Claims adjusters are insurance agents. They investigate insurance claims and determine the compensation that should be offered in those claims. In other words, the claims adjuster is the person that decides the outcome of a claim, including any settlement that is offer.
Reviewing Claims
When an insurance claim is filed, an adjuster is assigned. He or she reviews the claim, including determining the policy/coverage details. They look at the person(s) and/or property covered by the insurance policy, including any coverage limits, etc.
Determining Fault
In insurance claims that require the determination of “fault” or “responsibility,” like car accident claims in some states, it’s the adjuster’s job to decide fault. He or she determines fault by reviewing evidence in the claim. That evidence may include:
- Police reports
- Witness statements
- Interviews with you or other parties in the claim
- Photographs of the scene
- Medical evidence, which may include an Independent Medical Examination
- Property damage estimates
- Property repair bills
Valuing a Claim
Claims adjusters review the “value” of personal property and evaluate the cost of injuries. They look at actual costs, including bills, damage estimates, etc., but they also use computerized databases to see average costs or expenses. In other words, they use complex computer programs to see what the average values of claims like yours.
Making Settlement Offers
It is a claims adjuster’s job to:
- offer a settlement that makes the claimant happy
AND - keep costs manageable for the insurance company.
This means most settlement agreements are conservative. Sometimes settlements are actually significantly lower than the real value of the claim.
Unknowing claimants may accept a low settlement, not understanding that they are due fairer compensation for their injuries or property damage.
Negotiating Settlements
When a claimant knows how the claims process works, they may negotiate with the claims adjuster or may hire an attorney to handle negotiations for them. The claims adjuster usually starts on the low end when making a settlement offer. Likewise, claimants should start on the high end when demanding damages in a personal injury claim.
The claims adjuster and the claimant (or his or her attorney) negotiate the settlement offered until they arrive at a dollar figure both can agree is fair. If the claims adjust is unable to achieve a settlement agreement with the claimant, the claim may end up as a lawsuit, which can be quite costly for the insurance company. Adjuster work hard to settle claims for this reason.
