Claims Adjuster Training
Introduction
This is an intermediate-level course in claims investigation. One of the most important aspects of property and liability claims adjusting is the adjuster’s job of investigating and gathering the facts surrounding an accident or loss. Claims adjusters do not make the facts, they unearth them. Investigation is the process of unearthing relevant facts.
Course Objectives
- Understand the difference between a company adjuster and public adjuster
- Know the duties and responsibilities of an adjuster
- Learn the claim filing process
- Review the standards for fair and equitable investigations and settlement
- Review adjusting of property and casualty losses
- Learn the basic claim handling activities
- Study the alternative dispute resolutions
- Learn the settlement options and the types of releases
- Learn the types of adjuster reports
- Review the issues of dealing with coverage disputes.
- Understand guidelines for taking recorded and written witness statements
Lesson 1:Introduction to Claims Adjusting
I. The Insurance Adjuster
An adjuster is any individual who, for compensation, fee or commission, investigates and settles claims arising under property, casualty or surety contracts on behalf of either the insurer or the insured.
Types of Insurance Adjusters
I. Company Adjuster – A company adjuster is an adjuster representing the interests of the insurer, including independent contractors and salaried employees of the insurer.
2. Public Adjuster- A public adjuster is an independent contractor representing solely the financial interests of the insured named in the policy. The insured, and not the insurance company, pays the adjuster.
An individual may be licensed concurrently under separate licenses as a company adjuster and as a public adjuster but shall not act as a company adjuster and a public adjuster with respect to the same claim.
Relationship to the Legal Profession
The adjuster must work closely with the legal profession in the adjustment of claims. Once the claimant has hired the services of an attorney, the adjuster can no longer contact the claimant without the consent or presence of the attorney. Often the claims adjuster must negotiate with the attorney towards the final disposition of the claim. Attorneys representing the insurance company prepare releases for processing by adjusters.
Duties & Responsibilities of the Adjuster
- Fiduciary Agent
- Power to Bind
I. Fiduciary Agent
The adjuster’s professional responsibilities to the insurer are the same whether or not the insurer employs the adjuster. The adjuster is a fiduciary agent. This relationship requires maintenance of a high degree of fidelity and loyalty to the interest of the principal (insurer), whether or not the adjuster is a direct employee. As a fiduciary agent of the principal, the adjuster should not deal in any way with the principal’s property with motives of self, interest. The adjuster should not represent interests that are adverse to those of the principal and the adjuster should not profit, or seek to profit, from an outside source as a consequence of actions for and on behalf of the principal.
2. Power to Bind
Once the adjuster is appointed, the insured or claimant has a right to assume the adjuster has the power to ascertain the amount of the loss and to settle it. If there are any limitations on the authority of the adjuster, the insured is not bound unless there is actual knowledge of such limitation of authority. While an adjuster’s power to bind an insurer to an agreement made with a claimant varies by type of adjuster, the adjuster is normally considered the agent of the insurer for the purpose of adjusting a loss. The adjuster may thus act for the insurer and is ordinarily empowered to make agreements regarding value and loss on its behalf. Agreements between the adjuster and the insurer covering matters within the scope of the adjuster’s authority are thus binding on the insurer.