Claims Adjuster

What is 'Claims Adjuster '

A claims adjuster investigates insurance claims to determine the extent of the insuring company's liability. Claims adjusters may handle property claims involving damage to structures, and/or liability claims involving personal injuries or third-person property damage. A claims adjuster reviews each case by speaking with the claimant, interviewing any witnesses, researching records (such as police or medical records) and inspecting any involved property.

BREAKING DOWN 'Claims Adjuster '

Claims adjusters verify insurance claims and determine a fair amount for settlement. 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 police reports 

  • Speaking to witnesses 

  • Talking to property owners

For example, if a homeowner makes an insurance claim due to a tree falling on the house, a claims adjuster would interview the claimant (homeowner), along with any witnesses, and inspect the property to determine the extent of the damage and the costs of repairing the property. The claims adjuster then submits documentation to the insurance company describing the incident and recommendations for the claim amount (how much money the insured will receive from the insurance company to repair the property).

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 must pass 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). With this designation, they can operate without having to pass the state licensing exam. The state will also ask for proof that they have taken part in 24 hours of continuing educations at least every two years.

For whom do claims adjusters work?

Claims adjusters work for the insurance company. They either work directly for the insurance company, or they may be a freelance 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. It is a good idea to consider employing your own independent claims adjuster, who works to protect your interests in a claim. Your own claims adjuster will do everything possible to minimize your loss. This lack of conflict-of-interest between the adjuster and insurer is in the claimant's favor.