Our Work Strategy
 
Job Description:

Individuals and businesses purchase insurance policies to protect against monetary losses. In the event of a loss, policyholders submit claims, seeking compensation for their loss. Loss Adjusters also known as insurance claims inspectors investigate insurance claims made by policy holders on behalf of Insurance Companies. Their main role is to investigate the claims, determining the extent and validity of individual claims, assessing liability and authorizing payments to claimants, all the while mindful not being biased to the Insurance Company or to the Claimant. They must determine whether the customer's insurance policy covers the loss and how much of the loss should be paid to the claimant.

Their work also involves coordinating the services that may be required by policy holders following an accident or incident, for example contacting an approved tradesperson and organizing a visit from them to make repairs on a policy holder's home.
 
 
Typical work activities:

  • The process of dealing with a claim when it is first made by a policy holder.
  • Following a claim through to completion and settlement.
  • Visiting scenes of accidents, such as workplaces or loss (fire or theft)
  • Investigating the circumstances of an accident or loss and undertaking background research.
  • Checking details with policy holders and witnesses.
  • Providing advice on making a claim and the processes involved.
  • Contacting trades people from a network of approved professionals and arranging them to make repairs on the policy holder's property.
  • Gaining information from other professionals such as the police and medical and technical staff.
  • Liasing with loss adjusters, solicitors and other legal/claims professionals.
  • Deciding on liability.
  • Negotiating a settlement with claimants or legal representatives.
  • Completing relevant paperwork
  • Working with and assessing a range of factual information.
  • Collating information
  • Writing reports
Adjusters plan and schedule the work required to process a claim that would follow, for example, damage to one’s home or office caused by a storm. They investigate claims by interviewing the claimant and witnesses, consulting police records, and inspecting property damage to determine the extent of the company’s liability. Adjusters may consult with other professionals, such as accountants, architects, construction workers, engineers and lawyers, who can offer a more expert evaluation of a claim.

The information gathered, including photographs and written statements is set down in a report that is then used to evaluate the associated claim. When the policyholder’s claim is legitimate, the claims adjuster negotiates with the claimant and settles the claim. When claims are contested, adjusters will work with attorneys and expert witnesses to defend the insurer’s position.

Another occupation that plays an important role in the accurate settlement of claims is that of the appraiser, whose role is to assess the cost or value of an insured item. The majority of appraisers employed by insurance companies and independent adjusting firms are auto damage appraisers. These appraisers inspect damaged vehicles after an accident and estimate the cost of repairs. This information is then relayed to the adjuster, who incorporates the appraisal into the settlement. Auto damage appraisers are valued by insurance companies because they can provide an unbiased judgment of repair costs.

Many claims adjusters and auto damage appraisers are equipped with laptop computers from which they can download the necessary forms and files from insurance company databases. Many adjusters and appraisers use digital cameras, which allow photographs of the damage to be sent to the company via the Internet. Many also input information about the damage directly into their computers, where software programs produce estimates of damage on standard forms. These new technologies allow for faster and more efficient processing of claims.

When adjusters or examiners suspect fraud, they refer the claim to an investigator. Insurance investigators in an insurance company’s special investigative unit handle claims in which the company suspects fraudulent or criminal activity, such as arson, falsified workers’ disability claims, staged accidents, or unnecessary medical treatments. The severity of insurance fraud cases can vary greatly, from claimants simply overstating the damage to a vehicle to complicated fraud rings responsible for many claimants and supported by dishonest professional personnel.
 

The policyholder will often perceive the adjuster as the agent of the insurer with a single purpose to avoid paying the claim amount or some part of it. The adjuster has to win the confidence of the claimant by being firm but fair, sympathetic without being over generous with insurer's money and understanding needs of the policyholder at the time of crisis.
 

New technology, such as laptop computers and cellular telephones, is making telecommuting easier for claims adjusters and auto damage appraisers. Many adjusters work inside their office only a few hours a week, while others conduct their business entirely out of their home and automobile. Occasionally, experienced adjusters must be away from home for days—for example, when they travel to the scene of a disaster such as a hurricane, fire or flood—to work with local adjusters and government officials. Adjusters often are called to work in the event of such emergencies and may have to work 50 or 60 hours a week until all claims are resolved. On some days, adjusters may have to spend all day in the office, searching databases, making telephone calls, and writing reports.