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By MarcWites

What does an insurance claims adjuster do?

What does an insurance claims adjuster do?

An insurance claims adjuster conducts investigations into claims covered by an insurance policy. These can be any type of claim, from personal injury to property damage. In property damage claims, the main role of the insurance adjuster is to carry out a detailed investigation into the claim by:

– Inspecting the damage
– Reviewing any police reports
– Speaking to any witnesses
– Talking to the property owners

Once the investigation is complete, the adjuster will then be in a position to determine the amount of the insurance company’s potential liability to its insured. Adjusters very often try to convince property owners to accept less money than their claim is worth.

In Florida, insurance claims adjusters have passed certain exams and need to hold professional qualifications. Florida is slightly different from other states within the United States as it offers the opportunity for adjusters to qualify in accordance with the ACAD (Accredited Claims Adjuster Designation) which will then allow them to operate without having to pass the state licensing exam. It also asks for proof that they have taken part in 24 hours of continuing educations at least every two years.

Who does the claims adjuster work for?

Not you. The insurance adjuster works for the insurance company. They either work directly for the insurance company, or they may be an independent adjuster hired by the insurance company to handle specific claims. In either case, they will not have your best interests in mind, as their employer is the insurance company. This is why it is always a good idea to think about employing your own independent claims adjuster who will work to protect your interests. Your own insurance adjuster will be do everything possible to minimize your loss. As you may imagine, this is the preferred scenario as this way there will be no conflict of interest between the adjuster and your insurer.

Are claims adjusters all the same?

There are three different types of insurance claims adjusters:
– Staff adjusters – employed by the insurance company
– Independent adjusters – usually hired by the insurance company
– Public adjusters – employed by the policyholder (claimant)

*Independent adjusters may work for a company or an individual.

What will the claims adjuster do?

The claims adjuster first confirms that the damage that has been caused is covered by the insurance policy that you have in place. If it is, then the policy will be responsible for covering your losses, and may also cover any any associated hardships that may have materialized. For example, if your home was damaged so much that it became uninhabitable, any hotel or accommodation costs that you incur would also need to be reimbursed under the policy. It will be the claims adjusters’ role to liaise between you and the insurance company and take care of all the paperwork. The adjuster’s role can encompass all of the following duties:

– Informing the insurance company of the details of the loss
– Researching and assessing damage \ Ascertaining where the liability lies
– Investigating all aspects of your claim including damage to buildings and property, any contents, anyone involved in an accident due to the damage and all additional expenses
– Compiling a damage report so that financial losses can be determined
– Liaise with any specialists or tradespeople required to make good the repairs or re-building

As well as asking lots of questions, you will normally find the adjuster taking a great deal of photos. These will be submitted as evidence along with your claim. The adjuster will require access to all parts of the property, so do expect her to use ladders, tools, torches and safety equipment if she has to climb onto roofs or explore cellars or attics.

Who does the insurance adjuster represent?

The insurance adjuster represents the insurance company, and not you. If you believe the adjuster is biased and working for the interest of the insurance company and not you – the claimant – you should consider hiring your own public adjuster or lawyer.

Is an insurance claims adjuster the same as a public adjuster?

Usually not. A public adjuster is a specific type of insurance claim adjuster who works only on behalf of the insurance policyholder to sort out the claim. They normally work on a percentage of the settlement figure rather than being paid a regular salary. A public adjuster will perform the same tasks as the insurance company’s adjuster but will do so with your best interests in mind.

So should I hire a public adjuster?

It depends upon your circumstances. Once you notify your insurance company that you have a potential claim, they will send their own adjuster to visit the property to ascertain the damages and losses. Should you inadvertently give incorrect information or the wrong type of information to the assessor, she will pass this on to the insurance company. This could negatively impact your claim. Once the process has started, it will be more difficult for you to put your own public adjuster in place as your answers will have already have been transmitted to the insurer. If you are going to use a public adjuster, it is critical that you do so early stages of the claim. He will then be able to best represent you and ensure that you are reimbursed fairly for any losses. It is worth noting that even if you do bring in a public adjuster at a later stage, the adjuster can still re-negotiate settlement for a higher figure, even if a sum of money has already been paid to the insured party.

When will the claims adjuster visit me?

Claims adjusters don’t just work during office hours. They will often work evenings, weekends and even during public holidays. Before they come to see you they will have to make prior contact in order to arrange an appointment to suit you. They may travel to see you from an office or possibly they may be remotely located at their home. Depending upon the extent of the damage to your property and the general conditions of the locations, he may spend just a few hours with you or more. Repeat visits may be needed and, if a natural disaster has occurred, he may be visiting other properties and buildings in the area, as well as yours. These types of catastrophic events usually require the claims adjuster to be present for several days or even weeks in which case they would be accommodated in a hotel.

What is loss recovery insurance?

If you have this type of insurance in place, it will pay to cover the costs incurred when employing the services of a public adjuster to work on behalf of the policyholder. If you do have this type of cover, it is a good idea to make use of it as you will have peace of mind knowing that you can hire your own assessor and that he will be working in your best interests to protect your losses and not those of the insurance company.

Should I hire an insurance claims lawyer?

Miami Residential Property Damage Insurance Claim Attorneys wites law firm

If a claims adjuster is representing your insurance company, you may be surprised to find yourself being pressured to settle. If you are unprepared for this, you may lose out financially. It can be an extremely stressful situation as you want to get your property repaired as soon as possible but do not want to do so at the risk of your monetary claim being negated. In this case, it is a good idea to use an experienced property damage lawyer to represent you and provide you with insurance claims legal representation.

The insurance company will use a lawyer so it is only by you doing the same that you can be sure of competing with them on a level playing field. Your own lawyer will then do all that is possible to maximize your claim and the amount of money that you receive. Insurance policies are taken out to protect us and the only way to be fully protected is by ensuring that you have the correct insurance claims assessor in place or by hiring an insurance claims lawyer.

Wites & Rogers has a legal team that specializes in insurance claims and has taken cases as far as the Florida supreme court where we have won and forced the insurance company to pay the full amount of its $2 million dollar insurance policy. If you are going to fight your insurance company to get what you are owed make sure you bring a team of lawyers who will show that you mean business!
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Marc A. Wites

Marc A. Wites is the founding shareholder of Wites & Rogers. He directs the firm’s litigation practice groups for personal injury and wrongful death cases, class actions, property insurance claims, sexual assault, and investment fraud.

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