Claim Peace of Mind: Decode the Work of Insurance Adjusters

Like the saying, "When life gives you lemons, make lemonade," we often find ways to make the best out of difficult situations.

When it comes to insurance, the same principle applies. Whether facing a natural disaster or an accident, dealing with insurance claims during trying times can be stressful. 

However, a silver lining does exist – in the form of insurance adjusters. These professionals use their extensive training and tools like document management software to help navigate through the claims process.

For example, imagine you're driving to work on a rainy morning when another car rear-ends you at a traffic light. No injuries, but your vehicle is seriously damaged. After checking everyone's okay, you file a car insurance claim. That's when your insurer assigns a claims adjuster to handle your case.

In this article, we will delve into the role insurance adjusters play in supporting policyholders during their worst times. By demystifying their job, we aim to shed light on the process of obtaining fair and timely insurance reimbursements.

What does an insurance adjuster do?

An insurance adjuster plays an essential role in evaluating the coverage and compensation for policyholders when they experience a protected loss. 

To understand this better, consider this:

You own a small business when a hurricane causes significant damage to your office space. Your business operations are disrupted, and you need to file a claim to cover the damages and get your business back up and running.

Once you report the incident to your insurance company, they assign an insurance adjuster to assess the situation. The adjuster visits your office to inspect the extent of the damage, takes photos, and gathers all necessary information about the incident.

The adjuster then reviews your insurance policy to understand the coverage and limits that apply to your claim. They also collaborate with property damage and restoration experts to accurately evaluate the situation on the ground.

After collecting all the evidence and considering the repair and restoration costs, the insurance adjuster calculates the compensation based on your policy coverage. They maintain clear communication throughout the process to ensure you understand every step of the settlement.

Once you‘re satisfied with the adjuster's assessment, they take the necessary steps to facilitate the reimbursement from the insurer so you receive your rightful claims promptly.

Types of insurance claim adjusters

When you need to file an insurance claim, your primary point of contact is usually a claims adjuster.  However, you have to understand that the claims process varies since there are different types of adjusters.

Company or staff insurance adjuster

These professionals work exclusively for one adjusting firm full-time. The work comes with a stable salary, valuable benefits, life and health insurance coverage, and continuous education and training opportunities. 

Company and staff adjusters are assigned to handle specific types of claims, usually focusing on home and personal automobile insurance.

Independent insurance adjuster

Independent adjusters serve multiple insurance firms or third-party administrators. This adaptability makes it easy for them to handle various claims and provide multiple clients with valuable expertise.

 An insurance firm may hire an independent adjuster if it’s overloaded with claims or dealing with a specialized claim. Independent adjusters are commonly associated with handling catastrophe claims, and they often travel to affected areas after significant weather events or emergencies. 

Public insurance adjuster

Public adjusters work for policyholders. They help businesses or individuals reach an appropriate settlement if an insurer carrier’s proposed settlement seems unfair.

Generally, public adjusters are contract workers rather than salaried, and they often have their own claims adjustment offices. They might even have assistant city, county, or state attorneys who deal directly with accident claims before the matter gets to court. 

How insurance adjusters settle claims

Now that you understand how insurance adjusters work a little better, let's explore the process they use to analyze and settle insurance claims.

• Investigate the claim. The adjuster conducts an exhaustive investigation into the incident that led to the claim. Sometimes, a field adjuster visits the accident site to assess the damage firsthand. They carefully examine any physical damages and gather recorded statements from relevant parties, including witnesses.

• Review the damages. This stage involves creating a comprehensive claim file whereby the adjuster determines whether your insurance policy covers the claim raised. They may review the accident scene, police reports, video footage, or any other information related to the loss.

• Involve the policyholder. While the adjuster has general knowledge about the claim, they may not be as familiar with the details as you are. Documenting all relevant information is essential. This way, you provide clarity and, if required, offer evidence to support your case.

