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.[1] In the United Kingdom, Ireland, Australia, South Africa, the Caribbean and New Zealand 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.[2]
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In the two first instances, and the fourth, the adjuster operates on behalf of the insurer.
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. Also "All Lines Adjusters" may handle "any" type of claim already identified and also include Professional Liability, Hospital Professional Liability, Excess Liability, Physicians and Surgeons Liability, Aircraft Liability/Hull, Inland Marine, Ocean Marine, Boiler and Machinery, as well as various types of Bond Losses.
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.[3]
An independent adjuster could be working for multiple insurance companies or self-insured entities. If licensed by state authority they represent pinnacle of property loss knowledge in their field; whether it be residential, vehicular, marine, etc.
An adjuster will frequently verify that coverage applies through an insurance policy, investigate liability for the damages caused, and make compensation to the injured person based on their 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:
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.
IEA conducts certified online classes for people. The Insurance Institute of America also provides training leading to Professional Designations. Some states accept the Associate of Claims designation, and will waive the licensing examination, and grant a license by the State Insurance Commission. Some Insurance Carriers, and Independent Adjusting Companies, provide in house training certified by the State Insurance Commission. The must be pre approved by the Licensing Division. An adjuster license is issued to those that pass the requirements.
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 advantageous 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 offer the designation throughout the country.
In some instances, such as with collapse insurance, courts have been involved in order to predicate a reasonable understanding of the guidelines of the policy in question. The meaning of terms such as "collapse" have undergone rigorous constitutional assessment.[4] This leads to some ambiguity between what the law says and what is enforceable by modern mandates. The idea of "Structural Integrity" may not always be a universally understood term, but several articles have been published on the topic [3] which suggests the field is evolving toward a continuity in terminology. For those interested in the claims adjustment field, in-depth study of legal principle is a necessity.
Most states require licensed adjusters to continue their education through a 'continuing education' requirement. Florida requires 24 hours of CE every two years.[5] Texas Department of Insurance,Continuing Education Requirements:http://www.tdi.state.tx.us/licensing/contineduc/agent/index.html
Claims adjusters work long hours including work nights and weekends. Their work is appointment based and must revolve around the needs of clients.[6]
Staff adjusters are those who work for a specific insurance company and usually have a company provided office from which to work. Independent and public claims adjusters often work from home. They receive their work assignments daily by fax machine, email, or by checking in to a designated website. Staff 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, or other catastrophe, independent and public adjusters travel to the area to supplement local adjusters. Often this requires the incoming adjuster's presence in the field for days to weeks at a time.
Catastrophe adjusters may spend days to weeks in a hotel or RV near the field of operations. Husband and wife teams often enjoy this type of work as it allows them to work and travel together to different parts of the country. Adjusters should become familiar with the reimbursement rules for each company with whom they work and track all expenses used in the line of work. Keep your receipts for everything as virtually all expenses, while deployed in the field, are tax deductible (confer with a qualified tax specialist for specific advice on what is and isn't deductible as an expense). A good software program or bookkeeping system is recommended.
Computer skills are essential, including keyboard skills. Most insurance companies store all documentation digitally. A digital camera is highly useful in documenting claims visually. Estimates, including auto and property losses, are prepared on computers connected to a corporate network. Laptop computers, cell phones|pad, and other technologies make claims adjusting easier and consume less time. However, claims adjusting also requires a level of physical strength and stamina.
Property adjusters, for example, are often required to operate a 50-pound ladder and must stand, walk, kneel, crawl, and perform other physical demands as they investigate damaged property.[6]