Understanding the Role of an Insurance Adjuster

Insurance adjusters are responsible for evaluating damages and deciding your claim outcome. They assess claims for many types of insurance, including life, health, homeowner, and car insurance. This means if you make a claim, an insurance adjuster may be assigned to your case to evaluate whether to accept or deny your claim, as well as how much to pay out if your claim is accepted.

What Does an Insurance Adjuster Do? 

An insurance adjuster reviews the damage or loss and determines the payout size you receive. For instance, a property claims adjuster assesses damage to your home to decide whether the damage was in fact caused by a peril covered within your policy — and if so, how much it would likely take to repair the damage or loss.

An insurance adjuster reviews your policy documents to ensure they understand what you are entitled to under the policy’s guidelines. Depending on the severity of the damage and size of the claim, the insurance company may arrange a time for the adjuster to visit and assess the damage. For example, while a relatively minor claim — such as for theft as long as you were able to provide the necessary documentation — may not warrant an insurance adjuster’s personal visit, a larger claim for fire damage may trigger an in-person evaluation.

Their visit is likely to include inspecting and documenting any visible damage. In addition, they may interview you to create a comprehensive record of what happened. The claims adjuster may be able to decide on the outcome of your claim during their visit and review your options with you, or they may need to take further time after the visit to come to a conclusion.

Company vs. Public Adjusters 

A company insurance adjuster is on the insurance company’s staff, whereas a public adjuster is hired by you to work on your behalf and is paid from a percentage of your insurance payout. You will retain a public adjuster if you are unsatisfied with the company adjuster’s decision.

When you file a claim, you work with the company adjuster first. They evaluate the damages and decide your claim’s outcome on the behalf of your insurance company. If you disagree with their decision, consider consulting an attorney about on the likelihood of increasing your payout amount by hiring a public adjuster. 

Another type of adjuster is an independent adjuster. These individuals are hired by insurance companies if they need more assistance. Independent adjusters work for themselves, so they are not part of the company staff but are engaged on behalf of the company. 

How Does a Claims Adjuster Evaluate Damages?

A claims adjuster gathers evidence of damages to assess what you are entitled to under your policy. This process includes the following steps:

1. Review the policy documents. Claims adjuster familiarizes themselves with your policy details to clearly understand what you are entitled to. This includes your deductible, the maximum coverage limit, and the specifics of what you are covered for and under what circumstances. 
2. Gather and assess evidence. The adjuster arranges to come out and inspect the damages. They may want to take photographs and talk to you and anyone else involved. Once they have gathered sufficient evidence, they assess the damages against the policy and make a decision. 
3. Offer a settlement or deny the claim. If the deductible exceeds the costs of repairing the damage, then the adjuster may decide you are not entitled to a payout. If the cost exceeds the maximum coverage limit, the adjuster can only be able to confirm a partial payout. In cases where the policy does not cover the specific circumstances under which the damage occurred, the adjuster may not offer a settlement at all. 

How To Prepare for an Insurance Adjuster Visit 

There are a few things you can do to prepare for an insurance adjuster’s visit, such as:

• Do not clean up damage or the surrounding area. The adjuster needs to see as much evidence as possible, and if you clean the area, there may be less evidence to document. However, do whatever needs to be done to prevent further damage from occurring if possible, such as shutting off a water main or covering a broken window.
• Take photographs. Take pictures of the damage in advance so you can be sure that nothing is missed in the evaluation.
• Review your policy documents. Review your policy documents so you have a clear idea of their key features. This will help you better understand the coming discussion with the adjuster. 
• Arrange to have someone with you. Preferably, you would have someone who understands what repairs need to be done with you. For example, if your windows are broken, it may be helpful to have a trusted friend who has done window replacements before to help judge the repair cost estimates. However, having a trusted ally present as a witness in general can be helpful.
• Prepare for the adjuster’s questions. You can refuse to give a recorded statement. However, if you decide to go ahead with it, record the exchange on your own device. Be completely honest with the insurance company, and do not offer additional information beyond what is necessary. Listen carefully to the question and give only the facts.

Can You Hire Your Own Claims Adjuster? 

Yes, you can hire a claims adjuster to work for you, otherwise known as a public adjuster. If you go this route, you would pay them from a percentage of the claim payout. However, you do not pay the company adjuster, so think carefully about your needs before hiring a public adjuster to avoid unnecessary costs. 

If the company adjuster denies your claim or offers less than you believe you are owed, you might consider hiring a public adjuster. Keep in mind though that if the amount offered is lower due to a high deductible, a maximum coverage limit, or circumstances not being covered, then a public adjuster cannot help. However, if you think the company adjuster has not assessed the damages and associated costs fairly, then a public adjuster may be able to assist.

Before signing with a public adjuster, check the terms of their agreement. Ensure they would only be paid a percentage of any additional amount they secure. They should not take any part of the amount you were already offered. 

How To Contest a Claim Denial or Settlement 

If you decide to contest a claim denial or settlement, you may wish to consult a lawyer. Depending on your situation, this can sometimes be necessary. A lawyer might have a preliminary conversation with you to determine if their services may be required. 

When you are ready to contest the insurance company’s decision, contact your claimed representative and tell them you wish to contest the decision and why.

There may be forms for you to fill out, and you may be required to provide additional documentation. You may need to explain why you think your claim should not have been denied or why the settlement should have been higher. 

Do copy any filled-out forms before you send them back to the company. If you speak to them on the phone, note the date and time and what was said. It is important to keep your own records so you can communicate confidently about the facts as the situation progresses. 

Follow up consistently, and if you are unhappy with the outcome, ask if there is an escalated appeals process. See if there is more you can do to contest the denial.