Claims evaluation

When an insured customer submits an insurance claim, an insurance adjuster is dispatched to make a claims evaluation. During this process, they typically may evaluate:

  • The validity of the claim
  • The extent of the damage
  • Coverage under the purchased insurance policy
  • Entitled compensation, if any

What is an insurance claims adjuster?

An insurance adjuster (also known as a claims adjuster or claims examiner) is a person who investigates insurance claims to determine the extent of insuring a company's liability. Claims adjusters are usually split into two categories: inside adjusters, who primarily work in an office, and field adjusters, who visit the location specified in the claim, taking photos and conducting interviews.  

There are three main types of insurance adjusters:

  • Staff adjusters are employees of an insurance carrier.  
  • Independent adjusters can be hired by insurance carriers to investigate a specific claim. They may be employees of an independent firm, but they operate on behalf of the insurance carrier who contracts them.
  • Public adjusters are hired by policyholders, most likely because the policyholder is unsatisfied with the claim settlement offered by the insurance carrier. They are often independent contractors and may receive a percentage of the settlement fee they help negotiate.

The importance of claims adjusters

Insurance adjusters play an important role in maintaining transparency during the claims process. Their primary duty is to evaluate each situation accurately and reach a settlement.  

Key steps in the claim's evaluation process

The insurance claims process generally includes the following steps:

  • Claim Investigation: This step can include investigating the situation that led to the claim, gathering evidence, reviewing testimonies, and inspecting damages.
  • Policy Review: Insurance claims are determined by what the policy coverage states. Part of the claims process may involve examining policy documents to see if and how the claim may qualify for coverage.
  • Damage Assessment: This can include considerations such as: what sort of repair costs may be required? What was the value of the losses sustained?  
  • Settlement Determination: The insurance carrier may review the adjuster’s findings and provide a claim settlement offer to the policyholder, as outlined in their policy documents.

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