What is a Claims Adjuster?

By Jedidiah McKeehan

There are a number of weird words and job titles that I encounter in the legal field.  Where did the job title, “bailiff” come from?  Why is it called a “motion to quash” and not a “motion to squash?”  Where did the title, “guardian ad litem” come from?

A very common job title, whose name still does not make a lot of sense to me is the job title of, “claims adjuster,” which is often just shortened to, “adjuster.”

What is a claims adjuster and what do they do?  Claims adjusters are employed by insurance companies and they are the internal handlers of insurance claims made against their insured.  So, let’s walk through how an adjuster does their job.

When a car wreck occurs, if someone is injured or their car is damaged because of another driver, then the injured person will make a claim against the at-fault driver’s insurance.

That claim will be assigned to a claims adjuster.  If there is damage to someone’s car, then that portion of the claim will be called the “property” portion of the claim.  The injuries to someone’s person are the “personal injury” portion of the claim.  Those two different claims are usually handled by two different claims adjusters.

Property claims are usually resolved very quickly.  The adjuster may inspect the vehicle or review photographs of the damage, and then they will calculate the damage, and/or whether the vehicle should be totaled out as a complete loss and undrivable.  If the vehicle is deemed to be a total loss, then the claims adjuster may pull valuations of similar vehicles for sale in the region to determine the value of the vehicle.

Based on the claims adjusters’ investigation, they will make a settlement offer to the party with the damaged vehicle.  I have never personally heard of anyone being satisfied with the amount that they were offered by the insurance company for the damage to their vehicle, but maybe there is some person out there who was very happy with what they were offered.

As for the claims adjuster who handles the personal injury side of the claim, that adjuster will take a recorded statement of the injured party, they will discuss the matter with their own insured, and they will review medical records and medical bills incurred by the injured party after the wreck as well as any other documentation provided by the injured party.

After they have reviewed all of these items, the claims adjuster will generally make a two part determination.

They will first determine how responsible they think their insured is for the injured party’s damages.

Then they will determine whether they believe the medical treatment and expenses incurred by the injured party after the wreck were reasonable and necessary and were related to the wreck at issue.

Based on those factors, as well as a number of more subtle factors, the claims adjuster will make a settlement offer to the injured party.  Or they may offer the injured party nothing if they determine that their insured was not at-fault, or that the injured party was not really injured at all.

If the injured party decides to file a lawsuit, the insurance company will hire an attorney to represent their insured at the expense of the insurance company.  Although claims adjusters are not attorneys, after a lawsuit is filed, the claims adjuster is very much involved in the decision-making process of how the lawyer should handle the case or whether they should offer to settle the case.

 

Jedidiah McKeehan is an attorney practicing in Knox County and surrounding counties.

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