When you start a claim with an insurance company, you will be assigned a claims adjuster. Adjusters are different from insurance agents. Agents sell and maintain your policy, they do not handle your claim. Some people will report their accident/claim to their agent. Their agent will report the claim to their insurance company’s claims department and step out of the picture, with an adjuster taking over the claim.
The claims adjuster may work for the insurance company or be an independent adjuster or third-party administrator adjuster (TPA). The latter two types of adjusters are simply names for outsourced adjusters. Outsourced adjusters are normally used on smaller claims and will only have limited authority (the top end of the range of money they can offer on any one claim). You can usually spot an outsourced adjuster by their letterhead or email address being different from the insurance company’s. If you think you are dealing with a TPA, ask the adjuster if he/she works for the insurance company or are they a TPA. While it doesn’t make any difference to your claim, with the exception being a TPA may need to get more authority to handle your claim, it will show the adjuster that you are knowledgeable of the system.
Caseload, experience, and financial exposure are some of the factors insurance companies use to assign an adjuster. Case load is the number of cases an adjuster is currently handling. There is only so much time each adjuster has and each adjuster will have a maximum number of cases they can handle at any one time. You need to know that all adjusters handle a large number of cases. So much so, that many times they can only recall a case by looking on their computer system’s journal on your case to refresh their memory.
Adjuster experience comes into play when your claim is more complex. The more seasoned adjusters have worked through complicated liability or damages claims before and a claims manager will put claims needing a special touch with them.
Finally, there is financial exposure. Each adjuster has an authority limit. Authority is the maximum amount of money they are allowed to offer on a claim. New adjusters will be given very little authority, something like $5,000. All cases going to this adjuster are going to be estimated by the claims department at under this authority amount. Something ClaimClinic sees quite a bit is your claim getting transferred to another adjuster in the middle of the claims process. This is because insurance companies normally aggressively valuate (read: low estimate) claims where people do it themselves. Once the insurance company sees the claim may exceed their initial estimate, they will need to transfer it to an adjuster with more authority. Another common time claims are transferred is when a claimant (that’s you) hires an attorney. A claim will almost never stay with the same adjuster once a personal injury attorney steps into the picture. That is because it normally takes a differently trained adjuster to deal with an attorney.
Adjuster Responsibilities
An adjuster’s primary responsibilities are:
- Confirm the policy and coverage
- Investigate the facts, liability and damages of a claim.
- Evaluate the claim
- Reserve the appropriate amount of money
- Pay your claim and close the file.
Insurance companies monitor their adjusters for the total dollars of settlements each month, the number of claims an adjuster can close each month, and the number of settlements they can conclude without the claim going to an attorney to name a few. You may want to play dumb with the adjuster at the beginning of the claims process by asking them how their performance is monitored. Understanding what the adjuster’s day-to-day concerns about their job performance are could help you in negotiating down the road by giving you an argument that appeals to their overall performance concerns.
You need to understand that in the claimant/adjuster relationship, the adjuster has the power. He/she controls the money and is not harmed if the claim does not settle and goes into litigation. This means they also have the patience to see how desperate you are for a quick settlement and to find out if you know what you are doing.
But adjusters are also overworked. Insurance companies view your claim and the adjusters who handle your claim as an expense. Claims do not make the insurance company money. They lose money. Management is constantly cutting the number of adjusters and increasing each adjuster’s case load to cut bottom line costs. It is not uncommon for car accident claims adjusters to have over 300 open claims at one time. Just think how hard it is for an adjuster to keep the names and facts straight for this many claims. Adjusters can receive upwards of 50 phone calls a day and make an additional 50 more.
In today’s claims process, everything is computerized and your claim is kept on the computer. Adjusters run “journals” or “diaries” on your file. This is their working notes. They take notes on what they know about the case, their conclusions, telephone conversations, etc. The reason all adjusters will ask you for your claim number first is so they can pull up your claim and quickly scan the journal/diary to get familiar with your claim again before talking to you. It is a given that you will know more about your claim then they will. Most adjusters only care to know about a few key data points on your claim, things such as: special damages to date, length of treatment, severity of injuries, and amount of property damage.
The other takeaway here is that the more organized you are, and the better you document your case, the more the adjuster will respect your claim and how you are conducting your business. Adjusters who handle claims with people who don’t have lawyers are constantly dealing with emotional and unprepared claimants. Some adjusters are thankful when a claimant hires a lawyer because the adjuster then gets to deal with a professional on the other side of the claim. You can set yourself apart and use the powerful psychological technique of “reciprocity” to help your claim. A good adjuster will appreciate you helping them do their job easier by documenting your claim the correct way.
Adjuster Settlement Authority
Depending on an adjuster’s experience and skills, an adjuster will have a certain level of “authority.” Authority is the dollar limit of a case’s value that an adjuster is allowed to handle. For example, assume an adjuster has authority to handle cases up to $15,000. Suppose the adjuster reserves your case at $12,000 and later in the claims process the case value jumps up to $19,000. Your case is now above the adjuster’s authority and your file must get transferred to another adjuster or the adjuster needs to go to his/her manager to get additional authority. This may be the reason your adjuster is fighting increasing his/her offer – they don’t want to deal with having the file transferred or having to go to their boss to ask for an increase. This can be a powerful motivator for adjusters to cram the settlement down under their authority. If you think this is happening, respectfully ask the adjuster what his/her authority is. Ask them if they are not increasing their offer because they are fighting to keep the case under their authority level.
How To Talk To Adjusters
The most important rule in dealing with adjusters is to act calm and professional. That can be hard to do. For you, the accident can bring up all kinds of emotions. For the adjuster, this is a business transaction. That is the way you need to treat it as well to get the maximum settlement. The facts are the facts. To the adjuster, you claim is about the data of your claim – special damages, length of treatment, etc. You need to focus on the numbers and organizing them and their supporting documents to achieve a good settlement.
To get the adjuster’s respect:
- Indicate a willingness to work with them
- Promptly return calls and letters
- Allow the adjuster to inspect your car
- Thoroughly document your claim
- Be professional and courteous at all times
You should take notes anytime you talk to an adjuster. Use ClaimClinic’s Call Log in your Claim Binder to document each and every call. If you discuss something important, or one of you promises to do something, follow up the call with a confirming letter. If a n adjuster promises to do something on your claim by a certain date, always send a confirming letter re-stating what he/she said they would do and the date they said they would do it by.
When an adjuster says they will do or have something by a certain date for you, give the adjuster 2 days after their promised deadline and then call them. But don’t pester them. You simply want to send the message you are staying on top of your claim and trying to keep it moving forward. Nagging will make the adjuster resent you and not want to extend their full authority on your claim.
Never tell or let on to the adjuster that you don’t like personal injury attorneys, even if you do. If the adjuster knows you despise attorneys they will know you aren’t going to want to pursue litigation if settlement negotiations fail.
