an adjuster reviewing an insurance claim

What Is an Adjuster?

May 20, 2024
Mordechai Kamenetsky

In terms of insurance, an adjuster is a professional responsible for reviewing insurance claims. This person determines how much the insurance company owes by looking over the claim, considering the damage, and negotiating any settlements. This ensures all claims are accurately and fairly resolved.

What is an Adjuster’s Role and Responsibilities?

Adjusters have an important role in the insurance world. They are the main contact between the insurance company and the person who files a claim. 

Adjusters need to know how to review policies. They must understand terms, conditions, and overall coverage. They figure out what is covered under a policy and under which circumstances. 

Are there different types of Adjusters?

Yes, in the insurance industry, there are many types of adjusters, each doing different tasks. 

Staff adjusters are full-time workers for insurance companies and do claim work for their employer. Independent adjusters aren’t tied to a company. They are instead contractors who get hired by different insurers, often when there are lots of extra claims due to things like natural disasters. 

On the other hand, public adjusters are hired by people who have insurance policies. They represent their interests in claim negotiations. They are often key to getting a better settlement. Adjusters might have different employers and unique responsibilities, but they are all held to high ethical standards and legal regulations. This ensures lawful and fair processing of claims across the board.

Adjusters Specialize in Different Industries 

As an example, a property insurance claim resulting from an earthquake needs a detailed assessment of the physical damage. This means the adjuster needs to understand construction standards and building materials. 

On the other hand, health insurance claims require knowledge of medical terminology and procedures.

Having knowledge in certain fields makes some adjusters better able to handle different claims. This ensures all parts of a claim are evaluated well and fairly resolved. 

Understanding the Investigation Process

After a claim has been filed, the adjusters start an investigation process. This can encompass all sorts of different activities. For instance, the adjuster might visit the site of the incident. They also may interview witnesses or consult with experts. This could include medical professionals, engineers, and other professionals. 

The type of claim will often determine what the actual process is. So, it’s going to be different for a personal injury than a vehicle accident or property damage.

Documentation and Compliance Details

During the claims process, insurance adjusters need to document everything that happens. This includes the initial claim assessment, the final settlement negotiations, and everything in between the two. Documentation includes recording communication with everyone, findings, and any decisions that are made. 

Having comprehensive documentation is important to resolve disputes. However, it’s also useful for other reasons, including the need to comply with industry standards. 

The records also act as a trail to be sure all involved parties are treated fairly and each claim is handled consistently compared to others. Good documentation also protects the insurer from legal challenges while increasing the efficiency of claims.

The Goal of the Claims Process

Another huge part of an adjuster’s job is to negotiate with the person who filed the claim or their representatives to make a settlement. 

The main goal here is to settle claims in a way where the insurance company and the person bringing the claim are both satisfied. This requires a balance between the insurer’s liability and offering fair compensation for the event.

Skills Required of Adjusters

Adjusters need to have many kinds of skills to resolve and manage cases. For instance, analytical skills are crucial. They help an adjuster when interpreting policy details and assessing complex situations to be sure of coverage. 

Strong communication skills are also important to interact with claimants and other stakeholders. These individuals may be upset but have important information or need a decision explained to them.

Negotiation skills are useful to ensure fair settlements are reached that satisfy everyone. Organizational skills are also useful for managing the many tasks related to dealing with several claims at the same time. This is important since all need to be handled efficiently and within the different required timelines. 

Mordechai Kamenetsky

Mordechai Kamenetsky, co-founder and lead agent of Kickstand, is recognized as an expert in workers' compensation. He is passionate about helping small businesses manage risks and lower their workers' comp costs. In his articles, he educates readers and clients on the intricacies of workers' comp insurance.

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