Claims adjuster

A claims adjuster (claim adjuster, claims handler, claim handler or loss adjuster in the United Kingdom, Ireland, Australia, South Africa, the Caribbean and New Zealand) investigates insurance claims by interviewing the claimant and witnesses, consulting police and hospital records, and inspecting property damage to determine the extent of the insurance company's liability.[1] Other claims adjusters who represent policyholders may aid in the preparation of an insurance claim.

Duties

In the United States, claims adjusters typically:

• Verify an insurance policy exists for the insured person and/or property. In general, these are written by the policy-holding insurance company.
• Review the insurance policy to determine if coverage exists for the loss(es)
• Assess risk(s) of loss(es), or damages to property, culminating in the loss of property and or bodily injury.
• After completing the above investigations, evaluate the covered injuries and/or damages.
• Negotiate a settlement according to the applicable law(s), and identify coverages for which the insured is covered, following best insurance practices.

A claims adjuster or public adjuster does not, and should not, engage in the practice of law. While adjusting the claim does mean applying the loss circumstances to the insured's policy, it does not account for if and when there becomes an issue of coverage, which is a matter and practice of law, and should only be engaged by a properly licensed attorney.

In casualty insurance, the main types of coverage include, but may not be limited to, the following:

• First-party auto and other than auto coverages (sometimes referred to collision and comprehensive coverages). There are numerous types of first-party insurance coverages for any kind of risk of loss or damages.
• Third-party liability for property damage of others' property and bodily injury. (In law terms, these are "tort" claims.)

Classes

Claim service representatives (employed by the insurance company, or an independent adjusting company). 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 are licensed insurance professionals who work exclusively for the policyholder and charge a fee for this service based on a small percentage of the claim. This means there should be no inherent conflict of interest when it comes to advocating on the policyholder's behalf to the insurance company.

An independent adjuster could be working for multiple insurance companies or self-insured entities.

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.

Specific duties include:

• Notifying the insurer of a covered loss as defined under the policy of insurance
• Responding to claims in a timely manner
• Filing paperwork
• Communicating with policyholders
• Investigating liability
• Assessing damages
• Researching, detailing, and substantiating each aspect of the claim, including building damage, contents, and extra living expense claims
• Preparing a detailed damages report based on monthly updated insurance cost software for the purpose of making an offer of settlement to the insured
• If needed for specialty cost coding, negotiating 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
• Protecting the interest of the insurance company the adjuster represents when dealing with claimants
• Maintaining computer skills with a high degree of proficiency

Some states now require adjusters to disclose to claimants whose interest specifically independent, staff, and public adjuster represent before they proceed with the policyholder.

Local chapters of licensed public insurance adjusters or state agencies maintain records of adjusters, which can be checked to ensure that an adjuster is properly licensed and in good standing. National chapters include the American Association of Public Insurance Adjusters[2] and the National Association of Public Insurance Adjusters[3]. Some states also have state-level chapters, including the Florida Association of Public Insurance Adjusters.[4]

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. They must be pre-approved by the licensing division. An adjuster license is issued to those who meet the requirements.

Education

Most insurance companies prefer their claims adjusters to have a 4-year college degree preferably in business-related fields. In the past, high school graduates have become claims adjusters by promotion from within the claims department. 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 claims adjuster educational resources. There are also professional designations that have become prevalent among claims adjusters; for example, the American Institute for Chartered Property Casualty Underwriters awards the Chartered Property and Casualty Underwriter (CPCU) designation to experienced underwriters.

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 coordination with Polk State College in 2002, allows an individual to obtain the Florida All Lines Independent or Company license, without taking the state licensing exam.

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.[5] 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,[6] which suggests the field is evolving toward a continuity in terminology. For those interested in the claims adjustment field, an in-depth study of legal principles is a necessity.

Most states require licensed adjusters to continue their education through a "continuing education" requirement.[7] Florida requires 24 hours of CE every two years.[8]The number of hours required reduces based on the number of years the license has been held.

Working conditions

Claims adjusters work long hours including nights and weekends. Their work is appointment based and must revolve around the needs of clients.[9]

Staff adjusters are those who work for a specific insurance company and may have a team that works and travels 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.

Computer skills are essential, including keyboard skills, as most insurance companies produce and store estimates and other documents digitally, using laptop computers, mobile phones, and digital cameras. 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.[9]

References

1. US Dept of Labor, Bureau of Labor Statistics, Occupational Outlook Handbook, 2008-09 Edition, Claims Adjusters, Appraisers, Examiners, and Investigators
2. "American Association of Public Insurance Adjusters". American Association of Public Insurance Adjusters. Retrieved 2020-06-11.
3. "NAPIA". www.napia.com. Retrieved 2020-06-11.
4. "FLORIDA ASSOCIATION OF PUBLIC INSURANCE ADJUSTERS". FLORIDA ASSOCIATION OF PUBLIC INSURANCE ADJUSTERS. Retrieved 2020-06-11.
5. What Constitutes a Collapse Under A Property Insurance Policy? The Brief. Vol. 29, No. 2 (Winter 2000). American Bar Association. Robins, Kaplan, Miller & Ciresi, LLP Archived 2012-07-22 at the Wayback Machine
6. "Insurance Coverage For Collapse - How It Has Changed and Why". Adjusters International. Archived from the original on 2011-07-18. Retrieved 2010-08-11.
7. "Archived copy". Archived from the original on 2010-01-25. Retrieved 2010-01-23.CS1 maint: archived copy as title (link)
8. "Florida Public Adjuster Continuing Education Update". FAPIA. Archived from the original on 2011-07-23. Retrieved 2009-09-28.
9. "Claims Adjusters, Appraisers, Examiners, and Investigators". Occupational Outlook Handbook, 2008-09 Edition. Bureau of Labor Statistics, U.S. Department of Labor. 2007-12-12. Retrieved 2008-06-19.