Key Takeaways
- Insurance adjusters are professionals who determine how much money an individual or entity should receive after a claim or loss.
- Insurance adjusters can consult with industry experts to assess claims better.
- Adjusters may also investigate types of insurance fraud.
- Insurance adjusters primarily work for and with insurance companies, although there are various insurance adjuster types.
How Does an Insurance Adjuster Work?
Insurance adjusters work on behalf of a company or individual to help investigate, review, and settle claims. Insurance adjusters may also be known as claims adjusters.
More than half of all insurance adjusters work for insurance companies or for agencies, brokerages, and other activities related to insurance. For example, after a natural disaster, an insurance company might temporarily contract with an independent insurance adjuster to inspect home damage, if the insurer lacks sufficient staff adjusters.
Insurance adjusters are responsible for determining the amount of compensation that a policyholder is entitled to after a natural disaster, accident, or theft. They also investigate cases that involve fraud, arson, or vandalism, and are trained to ensure that the company is not liable for any damages it shouldn't be.
An insurance adjuster’s responsibilities could include:
- Ensuring a policy covers a claim
- Investigating and determining if a claim is valid
- Assessing the damages
- Negotiating with claimants on behalf of an insurer and settling claims
- Working closely with attorneys, doctors, and other professionals such as engineers or appraisers, particularly when a claim is complicated or questionable
Note
After a natural disaster causing significant property damage, adjusters may review the largest losses first.
Example of an Insurance Adjuster
Another driver hit your car, and the car is no longer driveable. You have the vehicle towed to an auto-body shop. An adjuster inspects your damaged car and assesses the severity—can the car be repaired, or is it totaled? The adjuster reviews the police report about the accident and takes photos of the damage to both vehicles. If you were injured in the accident, the adjuster may review any X-rays, diagnoses, and medical bills.
The adjuster will likely arrange their work schedule to accommodate evening or weekend interviews with you, the person who hit you, and any witnesses. They take written or recorded statements.
The adjuster then estimates the repairs needed and might work with an auto-damage appraiser to estimate the cost of repairs. Finally, the adjuster writes a report for the claims examiner, who looks over the auto claim to ensure the adjuster followed company policies and other guidelines.
When the examiner approves your claim, the adjuster negotiates with you to settle the claim and decide how much money you get. If you think the offer isn’t great and contest the settlement, the adjuster will defend the insurer’s position and settlement offer. If you accept the settlement offer, the insurer either sends you a check or pays the auto-body shop to perform the repairs.
Note
Adjusters represent the insurance company’s best interests. When in doubt, speak with an attorney. You might also choose to hire a public adjuster, who negotiates with an insurance company on the policyholder’s behalf.
Types of Adjusters
Various adjuster categories exist, although some may go by different names depending on the role and state. A few examples:
- Catastrophe adjusters: Performs claim assessments after an event such as a hurricane or tornado
- Crop adjuster: Investigates and settles crop insurance-related claims
- Property and casualty adjuster: Investigates and settles losses for a property and casualty insurance company, which usually includes auto insurance
- Public adjuster: An adjuster hired by a policyholder to advocate for a claim
- Health insurance adjuster: Reviews hospital and provider bills, and negotiates reimbursem*nts with out-of-network providers
Frequently Asked Questions (FAQs)
What are insurance adjuster education requirements?
To become an insurance claims adjuster, one must possess a minimum of a high-school diploma or GED. Insurance claims adjusters usually are qualified as experts in their field of insurance and may need a license, depending on state requirements. The adjuster understands different insurance policies and can read and understand complex contracts.
What is a public insurance adjuster?
A public insurance adjuster is hired by consumers or businesses to negotiate their claim with the insurance company. Consumers often hire a public adjuster when a claim is denied or to challenge their insurance company’s claim offer. In general, you may pay up to 15% of your settlement offer to the public insurance adjuster, even if you don’t end up with a larger settlement.
