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What is an insurance claims adjuster?

Fact-checked with HomeInsurance.com

Have you ever wondered what happens after you file an insurance claim? Your claim is handed over to an insurance claims adjuster. The individual works behind the scenes to gather evidence and determine how much should be paid out after an accident or loss. However, there are times when the insurance companies estimates for repairs fall short of what is reasonable and are then contested by the homeowner.

There are different types of claims adjusters — those employed by the insurance company to look out for the insurer’s best interests and independent insurance adjusters who work on behalf of the policyholder. Take a closer look at the role of an independent adjuster and learn more to answer “what does a claims adjuster do?”

What is a claims adjuster?

An insurance adjuster is a form of investigator. Once your claim is processed by the insurance company, it’s handed over to an internal insurance adjuster for an estimate of repairs to be generated. The claims adjuster rounds up documents and the required information about the claim to make an informed decision on financial responsibility. 

Should the final estimate come up short of what you feel the repairs are worth, you may involve an independent claims adjuster to negotiate or adjust the estimate. Independent claims adjusters are known by several different names.

Public adjuster

Most independent claims adjusters are referred to as public adjusters and hired by the policyholder to represent the insured’s best interests. You should consider hiring a public adjuster if you feel that the insurance company’s settlement offer is too low or not reasonable for the scope of repairs. 

Other insurance claims adjusters

When adjusting a claim, supplemental estimators and lawyers have some ability to serve as independent claims adjusters. Although estimators and attorneys can provide some insight into a claim, their legal abilities to negotiate and involvement in your claim differ from a public adjuster. Take a closer look at the two:

Contractor supplemental estimators

A contractor supplemental estimator is not on staff. Instead, this homeowner advocate is hired on a case-by-case basis. They are typically associated with the policyholder’s contracting company but have legal limitations on their involvement. A supplemental estimator may have a shared third party agreement signed with you and your contractor, permitting them to discuss your claim on your behalf with the insurance company. 

While they can request adjustments from the insurance company based on supporting documentation or justifications, supplemental estimators are not legally allowed to ‘negotiate’ the claim. 

Lawyers

An attorney or lawyer that specializes in insurance claims is occasionally necessary if the claim needs to be escalated. They can leverage insurance law to negotiate the best settlement on your behalf. A lawyer may be able to mitigate (lower) a claim or work out a settlement in which all parties are satisfied with the payout based on the insurer’s legal financial responsibility.

What does an insurance claims adjuster do?

An insurance adjuster has quite a few tasks they need to undertake. Imagine your neighbor’s kids broke a large window in your home while playing. The insurance adjuster will be assigned to the claim. 

They’ll start by reviewing any information provided during the claims filing. They may come out to the property to see the damage and take photos. They will probably want to speak with you and the neighbors to find out what happened from both sides. They will follow up with any witnesses. Finally, the claims adjuster may request quotes from window companies to determine the cost of repair or replacement of the window to make a determination on payout. 

What does a claims adjuster do?

  • Evaluate the claim and policy details. This is often handled from the office by a desk adjuster. 
  • Collect data and documentation. Often outsourced to a field adjuster to go to the location to collect statements, take photos and gather documents. 
  • Determine cause of loss. This is the most critical part of the adjuster’s job and ultimately sets the parameters for the insurance companies liability.
  • Preparing an alternative or supplemental estimate for repairs. Depending on the claim, may be performed by either a desk adjuster over the phone or in person by a field adjuster.
  • Follow up with the independent insurance adjuster on ‘negotiated’ items within the estimate.
  • Facilitate payment with the policyholder. Often handled by the desk adjuster to ensure the policyholder is paid.

An independent adjuster will follow a similar process, but from the homeowner’s perspective, evaluating the stated cause of loss and determining where insurance may be lacking in allowances for repairs. 

Who an insurance claims adjuster affects

As mentioned, the insurance claims adjuster mainly works behind the scenes. Policyholders don’t typically come into contact with a claims adjuster directly, although there are some circumstances when paths may cross.  

You may have to speak with a claims adjuster if you’re a witness in an accident or to provide your version of events to settle a claim. Other circumstances when you may be in contact with one is if you hire someone to negotiate or settle your claim.

