Understanding the responsibilities of the insurance adjuster will help you negotiate your personal injury claim.
Understanding who insurance adjusters are and how they operate might help remove some of the uncertainty from the insurance injury claim process. This article discusses:
What an insurance adjuster does When dealing with an injury claim, the adjuster’s primary goal is to resolve the claim as fast and inexpensively as feasible.
Tips for speaking with an insurance adjuster, as well as what to do if injury settlement talks aren’t yielding a fair outcome.
What Exactly Is an Insurance Adjuster?
Insurance claims adjusters have a variety of job names, including claims specialist, claims representative, and independent claims analyst, but they all accomplish the same thing: when an accident or other occurrence triggers insurance coverage, the adjuster manages the resultant claim.
Following a vehicle accident, for example, an injured passenger may submit an injury claim with the at-fault driver’s auto insurance company under the driver’s liability insurance policy. In such case, the wounded passenger’s claim will be handled by an insurance adjuster for the driver’s auto insurance company.
Will the Insurance Adjuster Always Work for the Insurance Company of the Other Party?
After an accident, you’ll normally engage with a claims adjuster hired by the at-fault party’s liability insurance carrier. However, this is not always the case.
Independent claims adjusters may work for an insurance firm and function similarly to in-house claims adjusters. The main difference is that they may have a lesser cash value authority limit to settle a case, and any settlement deal must normally be authorized by a claims supervisor.
State governments and major cities often have their own claims adjustment departments. They may even have assistant municipal, county, or state lawyers who handle accident claims before they get to court. Learn more about injury claims against the government in your state.
If you submit a claim with your own vehicle insurance carrier (for example, under your collision or uninsured motorist coverage after a car accident), you’ll negotiate an injury settlement with a claims adjuster who will serve as the business’s agent (not yours). However, this does not always imply that things will be hostile. Learn more about negotiating with your own insurance company after an accident.
What Is the Role of an Insurance Adjuster?
Continuing with the prior scenario of our wounded passenger in an automobile accident: When a passenger files a claim with the at-fault driver’s auto insurance company, an adjuster (who works for the driver’s insurer) will assign a claim number and collect some basic information (such as the date of the incident and the claimant’s name, date of birth, address, and contact information).
The adjuster will also request permission from the claimant to access accident-related medical documents.
At this stage, the adjuster will do the following:
Examine the accident and how it occurred, including any police reports.
Examine the claimant’s medical records, income records, and any proof of accident-related losses (“damages” in the language of the law)
assign a monetary value to the claimant’s damages, and manage the personal injury claim settlement negotiation process with the claimant (or the claimant’s attorney).
Learn more about how an automobile accident is investigated by an insurance adjuster.
The insurance adjuster’s primary function is to settle claims on behalf of the insurance company (always in service to the firm’s bottom line). That may include rejecting a claim or refusing to pay the claimant anything as all. However, most of the time, it involves negotiating a settlement of the dispute.
How Adjusters Handle Personal Injury Claims
Insurance adjusters are evaluated not just on how little money they spend on settlements, but also on how fast they resolve claims. Most adjusters get between 50 and 100 new claims every month. To keep even, they must settle that many claims each month (known as “clearing” or “closing” a claim file).
While an adjuster will know more about the claims industry in general than you, they will not know your specific claim as well. You were there at the time of the accident. You have direct knowledge of your injuries, including how long they took to recover.
The insurance adjuster, on the other hand, only has a few minutes every week to review your paperwork. All of this implies that if an adjuster understands the range of how much your injury claim is worth, they are unlikely to delay your claim. You have the negotiation edge as long as you are organized and understand the procedure. Learn how to handle your initial conversations with an insurance adjuster.
The adjuster has the ability to reach an agreement with you on the ultimate settlement amount. Once you and the adjuster have reached an agreement on the amount, the adjuster will simply email you the papers to formalize the settlement. However, adjusters’ ability to settle claims on their own is often limited to a predetermined financial amount, and they may need to seek clearance from a claims supervisor or claims manager.
How to Speak with an Insurance Adjuster
For submitting an insurance claim, many insurance companies provide an app or an online portal. Once the claim is filed, you may find yourself engaging with the adjuster mostly by email. This is typically helpful for everyone since there will be a written record of every communication and less of the on-the-spot tension that a phone conversation could cause.
Of course, you should always be cautious about what you say (or write) to an adjuster, particularly when it comes to:
How the accident occurred: Never provide material that suggests you were even partly to blame for the accident that resulted in your claim.
Your injuries are of the following types: Even if your injuries seem to be small, don’t assume you’re completely healed. You should emphasize that you are adopting a “wait and see” attitude.
What If You Do Not Accept the Adjuster’s Settlement Offer?
If the adjuster’s settlement offer is too low, it might be a negotiation strategy or an effort to determine if you comprehend the true value of your claim. At this time, it may be prudent to draft a formal personal injury demand letter that includes:
the specifics of the event and why the adjuster’s insured is at fault
a detailed description of your injuries (including diagnosis)
a synopsis of your accident-related medical care
a narrative describing how the accident and your injuries have impacted your life (as part of the “pain and suffering” component of your claim), and a counteroffer to settle your injury claim.
Obtaining Assistance Following an Injury
If you’re having issues with the insurance adjuster or just can’t get them to come to the table with a reasonable settlement offer, there’s nothing wrong with informing them you’re ready to turn the claim over to an experienced lawyer.
This technique may elicit a reasonable settlement offer from the adjuster, or you may choose to proceed and at least discuss your position (and your choices) with a lawyer. Find out more about hiring an injury lawyer. You may also use the tools on this website to find a personal injury attorney in your region.