How Does an Insurance Adjuster Approach Your Claim?

Insurance almost always figures into injury claims. Insurers offer liability insurance to cover the negligent actions of drivers, physicians, property owners, professionals, and others. You may work more with insurance companies during the course of a claim than with the at-fault individual(s). Knowing how insurance adjusters handle claims will help you prepare for the settlement negotiation process.

What Insurance Adjusters Do

Claims representatives, specialists, and adjusters are responsible for processing and closing claim files. They may work directly for insurance companies or with third-party agencies that specialize in claims processing activities. All adjusters exist to protect their employers’ best interest – not the interests of policyholders. They investigate claims, record evidence, and make claims decisions according to the insurance company’s policies.

Insurance adjusters may ask difficult questions about the case and search for red flags. While this level of diligence can identify instances of fraud, it can also hinder valid claimants from receiving benefits. Adjusters can use any number of tactics to stall or deny applications, and they generally look for the lowest cost ways to settle valid claims.

How the Insurance Adjustment Process Works

Insurance adjusters may reach out to you in the days or weeks after an incident. While they need to confirm basic information to initiate the claims process, many go beyond basic questions to try to find details they can use against you. They may ask if they can record the conversation and use the record to lower the insurer’s own liability.

Avoid giving any formal, recorded statement until after an accident investigation or until you speak with an attorney. During your initial discussions, focus on the facts of the claim and avoid specifics unless you are 100% sure. If you want to provide a statement to quickly secure a settlement offer, consider your answers carefully. Taken out of context, even the most innocuous phrases can hurt a claim.

After the initial conversation, the adjuster may request medical records, receipts, and other pieces of evidence to process the claim. While you may need to provide specific medical records, avoid giving a claims adjuster permission to independently access your records. They may use the opportunity to look for additional reasons to deny your request.

Insurance companies develop their own policies for calculating claim settlements. The adjuster will plug recorded expenses, current losses, policy limits, incident fault percentages, and other information into a system to calculate both economic and non-economic losses. Insurers typically follow a per diem or pain multiplier formula to determine compensation for pain and suffering and other non-economic losses.

Some adjusters may calculate a settlement range to create a starting place for negotiations. When they present an initial settlement offer, it may not include the maximum available compensation but rather the lower end of the settlement range. If you accept the offer, you may lose the ability to pursue further legal actions for compensation. Consider independently calculating the costs associated with your losses to effectively negotiate with the insurance company.

When to Hire an Attorney

The modern insurance system is complex. While some insurers offer fair benefits for valid claims, many do not. An insurance adjuster views claims and case evidence from a risk management standpoint. He or she may not get to know a claimant personally and will not consider a claimant’s best interests when evaluating a claim.

Personal injury attorneys deal with insurers every day. A legal representative will get to know your case. He or she can negotiate with insurance adjusters on your behalf and protect your rights to compensation under state laws. Consider talking to an personal injury attorney about your injury claim if you suspect unfair treatment or if your insurer offers an unreasonable settlement amount.