Insurance Claims

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Insurance Claims Handling

Individuals and business owners purchase insurance policies to protect against monetary losses. In the event of a loss, policy holders submit claims, or request for payment seeking compensation for their loss. Adjusters, appraisers, examiners, and investigators deal with those claims. They work primarily for property and casualty insurance companies, for whom they handle a wide variety of claims alleging property damage, liability etc.

Their main role is to investigate claims, negotiate settlements, and authorize payments to claimants. They must be mindful not to violate their rights under Federal and State privacy laws. They must determine whether the customer's insurance policy covers the loss and how much of the loss should be paid.

Adjusters plan and schedule the work required to process a claim. They investigate claims by interviewing the claimant and inspecting the property damage to determine how much the company should pay for the loss. The information gathered, including photographs and statements, either written or recorded is set down in a report that is used to evaluate the claim. When the policyholder's claim is approved, the claims adjuster negotiates with the claimant and settles the claim.

Some large insurance companies centralize claims adjustment in a claim center, where the payout amount is estimated and a check is issued immediately. However cases handled by independent adjusters, or those involving business losses or homeowner claims such as hurricane or fire damage, all require a senior adjuster to physically inspect the damage and determine proper compensation. Often insurance carriers use the service of independent adjusters on a freelance basis in lieu of hiring them as regular employees. In this case the independent adjusters work in the interest of the insurance company.

Helpful Tips

Know your policy: It’s important to understand what your policy says.  The policy is a contract between you and your insurance company.  Make sure you know what’s covered and what’s not and what the deductibles are.  If you have any questions about the policy, the time to ask is before you need to make a claim.


Make temporary repairs: If your home is damaged, you should make whatever temporary repairs are needed to protect your home or business from further damage.  These should always be covered by your policy.  Just remember not to start any permanent repairs until you hear from an adjuster.  If you make any temporary repairs, make copies of the bills for your records, just in case the adjuster loses them.

Document, document, document: This is important both before you need to make a claim and when you need to make one.  Save the receipts for items you buy.  That will help prove what items you had and how much those items cost.  Photographs and/ or videotapes of you home / business ( both pre and post disaster form) can also be beneficial.  These will help you establish an inventory of your belongings should the need arise.  Take photos or videos of the damage before you begin cleaning up.  Many cell phones now have cameras built in, so be sure you know how to use yours if you have one.  If you don’t have a camera phone, keep one disposable camera in your glove compartment and one at home or business.