Understanding who insurance adjusters are and how they work can help take a bit of the mystery out of the insurance injury claim process. This article covers:
Insurance claims adjusters come with different job titles—claims specialist, claims representative, independent claims analyst—but they all do the same kind of work: When an accident or other incident triggers insurance coverage, the adjuster handles the resulting claim.
For example, after a car accident, an injured passenger might file an injury claim with the at-fault driver's car insurance company, under the driver's liability insurance coverage. In that situation, an insurance adjuster for the driver's car insurance company will handle the injured passenger's claim.
When you file an insurance claim after an accident, you'll usually work with a claims adjuster who's employed by the at-fault party's liability insurance company. But that's not always the case.
Independent claims adjusters might represent an insurance company, and operate essentially the same as in-house claims adjusters. The only difference is that they may have a lower dollar value authority limit within which to settle a case, and usually must have any settlement agreement approved by a claims supervisor.
Public entities such as state governments or large cities often have their own claims adjustment offices. They may even have assistant city, county, or state attorneys who deal directly with accident claims even before the matter gets to court. Get details on injury claims against the government in your state.
If you file a claim under your own car insurance policy (under your collision coverage or uninsured motorist coverage after a car accident, for example) you'll negotiate an injury settlement with a claims adjuster who will be acting as the company's representative (not yours). That doesn't necessarily mean things will be adversarial, however. Learn more about negotiating with your own insurer after an accident.
Continuing with the earlier example of our passenger who was injured in a car accident: Once the passenger opens their claim with the at-fault driver's car insurance company, the adjuster (who works for the driver's insurer) will assign a claim number and gather some basic information (like the date of the incident and the claimant's name, date of birth, address, and contact information).
The adjuster will also ask the claimant for authorization to obtain accident-related medical records.
At this point, the adjuster will:
Learn more about how an insurance adjuster investigates a car accident.
The investigation and damages valuation phases of an insurance claim all lead to the insurance adjuster's main role, which is to resolve claims on behalf of the insurance company (always in service to the company's bottom line). That sometimes means denying a claim or refusing to pay anything at all to the claimant. But most often it means negotiating a settlement of the claim.
Insurance adjusters are judged not only by how little of the insurance company's money they spend in settlements but also by how quickly they settle claims. Most adjusters get between 50 and 100 new claims a month across their desks. They have to settle that many claims—known as "clearing" or "closing" a claim file—each month just to stay even.
While an adjuster will know more than you about the claims business in general, they will not know your particular claim nearly as well as you will. You were there during the accident. You know your injuries firsthand, including how long they've taken to heal.
The insurance adjuster, on the other hand, has only a couple of minutes a week to look at your file. All of this means that once an adjuster knows you understand the range of how much your injury claim is worth, they usually won't stall your claim. As long as you are organized and understand the process, you are the one with the negotiating advantage. Get tips on your first discussions with an insurance adjuster.
The adjuster has the authority to come to an agreement with you for what the final settlement amount should be. Once you and the adjuster agree on an amount, the adjuster simply sends you the paperwork to finalize the settlement. But adjusters' authority to settle claims on their own is usually restricted to certain dollar limits, and they may need to ask for approval from a claims supervisor or claims manager.
Many insurance companies have an app or online portal for filing an insurance claim. Once you get the claim started, you might find yourself communicating with the adjuster mostly via email. This usually ends up being beneficial for everyone, since there will be a written record of all correspondence, and not as much of the on-the-spot anxiety that might come from a phone call.
Of course, it's always important to watch what you say (or write) to an adjuster, especially when it comes to:
Learn more about talking with an insurance adjuster after an injury.
If the adjuster's settlement offer is unreasonably low, it may be a negotiating tactic or an attempt to find out if you understand what your claim is really worth. At this point, it might make sense to put together a formal personal injury demand letter that includes:
Learn more about writing a winning personal injury demand letter and see a sample reply to an unreasonably low settlement offer.
If you've run into problems with the insurance adjuster or you're just not getting them to come to the table with a fair settlement offer, there's nothing wrong with telling the adjuster that you're ready to turn the claim over to an experienced lawyer.
This tactic alone might spur a decent settlement offer from the adjuster, or you might want to follow through and at least discuss your situation (and your options) with a lawyer. Learn more about getting help from an injury lawyer. You can also use the features on this page to connect with a personal injury lawyer in your area.
Portions of this article were excerpted from the bestselling book How to Win Your Personal Injury Claim, by Joseph L. Matthews (Nolo).