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What Does an Insurance Claims Adjuster Do?

An auto insurance adjuster settles auto insurance claims, investigating and evaluating losses and determining a policyholder's payout, if any, based on the policyholder's coverage. In short, an insurance adjuster fulfills your auto insurance policy's promises. If you are an at-fault driver who causes an accident, an insurance adjuster will protect your assets by ensuring the validity of the claims against you. If you have been the victim of an accident, you will most likely be interviewed by the at-fault driver's insurance adjuster.

An auto insurance adjuster investigates and verifies claims against an at-fault policyholder.

A claims adjuster gathers evidence; interviews all the parties involved, including the policyholder; reviews the policyholder's coverage and makes a final report to the insurance company. A claims adjuster may work with the claims adjuster of another driver's auto insurance company, reaching a consensus so that all parties can avoid going to court.

Types of Insurance Claims Adjusters

Company Adjusters

Auto insurance companies employ their own adjusters who work on their behalf. Auto insurance company adjusters work on both bodily injury and property damage coverage claims.

Independent Adjusters

Independent adjusters are freelance contractors who represent insurers. Independent adjusters are not allowed by law to adjust claims for policyholders, only insurance carriers. They work on behalf of an insurance company's interests.

Public Adjusters

Public adjusters are independent contractors who solely represent the interests of the policyholder, or the "insured." They can only adjust property claims, not liability claims. While insurance companies pay for staff and independent adjusters, the policyholder pays for a public adjuster. According to IRMI, public adjusters' compensation typically takes 2% to 15% percent of the policyholder's insurance settlement.

How Does a Claims Adjuster Evaluate a Claim?

With your loss notice in hand, your auto insurance company's adjuster will take the following steps:

  • Inspect the accident site as soon as possible

  • Meet with the other adjuster, if any, to set a scope of loss

  • Analyze the damages

  • Assess the value of the loss

  • Review the policyholder's coverage to determine the portions of the loss that are covered

  • Assemble the necessary components of a successful claim presentation

  • Negotiate with the other insurance company, if any, to reach a settlement

When an auto insurance adjuster evaluates a claim, they are primarily doing two things: assessing the value of the loss and reviewing the type and scope of your coverage.

For example, if you're in a bad car crash, your adjuster will assess how much the car is worth for its age, make and model, then check your auto policy to determine the coverage, the coverage limits, restrictions and added endorsements to determine whether your car has been totaled.

If at fault, you can only seek reimbursement for damages from your own insurance company if you have comprehensive or collision insurance. If the other driver was at fault, you'd meet their insurance adjuster to assess a payout from the other driver's liability coverage.

Working with a Car Insurance Adjuster

After an accident, your claims adjuster becomes your main point of contact with your auto insurance carrier. When your auto insurance adjuster calls you to introduce themselves, you should obtain the following information:

  • Adjuster's name and contact information

  • Your claim number

  • Anticipated turnaround time to settle your claim

  • When you can expect to hear from the adjuster again

An insurance company may get 100 claims a month, so your carrier wants to settle these claims as fast as possible. While most claims can be settled in 30 days, some claims drag on for months because, for example, the cause of an accident is disputed.

Whose Side Is the Auto Claims Adjuster On?

Most adjusters must be licensed according to the laws of the state in which they operate. Further, adjusters are required to act on behalf of the policyholder in "good faith"—that is, they are ethically bound by law to treat the policyholder honestly, reasonably and fairly.

An auto insurance adjuster must deal honestly, reasonably and fairly with every policyholder.

Do I Have To Meet a Claims Adjuster in Person?

Not necessarily. Your claims adjuster will definitely want to interview you about the incident, but that interview may be conducted in person or over the phone, depending on the situation. If you feel uncomfortable meeting your adjuster in your own home, you can have a face-to-face consultation in the adjuster's office or, say, a venue of your choice.

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How Does an Auto Claims Adjuster Settle a Claim?

To settle your claim, an adjuster will take into consideration many factors, whether you are the victim or the at-fault driver. To fully assess the loss, the adjuster will master all the pertinent information, including the following:

  • Ambulance and emergency-room expenses

  • Medical expenses, including doctor's visits and rehabilitation

  • Car repair expenses

  • Lost wages

  • Pain and suffering

  • Evidence of fraud

The adjuster will submit their findings to the insurance company, recounting the incident and recommending an appropriate claim amount—that is, how much money you should receive.

However, adjusters must work with policyholders to resolve any differences of opinion in the claims settlement process. This process may require you to provide additional documentation to substantiate your claim.

Can I Negotiate with the Insurance Adjuster?

It is only logical that an auto insurance company and their paid adjuster would want to minimize losses and pay as little as possible to settle claims. That's good news if you're the at-fault driver: Your adjuster and your insurance company will work to minimize how much you are legally required to compensate other parties, thus protecting your financial stability.

On the other hand, this is not the best news when you yourself are the claimant. In fact, it is not uncommon for an adjuster to offer less money than a claim is worth.

When a policyholder is unhappy with their own auto insurance company's offer, they may hire a public adjuster.

Do your due diligence to ensure you get what you deserve:

  • Keep all receipts and records of medical visits, car repairs and any other expense you incur as a result of the loss event. For example, you may be eligible for "supplemental damages" should your medical care or car repair cost more than your adjuster initially calculated. Also, it is not impossible that an insurance adjuster might overlook some facet of your claim, so you'll need the documentation to prove your case.

  • Determine the value of your car using Edmunds or Kelley Blue Book.

  • Hire a public adjuster for a second opinion.

Your auto insurer may honor or partially honor a higher payout. On the other hand, some insurance companies may rescind the initial offer and refuse to make another one. In either case, you can either accept what you consider to be a low-ball offer or take your insurance company to court. You can also contact your state's department of insurance for help as well.

Taking an Insurance Company to Court

If you decide to take your own or someone else's insurance company to court, lawyers who see merit in your case will typically take it on with no money down, expecting a percentage of the settlement if they win the case for you. This "contingency agreement" typically entitles your lawyer to 33% to 40% of your settlement.

Starting a Car Insurance Claim

After you file a claim, the insurance company will write up your personal account as a "loss notice," which formally begins the claims process. According to the International Risk Management Institute (IRMI), a typical loss notice will require the following information from you:

  • Date and time the loss occurred

  • Location where the loss occurred

  • The insured's contact information (name, address and telephone number)

  • Type of coverage the insured purchased

  • The type of loss

  • The insurance agent's contact information

  • The claimant's contact information

  • Any eyewitnesses' contact information

  • Special issues, such a hospitalized claimant or potential language barriers

If you are unsure of your auto insurance coverage or policy number, your policy's declarations page contains this information.

Soon after filing a claim, an insurance adjuster will be assigned to your case.

Finding a Better Auto Insurance Option

After a car accident, an auto insurance claims adjuster works to fulfill the contractual obligations set down in a policyholder's car insurance policy. While an insurance company's adjusters represent the insurer's best interests, they must work in good faith to protect the insured's interests as far as the insured's coverage allows. A public adjuster can be hired by the policyholder "against" their auto carrier if offered an unfair settlement.

If you've had a less than positive claim experience or are simply looking to save money on car insurance, SmartFinancial takes the hassle and headaches out of finding you the right carrier. For free, real-time auto insurance quotes in your area, enter your zip code or call 855-214-2291 for a one-on-one consultation.

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