claim?

Based on the information gathered about a claim, relevant coverage, and the details surrounding a loss, an insurance claims adjuster can recommend to the carrier that a claim be denied. Ultimately, the decision rests with the insurance company, and policyholders can always dispute these findings. You can also hire a public adjuster to represent you if your claim is denied or you feel that the settlement amount is insufficient.

How long does it take for an insurance claim to be adjusted?

An insurance claim can take anywhere from a few days to multiple weeks to be investigated and a determination made. There are state specific laws and regulations that determine the time periods.

What may insurance claims adjusters ask?

An insurance claims adjuster’s job is to investigate a claim and help determine coverage, which involves asking questions about the loss and how it occurred. For property damage claims, they may also ask questions about your property, including any previous work or repairs that may have been done.