• Calculate a claim payout. After gathering the evidence, the adjuster calculates the appropriate amount for compensation. They present the offer to you, initiate negotiations, and work toward reaching a settlement agreement. At times, involving a lawyer during this process may be necessary to confirm you receive a fair claim settlement.

• Settle the claim. Once everyone involved agrees to the final settlement amount, the adjuster proceeds to close the claim according to your insurance coverage and the legal obligations of the insurance company. You receive the settlement, and the claim is officially closed. 

Working with a claims adjuster

Dealing with a loss and navigating the insurance claim process cause immense amounts of stress. However, several steps can make your experience as smooth as possible.

Know your rights

Familiarize yourself with the laws specific to your state and grasp how its insurance claims work. If you need more clarification, consider seeking assistance from an attorney specializing in insurance laws. 

Document everything

To maximize your chances of success, go the extra mile and be exceptionally thorough in your documentation. Record injuries sustained, medical treatments received, recovery progress, property damages, and repair expenses.

Use photographs, videos, written reports, and bills to support your claim. The more comprehensive your documentation, the more difficult it becomes for the adjuster to dispute or deny your case.

Communicate strategically

Maintaining open communication with the adjuster is crucial throughout the claims process. Don't hesitate to ask questions to gain clarity and understand what to expect. 

Inform the adjuster of your preferred communication method and timing to prevent unnecessary delays or missed opportunities. You can also request communication through your lawyer to further guarantee effective and efficient case handling. 

Don't accept the first offer

Insurance adjusters may initially present a low settlement, hoping that you accept it to close the case quickly. Remember, you have the right to a fair settlement that compensates you for expenses, pain, suffering, and other losses resulting from the accident. Consider the extent of your loss when determining what constitutes a fair for you. 

Be patient

Insurance adjusters often employ stalling tactics to pressure you into accepting a lower settlement. Practice patience and communicate your willingness to wait for a fair resolution. 

Accepting a lowball offer could mean you shortchange yourself by a significant amount, potentially hundreds of thousands of dollars. Your perseverance and determination will lead you to a proper settlement that adequately compensates you.

Hire a lawyer

Keep in mind that insurance claims adjusters prioritize their employer's interests, which are aligned with the insurance company, not necessarily yours. Think about hiring an attorney who can effectively represent your interests. 

Attorneys possess in-depth knowledge of the law and insurance adjusters' tactics. They can vigorously fight for your rights. Employing a lawyer sends a clear message to the adjuster that you are serious about protecting your rights and are prepared to take legal action if required. 

When do you need an attorney?

An attorney or advocate can be essential in pointing out rights you may be entitled to, mainly because insurance companies may not disclose every benefit you qualify for, as they are not legally obligated to do so. While insurance adjusters prioritize their company's interests, an attorney safeguards your interests. 

Instances when it may be necessary to hire an attorney:

• If you believe your insurance company owes more than it's willing to pay.
• If an insurance company refuses to negotiate with an adjuster,
• If trained insurance adjusters use different communication methods to get you to say something that might undermine the value of your claim.
• If you need to meet with the adjuster in person.
• If the insurance company requests recorded statements from you and the other parties involved in the accident.

Having an attorney by your side can protect your rights and pave the way toward your fair compensation.

Technological advancement in the claims management industry

Traditional insurance companies have long relied on claims adjusters to manage various claims, but the landscape is evolving with the integration of technology. 

While the expertise of claims adjusters remains invaluable, emerging technologies such as live-streaming applications and artificial intelligence (AI) are transforming the industry by automating workflows for insurance firms. Innovations like these enhance the speed and accuracy of claims handling, benefiting insurers and policyholders.

By understanding the various technologies insurers use to evaluate claims, you can effectively document damages, essential information, and proofs that can lead to accurate and comprehensive claim submissions.

Predictive analysis of data

Predictive analysis involves analyzing data to forecast future events, conduct risk assessments, and foster effective management. By using historical data and advanced analytics, insurers accurately predict the potential cost of a loss. 

