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What You Need To Know When You Start a Claim With Your Insurance Company

Your Insurance Claim Contact

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 but they do not handle your claim. Be sure to contact your insurance company to speak to an adjuster and bypass your agent to save yourself the extra step.

The claims adjuster may work for the insurance company or be an independent 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). Ask the adjuster if he works for the insurance company or if he is 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 him 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 will most likely have the maximum quantity of cases.
  • Adjuster experience comes into play when your claim is more complex. The more seasoned adjusters have worked through complicated liability or damages claims before so a claims manager will put such claims with them.
  • Finally, there is financial exposure. Each adjuster has an authority limit. Authority is the maximum amount of money he is 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 we see 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, as in low balling the claims, when 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

  • 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 him how his performance is monitored. Understanding what the adjuster’s day-to-day concerns about his job performance are could help you in negotiating down the road by giving you an argument that appeals to his overall performance concerns.

You need to understand that in the claimant/adjuster relationship, the adjuster has the power. He controls the money and is not harmed if the claim does not settle and goes into litigation. This means he 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 than they will. Most adjusters only care to know about a few key data points on your claim, things such as: special damages (medical expense, lost wages) to date, length of treatment, severity of injuries, and amount of property (car) damage.

The other takeaway here is 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 he 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 him do his job easier by documenting your claim the correct way.

Adjuster Settlement Authority

Depending on adjusters’ experience and skills, they will have a certain level of “authority.” Authority is the dollar limit of a case’s value they are allowed to handle. For example, assume adjusters have authority to handle cases up to $15,000. Suppose they reserve your case at $12,000 and later in the claims process the case value jumps up to $19,000. Your case is now above their authority and your file must get transferred to other adjusters or they need to go to their manager to get additional authority. This may be the reason adjusters are fighting from increasing their 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 what their authority is. Ask 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.

You should take notes anytime you talk to an adjuster. If you discuss something important, or one of you promises to do something, follow up the call with a confirming letter. If an adjuster promises to do something
on your claim by a certain date, always send a confirming letter re-stating what he/she promised to do and the date it would be completed by.

When an adjuster says he/she will do or have something by a certain date for you, give the adjuster 2 days after the promised deadline and then call back. But don’t pester the adjuster. 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 the full authority on your claim.

A Lawyer Can Get You More

A 2008 Insurance Research Council study shows people with lawyers handling their claim get a whopping 181% more than if they were to handle it themselves! Yes, we do work on contingency meaning our fee is 33% (standard fee) of the settlement we get for you but you’ll see in this scenario, you’d still be ahead. Just look at the numbers:

  • $9,278 average settlement with a lawyer
  • – $3,062 contingency fee of 33%
  • $6,216 settlement to you with a lawyer

Compare this to $3,301 which is the average settlement without a lawyer. That’s $2,915 MORE you would receive with a lawyer! The numbers speak for themselves. Do know this is an average and your accident may not be as severe to warrant an average settlement so it may not make sense to hire a lawyer.

Your Concierge Service

See us as your concierge service! Our firm can take the burden, time, and frustration off your shoulders. We are here to help you. Attorney David Brauns will personally talk with you over the phone without cost or obligation of any kind regarding your injury claim. He will consult with you to determine if a lawyer should be involved or if it makes more sense for you to handle it yourself. Call 404-348-0889.