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How do Insurance Adjusters Handle Insurance Claims?


If you ever get involved in a personal injury claim, you will have to interact with an insurance adjuster. Insurance adjusters, also known as claims representatives, works for insurance companies and negotiates insurance claims on their behalf.

If an insurance company has a branch office in an area, it may hand over the claim handling to an independent insurance adjuster. Independent insurance adjusters usually have to get the claim amount approved by an employee of the insurance company. As far as negotiating with a claimant goes, independent insurance adjusters have the same rights and authority as in-house adjusters.

Adjusters handling government claims are difficult to negotiate with because of the idea that its public money that one is spending in settling a claim. If the claim goes to court, the judges too will be loath to award a high amount. When it comes to such claims, you should expect an amount that is anything from 10% to 25% lower than what you could expect from a claim against a private party.

It is possible that you may have to deal with an attorney hired by the insurer. Attorneys instead of insurance adjusters are not uncommon. But that’s no reason to feel unnerved. An attorney cannot do anything different. At the most, an attorney may indulge in some bluff and bluster.

Remember, an insurance adjuster is the insurance company’s representative talking to you; even if it is your insurer and not the defendant’s.

Insurance claims get stalled when there is disagreement between the adjuster and the insured about the amount. Once that is cleared, claims get processed fast. Insurance adjusters get around a 100 claims a month and they have to not only process these claims but also save the insurance company money.

The most important thing to understand is that the insurance adjuster does not have any kind of advantage over you. If anything, you are at an advantage during negotiations because you have the facts with you; you have gone through the stages of accident, injury, treatment, and healing. The adjuster only has the information gathered from reading reports, bills, prescriptions, and invoices. Insurance adjusters can settle claims on their own, without involving senior supervisors. Experienced insurance adjusters can settle claims of up to $20,000. If the claims amount exceeds what an adjuster can authorize, then the matter gets escalated to a claims manager. In such cases, you must obtain a date by which you’ll hear back from the adjuster.

It is possible that the insurance adjuster may reject your claim outright. The usual reasons cited for rejection include a lapsed policy, accident or injury type not covered, location not covered, disqualification for raising a claim under state laws, etc. And to buttress their assertion, the insurance adjuster may include a lawyer’s letter stating pretty much the same – that you don’t have a claim.

It is important to know that the insurance adjuster can opine on whether your claim will be honored or not, but that opinion is not final. This is the reason why small claims courts and civil courts accept claims’ disputes.

To initiate further proceedings, you must ask the insurance company to provide you with a written explanation for the rejection. This demand will let you know if the insurance adjuster is only testing waters or he actually means that you don’t have a case for claims. If the adjuster refuses to provide such information, then escalate it to the claims manager asking for the same information on reasons for rejection and the specific provisions in the insurance policy that are being invoked. This letter that you write to the claims manager can serve as valuable evidence in your favor should the matter reach the courts.

In many cases it happens that the adjuster first rejects the claims outright and then when you make it clear that you’re not abandoning your claim, the adjuster displays willingness to negotiate.

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