Consider a scenario where an earthquake is expected to impact a specific area. If this region has a history of experiencing high-magnitude earthquakes, insurers can use advanced analytics to evaluate potential damages and short-term obligations more precisely. This data-driven approach empowers insurers to make well-informed decisions.

Chatbots

These AI-enabled communication channels fine-tune customer interactions online, making raising and checking claims convenient. By capitalizing on AI-driven chatbots, insurers offer seamless, real-time customer support and reduce the time and effort required to handle claims. 

As a claimant, you simply describe your claim to the chatbot. It prompts you for more details, accesses your policy from the insurer's customer relationship management (CRM) tool, and attempts to provide you with the necessary information. If you are not satisfied, you can escalate the issue.

Aerial imagery

Using advanced aerial imagery, insurers can conduct comprehensive assessments without the need to be physically present at the damaged site. This technology proves especially valuable when in-person visits are impractical, as it provides adjusters with real-time data for a more precise evaluation of damages.

Virtual inspections save valuable time for adjusters and give the insurance industry the tools to efficiently manage a higher volume of claims. As a result, policyholders benefit from quicker resolutions to their claims and a smoother, more satisfactory claims experience.

Artificial intelligence 

AI lets insurers tweak their processes for more efficient claim resolutions and reduction of overcompensation.

• Underwriting, which once involved a lot of paperwork, can now be automated through AI-driven natural language processing (NLP) tools. 
• Optical character recognition (OCR) tools automatically convert images containing written text into machine-readable data. 
• AI-driven data analysis enables insurers to assess damages and losses accurately for fairer claim settlements.
• Advanced machine learning software can analyze extensive data from multiple sources, making it easier to identify potential fraud patterns.

This digitization process enhances productivity and minimizes human error during claims handling. 

Internet of Things (IoT) devices 

Insurance companies receive immediate notifications about their location with IoT platforms when an accident occurs. Devices can also be used to assess the damage. For instance, a drone can quickly evaluate losses in disaster-stricken areas.

This data transmission speeds up the claims process, discourages frauds from manipulating information to exaggerate damage and addresses critical needs during challenging times.

What insurance adjusters won't tell you?

Insurance adjusters are designated to guide you through the claims process, but they’re known to keep certain facts to themselves. 

Being aware of these hidden facts empowers you to navigate your insurance claim more effectively and protect your rights as a policyholder.

A “fair” settlement means fair for the insurance company – not for you

Insurance adjusters will likely claim that they’re offering you fair compensation. While not technically untrue, what they mean is appropriate from their perspective as the insurance company. Their job is to get the lowest possible settlement, whether that adequately covers your personal injury expenses or not.

You don't need to rely on the insurance company’s evaluation of losses

Insurance companies use their experts to appraise what they consider a fair value. Sometimes, an adjuster might attempt to reduce your settlement by arguing that your loss doesn't align with your financial claim. 

But that doesn't necessarily mean you have to accept their evaluation. If you disagree with the adjuster, you have the option to seek assistance from external professionals who will evaluate the damage and report the actual value of your loss.

It's best for you to hire an attorney

Settlements handled without an attorney are often cheaper for insurance companies, so they're likely to dissuade you from involving legal representation. 

An insurance adjuster may ask that you wait for their offer before calling an attorney. You certainly have that right, but you may lose out on valuable information that a lawyer could provide or even be tricked into admitting guilt. 

You might get questions even when they know the answers

While it’s advisable to avoid speaking with insurance adjusters, certain instances make that impossible. Some insurance companies may repeatedly attempt to contact you and inquire about the accident. 

Before responding, remember that they probably already know the information they’re “looking for.” Their questions may be aimed at eliciting a response they can use against you during the claim process. Direct all questions from insurance adjusters to your attorney to safeguard your interests.

A quick payout isn't always the best option for you

Be aware of the potential types of compensation available. Insurance adjusters typically focus on settling medical bills and property claims.

However, you may also be entitled to seek compensation for non-economic losses, such as mental illness, pain, and suffering. Unfortunately, insurance companies might not readily inform you about these options.

