Adjuster

Reviewed by Stefan Tirschler

Noun

ad·just·er | əˈdʒʌstə

Definition: A person who investigates insurance claims on behalf of an insurer to determine the extent of the insurer’s liability.

I spoke with the insurance adjuster today. She asked if we had any more receipts for all the damaged furniture.

What is an insurance adjuster?

When a person with an insurance policy experiences a loss, they’ll submit a claim to their insurance company. The adjuster (a.k.a. insurance adjuster or claims adjuster) is the person who investigates that claim on behalf of the insurance company.

Insurers have to do their due diligence when it comes to paying out on claims. Otherwise, they might end up paying claims that fall outside of the policy’s coverage or claims that are fraudulent in nature. This would use up all of the funds that the insurance company needs for legitimate claims, eventually causing the company to go out of business. Then no one would have insurance.

To avoid this, insurance companies hire adjusters to investigate claims and help arrive at settlements that are fair to both the insurer and the insured. The adjuster communicates with the insured throughout the claims process on behalf of the insurance company.

In Canada, each province and territory has its own insurance regulator. Insurance adjusters are licensed by these regulatory bodies. They need to have the right license for the province in which they’re working.

What does an adjuster do?

The job of a claims adjuster is a busy one. When an insured person files a claim with their insurance company, that claim will be assigned to an adjuster. The adjuster will then start a claim file and collect the necessary details. They need to deliver a report to the insurance company that explains everything about the claim and how much the insurer should pay to settle it. The adjuster will also analyze the insurance policy to determine which parts of the claim are or are not covered.

Example

Anwar is a claims adjuster working for an insurance company. One day, he receives a claim from a customer; this customer had their home broken into and had some of their expensive jewellery stolen. The first thing he does is call the insured to hear their story and find out more about the incident. He finds out that the insured was away on vacation at the time, so they don’t know much beyond what’s missing and what’s damaged. They did file a police report, though. After getting the basic information, Anwar gets in his car and drives across town to meet the customer and take a look at the scene of the burglary.

In order to make an accurate and fair determination of the settlement amount, the adjuster needs to gather a lot of information. During their investigation, they’ll visit the site of the damage, interview claimants and witnesses, review police reports, consult with relevant experts, or anything else they need to do to get the full picture. If you’re submitting a claim, the more details you can provide your adjuster, the better; you’ll save them time trying to track things down, and they’ll be able to settle your claim faster.

Along the way, the adjuster will often be able to help the insured take necessary steps like obtaining repair estimates and selecting professional contractors.

Once they’ve concluded their investigation and determined the cause of the loss and the extent of the damage, they will report all of that information to the insurance company along with a recommended settlement amount. The adjuster tries to determine the amount that covers the insured loss, no more and no less.

Example

After speaking with the customer, taking some photos of the damaged door, and reviewing the police report, Anwar has determined that the customer’s policy will cover this claim; the jewellery had clearly been stolen, the customer had chosen to add sufficient jewellery coverage to their policy, and they had receipts to confirm the jewellery’s value. Anwar calculates the cost to replace the stolen jewellery will be $7,000 and the cost to repair the damage the burglar caused by breaking in will be $800. In his report to the insurance company, he recommends they pay the customer $7,800 to settle the claim, minus the customer’s deductible of $1,000.

Of course, sometimes things don’t go perfectly smoothly; it can be hard to figure out the precise cause of a loss, or sometimes the insured won’t agree with the adjuster’s settlement amount. The adjuster also functions as a negotiator. Even though they’re working for the insurer, they want to make sure that both sides are content with the settlement. It’s a delicate balance.

An adjuster may handle claims differently depending on the insurance company (or insurer) they work for. For example, some adjusters may be authorized to pay out small claims quickly, under express settlement processes. For example, at Square One, many small claims can be handled using our online claims process. Larger, more complex claims still require some legwork, but most of Square One’s claims in Canada are settled within 60 days.

What is an independent adjuster?

Insurance companies usually have in-house adjusters, but they’ll also often outsource the adjusting process to independent adjusters. Independent adjusters are third parties who perform adjusting services on a freelance basis. If an insurance company issues policies in an area where they don’t have an office (a very common occurrence), they’ll hire an independent adjuster to handle claims coming from that area.

Apart from working on a freelance basis, independent adjusters pretty much function the same way as in-house adjusters. They investigate claims, speak with claimants, file reports, and determine how much the insurer should pay to settle the claim.

The important points

  • An insurance adjuster works for an insurance company (or an independent adjusting firm).

  • When an insured person submits a claim, the adjuster investigates the details of that claim to decide how much the insurance company should pay.

  • The adjuster also acts as the insured person’s point of contact during the claims process and negotiates the final settlement with them on behalf of the insurance company.

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