Having an insurance policy adds a layer of protection and security for your life, health, and properties when it comes to unexpected events. Losses and damages can be a major setback to your way of living but with insurance coverage, you can get back on track with your life faster. The insurance adjuster or claims adjuster is the person you will be frequently interacting with when you make an insurance claim. They represent the insurance company that provided your insurance policy and are responsible for determining if a claim is valid and falls under the terms of your insurance policy and how much coverage the insurance company is accountable for.

To help you understand the insurance claim process better, we will discuss here some of the responsibilities of an insurance adjuster.

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Verifying if a Claimant’s Insurance Coverage Applies to the Loss

Verifying if a Claimant’s Insurance Coverage Applies to the Loss

An insurance adjuster assesses different types of losses or damages including personal injury and property loss or damage. While insurance adjusters often represent the insurance companies, you can also hire an independent contractor as an adjuster who will represent you as a claimant. Whether the adjuster represents the insurance company or the claimant, they need to have a thorough understanding of the insurance policy and coverage terms.

Thus, an adjuster must determine the cause of the accident and analyze the causal factors and variables that led to the loss or damage. The adjuster may even interview the claimants, witnesses, and relevant individuals connected to the claim (police officers, fire marshals, physicians, and other experts or authorities). They need as much information as they can to verify the veracity of the claim and if it is within the insurance coverage terms.

Assessing Damages to the Claimant’s Property

The insurance adjuster must be proactive and hands-on with their approach regarding damage or loss assessment. They need to check the scene of the incident if necessary or collect visual evidence of the reported loss or damage. It is indispensable for appraising the value of the property and estimating the value of the losses. These values are essential references for calculating a suitable settlement payment.

Facilitating the Timely Processing of Claims Evaluation

Facilitating the Timely Processing of Claims Evaluation

Timeliness is an essential factor in processing claims to avoid technicalities and piling liabilities on the insurance company. Thus, insurance adjusters need to be prompt with their claims evaluations as many insurance companies have specific and strict requirements regarding the initiation of claims evaluation within particular timeframes. This timeframe takes effect immediately after the claims adjuster has notified the insurer of the covered loss under policy terms and may vary depending on the type of loss involved.

The insurance adjuster also has to review medical bills, medical records, property damage reports, and other relevant reports related to the insurance claim to account for all the damage costs relevant to the claim. The insurance adjuster will then verify if all or some portions of the damage costs are covered by the policy and estimate the covered cost that will be settled by the insurance company.

Negotiating Settlements with Claimants

An insurance adjuster needs to have remarkable negotiation and communication skills as they are the representatives of the insurance company and facilitators of the processing and finalization of insurance settlements for the claimants. They need to clearly and effectively relay to the claimants the essential provisions of their policy contracts and what the coverage conditions are. A claims adjuster also needs to arrive at a settlement that benefits both parties (the insurance company and the claimant).

Good decision-making is another skill that insurance adjusters must possess if a negotiation proves futile or breaks down. They can suggest a litigation process to help speed up the resolution of the settlement claim.

Investigating Suspicious Claims

Investigating Suspicious Claims

Most insurance adjusters are representatives of their respective insurance companies. Thus, they need to protect the best interests of the companies they represent and safeguard them against suspicious and fraudulent claims. This is why claims adjusters take time to carefully analyze records and pieces of evidence submitted by claimants to validate the veracity of the claim and filter out questionable claims. Insurance fraud is a threat to the operational integrity of insurance companies, and insurance adjusters are responsible for determining if insurance fraud is at play. The intercepted fraudulent claims need to be referred to the company and the legal authorities for proper handling.

One misconception about insurance adjusters is that they have it easy with handling and evaluating insurance claims. In reality, their jobs handle a delicate position of balancing a satisfactory settlement for claimants and coverage that does not put the company at an excessive or unnecessary loss. Having an idea of what an insurance adjuster does can help claimants substantiate their claims better and file reasonable insurance coverage claims.

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