Remaining patient throughout the process and insisting on what you rightfully deserve is essential. Having legal representation helps maximize the potential recovery of your claim.

Be careful with your social media

Social media can inadvertently damage your case if you post images contradicting your statements or sharing statuses about the accident that differ from your initial report. Insurance adjusters may use your social media activity against you, potentially leading to the denial or reduction of your compensation claim.

Minimizing social media usage after an accident is smart. If you can't avoid it entirely, exercise caution and refrain from posting anything detrimental to your claim. 

Insurance Adjusters: Frequently answered questions (FAQs)

1. How long does it take to receive a visit from an adjuster?

After you send a demand letter, you should expect to be contacted within 1-3 days to schedule a meeting, which may occur up to 2 days after that.

2. How long does an insurance adjuster have to respond?

It depends on the state; each state issues different guidelines for responding to claims. For instance, by law, insurance companies in Minnesota have 10 days to acknowledge the claim, 30 days to decide on the claim, and 60 days to pay the claimant.

Under typical insurance policy terms, the adjuster should complete an initial review and send a response, usually within 30 days. Unfortunately, as we said above, that's not always how things go. Instead of paying a claim quickly and in total, liability insurance claims adjusters often drag their feet.

3. What if my insurance adjuster isn't responding?

Resolving an insurance claim sometimes comes with long delays. In these situations, it's essential to understand the possible reasons behind the lack of response.

However, you should also know that companies might intentionally slow down the process to pressure claimants into accepting low settlement offers. Communication with the insurance adjuster is best left to your attorney to protect your rights.

Your attorney can assess if the adjuster might be negotiating in bad faith and then take appropriate steps, such as making phone calls, sending emails, or contacting the adjuster's supervisor to escalate the matter.

4. How can I negotiate with an insurance adjuster?

Needing to negotiate with an insurance claims adjuster isn't a skill most people need regularly. But when faced with the assignment, it becomes apparent how essential – and frustrating – it can be.

Recognizing that an insurance company prioritizes its interests over yours is vital, so preparation is the most crucial rule for negotiating with a claims adjuster. Describe injuries or damages and the related treatments and repairs.

Document everything meticulously to increase your chances of receiving a fair settlement. If you encounter a roadblock at any stage, get a lawyer.

5. What if I disagree with the insurance adjuster's settlement offer?

If the adjuster's settlement offer seems unreasonably low, it could be a negotiating tactic or an attempt to test your understanding of the actual value of your claim. To combat this, consider preparing a formal demand letter that includes the following:

• The facts about how the accident occurred.
• A clear account of your injuries or losses
• A summary of any medical treatment you underwent
• An explanation of how the accident or disaster has affected your life
• Your reasons for believing the settlement is insufficient
• A counteroffer to resolve your injury claim

6. Can I report an insurance adjuster who is acting unethically or unprofessionally?

In some cases, adjusters may use tactics that are inappropriate or illegal to pressure claimants into accepting offers that may not be fair.

For instance:

• They pressure an injured person to sign a settlement under the influence of medicine or other drugs.
• They create false witness statements to coerce a claimant into admitting fault or accepting a lower compensation amount.
• They improperly alter evidence to downplay the severity of an injured person's claim.
• They deliberately discard photos, written statements, or other evidence that could benefit the claimant.

Taking appropriate action is essential and advised if you have experienced such behavior from an insurance adjuster. Notify the adjuster's employer through a “claim of bad faith” letter.

Another option is filing with your state's regulatory body. If the claims are substantiated, the insurance company will be held accountable and must provide additional compensation beyond the original claim amount.

Justice is insured

Navigating the insurance claims process challenges everyone involved. However, being well-informed makes a significant difference in going on a smoother journey toward a fair settlement. A key aspect of this process is understanding the role of an insurance adjuster. With this knowledge, you can confidently advocate for fair settlements and receive the compensation you deserve. Remember, it's your right to seek what is fair and just.

Dreading the long and drawn-out process that often accompanies filing a claim? Discover the leading insurance software designed to fast-track the entire process.