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Dear Clueless About Claims:
Just as you might adjust your television set to get a better picture, your insurance company sends an adjuster to get a clearer picture of your claim.
An adjuster can be an independent, licensed professional hired by the insurance company to investigate a claim on its behalf. Independent adjusters typically specialize in a certain type of loss -- for example, business income, liability, fire -- and have expertise in settling those claims. However, some insurance companies have their own adjusters on staff -- the staff adjuster.
In this scenario, let's say that an independent adjuster was sent to investigate the cause of your loss. He/she will pass the results of their investigation to the insurance company who is handling your claim. Remember that your contract is with the insurance company. Your insurance company will then decide whether or not your loss is covered under your insurance policy and, if it is, will pay your claim. There are times, however, that the insurance company may authorize the independent adjuster to settle the claim directly (up to a specific amount).
For the most part though, the independent adjuster's job is simply to gather the facts about your case and report them to your insurance company; the adjuster does not decide whether or not your claim should be paid, although he or she may make recommendations to the insurance company. So if you disagree with the insurer's decision about your claim, contact the claims manager, not the adjuster (except of course, in situations where the insurance company has authorized the adjuster to settle claims directly).
Just to add another ingredient to the mix, besides the independent and staff adjusters, there are also public adjusters, who, as their name implies, act on behalf of the public, or policyholders. They are hired -- and therefore paid -- by the policyholder (you) instead of the insurance company. Although a public adjuster is probably not needed for personal insurance claims -- like your stolen jewellery -- some policyholders may prefer to hire a public adjuster if they believe that their claim is too complex or technical to handle themselves. It's your choice, but remember, if you decide to retain a public adjuster, you will have to foot the bill for his or her fees. Ask beforehand what it will cost.
Whether your claim is to be settled by an independent adjuster or a staff adjuster, your job is to give him/her the facts and figures, and the insurance company will determine how much is to be paid.
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