Dealing with Insurance Claim Adjusters

Insurance claim adjusters are people who go through intensive training courses and work in various capacities for insurance companies. During their careers, they participate in continuing education to stay up to date with trends and practices in their industry.

An adjuster's primary duties are to:

• Investigate accidents
• Research the circumstances of accidents and advise the company of liability
• Determine amounts of compensation to be paid
• Negotiate and settle claims with accident victims

Types of Adjusters

Insurance adjusters fall into three basic categories:

1. Independent adjusters: Freelance adjusters who work for themselves or for private companies under contracts with insurance companies.


2. Public adjusters: Freelance adjusters who offer their services to the public instead of insurance companies.


3. Claims or Staff Adjusters: Full-time employees of insurance companies. They are responsible for investigating accidents and negotiating settlements with victims.

Car Accidents And Staff Adjusters

Depending on the circumstances of your accident, you could have to deal with insurance adjusters from three separate divisions within the company. They are:

1. Personal injuries resulting from an auto accident
2. Property damage to vehicles and their contents
3. Vehicles considered total losses (when a car is "totaled")

Within moments of filing an insurance claim, your information is transferred to a claims adjuster. She'll enter your information into a specialized software program that insurance companies use for claims handling. You should hear from an adjuster within days of reporting the accident.

As much as you might like to have your claim settled quickly and for as much as possible, it usually doesn't happen that way. Dealing with insurance claim adjusters takes hard work and preparation. They are professionals who have handled hundreds, if not thousands of accident claims.

First Contact With The Adjuster

In your first contact, the adjuster will probably request your recorded statement and ask you to sign medical releases (so she can access copies of your medical records and bills). You will be bound by what you say in the statement, so if you aren't ready politely tell the adjuster you need a few days.

No law requires you to give your statement the first time the adjuster contacts you. You are letting her know you aren't in any rush to begin negotiations and you are serious about your claim.

Tell the adjuster the names of the doctor(s) you are seeing. Assure her you'll continue with your treatment and will keep her advised of your progress. Make it clear you do not want to discuss any settlement offers until you're fully healed or released by your doctors. Ask the adjuster to send you a letter confirming you reported the claim. If you don't already have one, ask her for the claim number.

Following this conversation, you will probably receive a Reservation of Rights letter from the insurance company. The letter's purpose is to inform you that although the insurance company has agreed to discuss the claim with you, at this point they haven't agreed to accept liability.

During the course of your claim and settlement, you'll receive several letters. Keep all the letters and file them with the other papers from the claim.

Car Repair and Interim Transportation

Decide where your car is going to be repaired (you aren't required by law to seek more than one estimate). Take your car to a shop you trust. As long as the repair shop charges normal and reasonable rates, the insurance company should accept them. Tell the adjuster you want only original equipment manufactured (OEM) parts used to repair your car, not the less expensive substitutes.

If you're filing a first-party claim and your policy includes rental coverage, request a rental car. If it's a third-party claim, request a rental car while your car is being repaired.

Preparing to Negotiate with the Adjuster

Immediately after the accident start preparing a settlement packet. Keep all of your papers organized in files and use a notebook to write down general notes and summaries of conversations with the adjuster. In separate files or tabbed sections keep:

• Medical bills
• Receipts for medications
• Receipts for gasoline and parking fees
• Proof of your lost wages
• Car repair invoices
• Personal property damage
• Miscellaneous

During the time you're in treatment, keep the adjuster up to date by continuing to mail, fax, or email her copies of your medical bills, out-of-pocket expenses and lost wages. Your adjuster always has several claims in progress at any time, so you're helping her stay organized and efficient.

Claims adjusters appreciate dealing with claimants who are prepared, polite and professional, and who have realistic ideas for settlement amounts. If you can do those things, you'll increase your chances of getting a higher settlement in a shorter period of time.

Insights into Settlement Negotiations

Same Goal, Different Purposes

Good settlements don't just happen, they must be earned. You can't settle your claim without the claims adjuster and she can't settle it without you. You and your adjuster have a mutual interest in settling the claim promptly and fairly, but each of you may have different concepts of fairness.

You want to be fairly compensated for your damages, and the adjuster wants to close out your claim as quickly and cheaply as possible. You need the money and she needs to move on to other claims.

An insurance claim adjuster's job is to settle claims for as little as possible. Their raises, bonuses and promotions are highly tuned to results, and making consistently lower settlements results in successful careers. Remember, insurance companies exist to make money.

Your job is to make sure you are being treated fairly. Be informed, persistent, and committed to negotiating a settlement that is fair for you.

The Adjuster's Conflict of Interest

If you live in a no-fault jurisdiction or have PIP insurance, you'll be negotiating with your own insurance company. This is called a first-party claim.

You've paid premiums, sometimes for years without ever making a claim. You believe your insurance company will be there in the event of an accident. You feel like you have a good relationship with the company. But when you file a claim for an auto accident, don't assume that everything will go your way.

The truth is, the claims adjuster for your own company will treat you the same as in a third-party situation. It seems like a conflict of interests because the company you've been paying is depending on their adjuster to settle your claim for the lowest possible amount.

It's not personal, it's business. Even in a first-party claim, you have to be prepared to defend your position and negotiate to receive the highest settlement you can get.

Final Negotiations with the Adjuster

When you've completed treatment for your personal injury, you can enter into negotiations with the adjuster. Mail your completed settlement packet with copies of everything you've saved in the various categories.

Be realistic when making your first demand. Asking for two or three times the total of your medical bills is realistic for a typical soft tissue injury. Asking for 10 times the amount of your medical bills in hopes the adjuster will split the difference is wrong, and it will slow down negotiations.

Finish the negotiations as you began them. Be professional, prepared and committed. The result should be a settlement you will be happy with.