How to negotiate a settlement with an insurance claims adjuster

Negotiating a settlement will vary depending on the type of insurance claims adjuster you hire. Here’s a closer look on how to negotiate a settlement, based on the insurance adjuster:

Insurance company adjuster

The first thing to keep in mind is that an insurance company’s adjuster is not technically on your side — they advocate for the insurance company. Ask them to explain how they came to the settlement amount they’re proposing and request they put the offer in writing. 

Take your time to review the points that led to the amount. If you strongly disagree with the total, or with specific items included on the estimate, you could counter with competing quotes from contractors or subcontractors for labor and materials. Be sure to provide documentation as evidence of why you believe you’re owed more. If you feel like you’re not getting anywhere, or you’re not comfortable discussing the itemized estimate on your own, consider consulting with a supplemental estimator, public adjuster or attorney.

Public adjuster

A public adjuster is typically more objective. Public adjusters have certification requirements that enable them to legally negotiate the claim. Although these advocates have more power and can net a higher claim payout, negotiations can take longer overall to finalize. However, the timeline is regulated by law, so you can be assured of an eventual resolution.

Lawyers

If you’re not sure about the proposal you’ve received from an insurance company, seeking out legal advice from a lawyer could help you get clarity on whether the offer is legal and worth accepting or not. In addition, an attorney may be able to settle or mitigate a lawsuit before it goes to court, which could get costly. Claim negotiations involving a lawyer often take the longest to settle but the payout potential is highest when a legal representative is involved.

Contractor supplemental estimators

Comparatively, a supplemental estimator can only discuss the claim on the behalf of the policyholder, with the policyholder’s permission. They often function as an entity of the contractor. 

Although not legally allowed to negotiate the claim, supplementers can provide a corrected or supplemental estimate on behalf of the policyholder, along with supporting documentation verifying the validity of the revisions within the estimate. Settlement amounts can be smaller than with other types of advocates but generally take the least amount of time to resolve. For smaller claim disparities, this can be an effective way to resolve the discrepancies. 

How to hire an insurance claims adjuster 

As previously mentioned, a company adjuster doesn’t always have your best interests in mind. If you’re dealing with a large claim, hiring an independent claims adjuster may be worth the expense — particularly if there is a dispute over cause of loss.

Scenarios for when an insurance adjuster is worth hiring include when you feel there are disputes in the assessment that the insurer didn’t address, certain damages weren’t included, you feel a second opinion would help or if you believe the company adjuster didn’t review the claim properly.

A contractor’s supplemental estimator is the easiest, least time-consuming and least expensive option. You may need a public adjuster if the claim is more complex and the negotiation amount is higher. If an acceptable settlement cannot be reached, escalate the claim by retaining a lawyer. Lawyer’s fees will be the highest, but your chances of resolving the settlement and receiving the full amount you are legally owed is also highest.

How to become an insurance claims adjuster

Whether you wish to work on behalf of the insurance company or as a homeowner advocate, there are several prerequisites to becoming an insurance claims adjuster. If you’re a high school graduate or have your GED, you can get licensed to become a claims adjuster by taking a course and passing an exam. 

Not all states have the same requirements — some require you to complete an insurance licensing program while other states have no certification requirements at all.

If you’d like to work as a claims adjuster locally or nationwide follow these steps:

  • Complete high school or a GED
  • Earn a DHS (designated home state) license
  • Gain employment with an insurance company or build clientele if working as an independent adjuster
  • Earn continuing education (CE) credits while working or from an online course

The takeaway: 

  • Claims adjusters vary in type and involvement 
  • Some work on behalf of the insurance company and some can represent you and your best interests
  • A lawyer or contractor supplemental estimator could also advocate on your behalf to settle a claim within certain limits

Conclusion

If you’ve filed a claim due to a property loss or injury, the claims adjuster plays an important role in the process. They investigate the claim to determine responsibility and how much should be paid out. You don’t have to accept the first settlement proposal provided. You can negotiate a better offer or hire a public adjuster, lawyer or contractor supplemental estimator to help you get a better settlement.

Cynthia Paez Bowman

Writer

Cynthia splits her time between Los Angeles, CA and San Sebastian, Spain. She travels to Africa and the Middle East regularly to consult with women’s NGOs about small business development.

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