What Does a Claims Adjuster Do?

Claims adjusters work for auto insurance companies to investigate accidents and determine the extent of the insurer’s liability. They may inspect accident sites, review police reports, interview witnesses, and obtain claimant statements in determining how much money to include in a settlement offer. Understanding the role and responsibilities of a claims adjuster can help you and your personal injury lawyer during car accident settlement negotiations.

What Are the Claims Adjusters Chief Duties?

The first letter you’ll receive as a claimant will introduce you to your adjuster, the policy limits that apply to your case, and will likely request additional documents.

Claims adjusters:

  • Evaluate – Their first task is to determine whether or not your specific policy covers the loss you are claiming. If coverage is found, the adjuster may come up with a figure. Sometimes public adjusters or attorneys are consulted if the claim is large.
  • Investigate – By the time a claims adjuster contacts you, they will have read through your specific policy and preliminary accident reports. They will have looked into your history to see if you filed a personal injury or property damage claim in the past. They may interview eyewitnesses, the other motorist, or consult outside professionals for their opinions.
  • Request Documents — They may request the police report or documents filed with the NYS DMV if such documents exist. Claims adjusters will typically ask you to sign a medical release form so that the insurer can access your records– though you do not have to provide such broad consent. They may also ask for your medical bills, proof of earnings as well as property damage. You may be asked for a recorded statement describing the accident and your injuries, but you are under no legal obligation to do so.
  • Case Valuation – Medical and therapy bills play a major role in determining how much your case is worth now and how much it might be worth in the future. Loss of income due to time off work factors in as well. A “pain and suffering” multiplier can range from 1.5 to 5x the economic losses.
  • Negotiate – It is the adjuster who will let you know how much money the insurance company is willing to pay for your losses. If you do not accept the first offer, the adjuster is allowed to make a counteroffer.

What Is the Work Environment Like For Claims Adjusters?

Claims adjusting is a fast-paced, high-demand work environment. Work may take place in an office or remotely and cover a wide geographical area. Most car insurance claims adjusters see 50 to 100 new claims on their desks each month. Half of claims adjusters are working well over 40 hours a week. Their job performance is evaluated based on how many claims they can successfully handle without involving supervisors or corporate lawyers.

You could say the internal incentive structure is a conflict of interest– directly at odds with the perceived goal of “helping the insurance customer.” In reality, they are paid to help the insurance provider save money. At some companies, employees are allegedly provided bonuses for limiting the amount of Personal Injury Protection paid on a claim and for settling totaled car claims at or below the National Automobile Dealers Association (NADA) guide value by using cheaper aftermarket crash parts.

Claims adjusters do not necessarily have a college degree. They can be hired with a high school diploma or GED equivalent but must complete an insurance licensing course and exam to receive a state license. Ongoing education may be necessary. What is most important to understand is that they have no medical or legal experience. They generally do not have the time, nor the resources, to investigate or study your claim as thoroughly as it deserves.

What Do I Say to An Insurance Adjuster?

Knowing what you should or should not say to a claims adjuster can affect the dollar value of your offer. You want to be honest and cooperative, but you don’t want to inadvertently work against your own self-interest. Car accident victims have certain rights which they might be unaware of. Many people accept the adjuster’s word as gospel, assuming “that’s how the process works.” In reality, the process works against you.

  • Do not imply you’re okay. An adjuster may casually ask, “How are you today?” Simply saying “I’m fine” can appear in the adjuster’s written report to mitigate compensation. 
  • Do not go into detail. The worst thing you can say  is that the accident “aggravated an old injury.” While this is very medically likely and probably true, preexisting conditions offer an avenue for the insurer to outright deny or minimize claims.
  • Do not allow recording. The adjuster may also ask if they can record the conversation for quality assurance purposes, but you should politely decline and take time to consult with an attorney. You can say, “I’ll be happy to go over anything informally, but I prefer to speak with my lawyer before giving a recorded statement.”
  • Do not go to a repair shop blindly. The claims adjuster may instruct you to take your car to the insurer’s “approved and certified” body shop for a quote and repairs. While this may sound reasonable, you should research the reputation of the body shop and ask if they intend to use new or refurbished “aftermarket” parts in the repairs.
  • Do not agree over the phone. Always ask for the offer in writing. Often, adjusters will make it sound like they are doing you a favor by “wrapping things up quickly.” Have your lawyer look over the offer to help you determine whether to accept or reject it.

How Much Can A Claims Adjuster Do for Me?

A claims adjuster has the authority to reach a settlement agreement with you following a car accident. However, there are limitations on the amount of negotiations allowed. Less experienced adjusters may only have $5,000 to $10,000 to work with, while more experienced adjusters may be allowed to offer up to $10,000 to $20,000. Adjusters are not allowed to disclose the limits of their authority, but you can ask to speak with a supervisor or claims manager who may have greater authority. 

Who Else Can Help Maximize My Car Accident Settlement?

A team of New York City personal injury lawyers can serve as your best advocate in claim negotiations. They understand your hardship, offer free consultations, and contingency-based representation. This means you pay nothing upfront for their legal advice and services. In fact, you only pay the standard legal fee and costs (about a third of the total settlement) if the law firm succeeds in obtaining compensation on your behalf. Since they are compensated based on a percentage of the settlement, it is in their best interest to fight for as much money as possible.

Contact us at Douglas and London

In nearly every case, the clients end up with more money when they have legal representation than they could have ever possibly received going it alone through direct negotiations with the insurer. The last thing adjusters (or their employers) want is for you to take them to court, as this drives up the expense for them and almost assures a maximized claim payout. Contact Douglas and London to speak with our experienced New York City car accident lawyers.