Adjuster – A professional who assesses insurance claims to determine the extent of the insurer's liability
Imagine this: After a storm damages your shop’s roof, you’re waiting for an insurance payout to repair the damage. The adjuster plays a crucial role in this process, affecting not only how much you’ll get paid out, but how quickly too.
TL;DR
- What an adjuster is: An adjuster is a professional who evaluates insurance claims and determines the insurance company’s liability.
- Why it matters in day-to-day agency work: Effective adjusters can expedite the claims process, leading to higher client satisfaction.
- One common pitfall or misunderstanding: People often confuse the roles of company adjusters, independent adjusters, and public adjusters.
- One quick win or best practice for agencies: Agencies should explain the role of the adjuster to clients before a claim needs to be filed—this can prevent a lot of confusion and potential frustration.
What Is Adjuster in Insurance?
In a plain language explanation that a client could understand, an adjuster is like a detective for the insurance company. They look at things like damaged cars or houses and figure out how much it should cost to fix or replace them.
Technically, an adjuster’s job involves evaluating insurance claims to decide how much an insurance company should pay out. They do this by inspecting property damage, reading police reports, and talking to the claimant and any eyewitnesses. This role is commonly seen in all types of insurance—property, automotive, health, and more.
Key Related Terms to Know
- Claims Adjusting: This is the process by which insurance claims adjusters investigate a claim and figure out how much money should be paid to the policy owner.
- Insurance Adjuster: This is another term for an adjuster.
- Independent Adjuster: This type of adjuster works independently, rather than for a specific insurance company. They may work for several insurance companies at once.
- Public Adjuster: Unlike other adjusters, public adjusters work for the policy owner, not the insurance company.
- Staff Adjuster: This type of adjuster is an employee of an insurance company who handles claims for that company exclusively.
- Loss Adjuster: This term is often used interchangeably with “insurance adjuster.” Both refer to someone who evaluates insurance claims to determine how much should be paid out.
Common Questions About Adjuster
What Does An Insurance Claims Adjuster Do?
An insurance claims adjuster investigates claims made against insurance policies. Their tasks include inspecting property damage, interviewing claimants and witnesses, reviewing police reports and medical records, and consulting with professionals like doctors or architects. They then use this information to determine how much the insurance company should pay the claimant. The adjuster might negotiate with the policy owner to settle on a fair claim amount.
What Is the Work Environment of an Adjuster Like?
The work environment for an adjuster can be demanding, particularly during busy seasons following natural disasters or catastrophic events. They typically work irregular hours and need to be flexible to accommodate client schedules. Much of their work takes place at the site of an insurance claim, such as the location of a car accident or a damaged home.
Who Is an Adjuster in the Context of Health Insurance?
An adjuster in the context of health insurance evaluates claims related to medical costs and care following an injury or illness. They examine medical reports and bills to determine what the insurance policy covers and how much the insurer should pay.
How to Become a Claims Adjuster?
Becoming an insurance claims adjuster typically requires at least a high school diploma, though some positions may require a bachelor’s degree. Most states also require adjusters to be licensed, which involves passing a licensing exam. Additionally, previous work experience in fields such as insurance sales or construction can be beneficial.
Adjuster vs. Claims Agent
An adjuster evaluates insurance claims to determine the payout amount, while a claims agent (also called an insurance claims agent) assists policy owners with the initial filing of the claim and acts as the liaison between the claimant and the adjuster.
Comparison Area | Adjuster | Claims Agent
|
Primary use case | Evaluates claims to determine payout. | Assists clients in filing claims. |
Coverage / concept type | Evaluate damage and estimate cost. | Organise the claim process. |
Typical exclusions | Not typically involved in the initial filing of a claim. | Doesn’t determine claim payout. |
Who is most affected by errors | Policy owners and insurance companies. | Policy owners and insurance companies. |
Common mistakes | Misjudging the cost of repairs or medical expenses. | Misfiling claims or not properly communicating with clients. |
Real Claim Examples Involving Adjuster
Scenario 1: A business owner files a property damage claim after a natural disaster. The adjuster’s assessment helps determine the fair payout, alleviating the business owner’s financial burden and enabling timely repairs.
Scenario 2: A person involved in a car accident contacts their insurance company to file a claim. The adjuster evaluates the damage, and their evaluation directly affects the size of the claim payout.
Scenario 3: After a theft at a residential property, the homeowner files a claim with their insurance company. The adjuster reviews the provided documentation and makes a recommendation for the payout based on the policy’s terms.
Limitations and Common Mistakes
- Not Understanding the Role of the Adjuster: A common misconception is that adjusters are always working against the policy owner’s interests. This isn’t always true, especially with public adjusters.
- Miscommunication with Adjusters: Misunderstandings can arise when the adjuster effectively communicates their findings, especially when it comes to policy details and payout amounts.
How to Explain Adjuster to Clients
To a Homeowner: “Think of an adjuster as a home repair expert who works for the insurance company. Their job is to look at the damage, figure out how much it should cost to fix, and then help the insurance company decide what they should pay.”
To a Small Business owner: “When you make an insurance claim for something like storm damage to your store, an adjuster is the person who figures out how much money you should get.”
To a CFO or Risk Manager: “An adjuster is an insurance professional who evaluates business claims to determine the insurance company’s payout. Their findings directly influence claim settlement amounts.”