There are a few steps required before an insurance company can issue a payout due to an injury, illness, or property damage. The first thing needed is to file a claim. The second step is sending the claim to an insurance adjuster.
The role of an insurance adjuster, also known as a claims adjuster, is to review the information within a claim. Their goal is to determine if the insurance company should pay for damages or medical care. In some situations, they must decide if the claim is entitled to full or partial payment.
The adjuster either works within the insurance firm or is hired as a contractor to assist in claim examination. They make their decisions based on several criteria, including the following:
The reason the claim was created.
The extent of damage, injury, or illness.
A personal investigation of the person or the property.
In-person or phone interviews to gather more information.
Interviews with witnesses or officials like police officers.
The costs are connected with the liability.
Insurance adjusters aren’t much different than attorneys when they decide on a claim. The first thing they do is gather the needed information. Once this is done, they compile it into something they can present to the insurance company for review.
What they provide isn’t simply testimonials. They offer evidence like photographs, police reports, and invoices related to medical and property costs. With this, they include their advice on whether or not the insurer should pay out the claim.
Let’s say a homeowner’s roof was damaged by hail during a particularly heavy thunderstorm. Once a claim is filed, the adjuster would come out and assess the situation. They would examine the roof to check the extent of the damage. Additionally, they would review the attic and other elevated areas to determine if there was any internal damage.
Using photos they took at the site, the adjuster would present their findings to the insurance company with a recommendation for or against covering the damage. In the end, it’s up to the insurer to give the go-ahead. There are some situations where underwriters will accept a claim when the adjuster believes it isn’t worth it.
Normally, the title given to someone who reviews claims is an insurance adjuster. Then some are given the role of Adjuster in Claims (AIC). These are individuals who are subject matter experts in a variety of claim types. These can work directly for an insurer or be a freelancer who works for several companies.