What Is The Job Of A Claims Adjuster?

When you file an injury claim, one of the most important decision-makers in the process is the claims adjuster. This is a person appointed by the insurance company to investigate the validity of the claim. Among the first questions many folks have for a personal injury attorney, though, are what is an adjuster's qualifications and what do they do?

Adjuster Qualifications

Other than state-level licensing requirements, there are no standard qualifications for an adjuster. In theory, an adjuster could have a high school education and no previous work experience. In practice, most companies want them to have either a bachelor's degree or equivalent real-world experience in investigations, finance or insurance. Some have backgrounds in accounting, for example.

Who Does the Adjuster Represent?

Most adjusters are independent professionals paid by the insurance company to conduct unbiased assessments of incidents and claims. They do not have a fiduciary responsibility to the insurance company. Instead, the adjuster is largely trying to make sure that fraud hasn't occurred. If there isn't provable fraud in a case, the recommendation of the adjuster is usually for the insurance company to offer a settlement.

What is the Goal of the Process?

Notably, the insurance company also does not have a fiduciary responsibility to you, meaning they don't have to put your best interests first. The primary motivation of an insurance company is to minimize its legal and financial exposure due to lawsuits.

In practice, this means that an adjuster wants to wrap a bow on a claim as quickly as possible. This is a balancing act, with the adjuster typically taking data from the company's servers to compare your claim against similar ones from where the incident occurred. They then start the negotiation process based on this information.

If they determine there is potential fraud, they will most likely reject the claim. The same applies if the adjuster doesn't feel the claim will stand legal scrutiny. For example, an adjuster might conclude a severe-weather vehicle accident was legally an Act of God rather than a particular driver's fault.

How Do You Respond to a Settlement Offer?

The insurance company will send a letter to you or your appointed counsel. If you were involved in a car wreck, for example, they would send the settlement to your lawyer. Your auto accident attorney has a legal obligation to provide you with the details of all settlement offers. They also can advise whether they feel the offer is fair or not.