Claims adjusters investigate insurance claims by interviewing the claimant and witnesses, consulting police and hospital records, and inspecting property damage to determine the extent of the company’s liability. In the United Kingdom, the Republic of Ireland, Australia, and South Africa the term Loss adjuster is used.
Claims adjusters have the knowledge to complete the preparation of a property damage claim which, to an unrepresented homeowner, may be unfamiliar territory. The documents contain technical terms such as depreciation, replacement costs, and actual cash value, that may be unknown to the policyholder, and a trained claims adjuster can ensure a correct completion.
There are three classes of claims adjusters:
*staff adjusters (employed by an insurance company or self-insured entity),
* independent (independent contractors; not insurance company employees)
* public adjusters (employed by the policyholder).
It should be very clear that in the two first instances, the adjuster defends the rights of the insurer and works for a fair settlement for both parties.
Adjusters may handle "property claims" involving damage to buildings and structures, or "liability claims" involving personal injuries or third-person property damage from liability situations, such as motor vehicle accidents, slip and falls, dog bites, or alleged negligent behavior. Some adjusters handle both types of claims and are known as "Multi-Line" adjusters. Public adjusters work exclusively for the policyholder. This means there should be no inherent conflict of interest when it comes to advocating on the policyholders behalf to the insurance company.
An independent adjuster could be working for multiple insurance companies.
An adjuster will frequently verify that coverage applies through an insurance policy, investigate liability for the damages caused, and make restitution to the injured person based on their physical, emotional, or physical property damages.
Many homeowners reach a fair settlement with the staff or independent adjuster they are working with. In the event they are not, they can hire a public adjuster. Public adjusters claim that many homeowners do not collect all the money to which they are entitled due to a lack of familiarity with the claim process. The use of a public adjuster may mitigate this risk and could help put the policyholder on a more equal footing with the insurance companies, which increasingly use experts to support their side of a claim settlement. Public adjusters charge for their services, the standard rate is 10% of your claim settlement. For example, If you suffer a $250,000.00 fire loss, the public adjuster fee for assisting you would be $25,000.00 This $25,000.00 is taken out of your claim settlement. The objective of a claims adjuster should be to protect the insured against not only financial loss, but also the cost of recovering it.
Specific duties include:
* Responding to claims in a timely manner
* Filing paperwork
* Communicating with policy holders
* Investigate liability
* Assess damages
* Research, detail and substantiate each aspect of the claim, including building damage, contents, and extra living expense claims.
* Negotiate with product/service providers on time and cost of repairs for the purpose of making an offer of settlement to the insured.
* Ensuring accurate procedures
* Protect the interest of the insurance company the adjuster represents, when dealing with claimants.
Some states now require public adjusters disclose to claimants whose interest specifically independent, staff and public adjuster represent, before they are retained by the policyholder. There is no such requirement at this time for insurance companies to do the same.
Most Colleges have not yet recognized the need for a major specifically for those who wish to become Claims Adjusters, however there are some professional designations that have become prevalent among higher achievers in the field. For example, The American Institute for Chartered Property Casualty Underwriters awards the Chartered Property and Casualty Underwriter (CPCU) designation to experienced underwriters. Some Adjusters find that gaining these types of designations have been very advatantageous to their careers. Many insurance companies prefer their claims adjusters to have a 4-year college degree preferably in business related fields; however having a degree in liberal arts is acceptable as well. There are times in which a person with a high school education will become a claims adjuster usually by promotion from within the claims department while serving as a customer service representative. Since there are no college majors for claims adjusters, many states require a state certification in order to practice as an adjuster. States also require that a certain number of continuing education credits for claims adjusters are earned each year in order to maintain their license. This continuing education is achieved by attending seminars and online training from different claim adjuster educational resources. One brief example of an educational seminar is where a group of claims adjusters will meet and discuss how to distinguish a false claim from a true claim.
Florida is one of the few states in the United States that has created specific designations for the licensing of insurance claims adjusters. The Accredited Claims Adjuster Designation, created by statute in 2003, allows an individual to obtain the Florida All Lines Independent or Company license, without taking the state licensing exam. The University of Central Florida is the only major university in the state to recognize the expanding need for insurance pre-licensing and offers the designation throughout the country.
Most states require licensed adjusters to continue their education through a 'continuing education' requirement. Florida requires 24 hours of CE every two years. Courses, such as those found at the University of Central Florida, are offered live and online.
Many claims adjusters may work long hours. The majority of claims adjusters work more than 50 hours a week, they work nights, and sometimes weekends because claims adjuster usually have to make appointments to see their clients, so the adjuster must be able to adapt their schedules in order to accommodate their clients.
The more experienced claims adjusters are able to work from home. They will receive their work load for that day through their private fax machine or their email accounts. The most common claim adjusters receive their assignments when they arrive at the office first thing in the morning. In the case of a severe natural disaster such as floods or tornadoes, adjusters from another city or town are called in to support the local government. This results in the adjuster being away from home for days at a time until all claims are resolved.
Laptop computers, cell phones, and other technology has made the process of claims adjusting easier and it consumes less time; however, there are positions that require physical strength as well as stamina. Property adjusters, for example, many times are required to operate a 50-pound ladder, able to stand, walk, kneel, crawl, and other physical demands as they investigate property that has been damaged.