Everything You Need to Know about Insurance Claims & Insurance Adjusters

The process of filing a claim involves many actors, at Avner Gat, Inc, our team of public adjusters works to provide you a better understanding of each one of them.

Generally speaking, an insurance adjuster is someone who inspects property damage or personal injury claims and determines how much an insurance company is contractually bound to pay based on the policy of the insured. The scope of their position involves:

• Investigating insurance claims
• Interviewing the claimant as well as any witnesses
• Inspecting the property involved in the claim (home, business, automobile, etc.
• Performing additional research (police reports, speaking with doctors and employers, etc.)
• Negotiating settlement payments
• Reviewing the policy of the insured party (learn more about YOUR policy here: Getting to Know Your Insurance Policy – Part 2

The three types of insurance adjusters are company adjusters, independent adjusters, and public adjusters. Each type of adjuster has their own unique responsibilities and skills, but they all play a crucial role in the insurance claims process and help ensure that policyholders receive fair and just compensation for their losses.

If you are beginning the insurance claims process or are already in negotiations with your provider, it’s important for you to know the difference between the three types as you will likely come into contact with more than one along the way.

Type 1 – Public Adjusters

Public Adjusters work on behalf of individual policyholders in order to help them receive fair settlement payments from their provider based on their policy. Policyholders hire public adjusters to assist in the preparation, presentation, and settlement of their claim.

Insurance policies are often full of complex language and industry terminology that make them difficult to understand for those who don’t have experience in the field. A public adjuster serves as counsel for the policyholder, guiding them through the claims process and helping them to understand what they are owed based on the incident and details of their policy.

Public adjusters also assist their clients by:

• Compiling the necessary claim information and documents
• Investigating details of the incident and claim
• Soliciting relevant information from the claimant and any witnesses
• Negotiating with the insurance company on their behalf for the highest possible settlement

A public adjuster’s compensation is based on a percentage of the settlement that is finalized by the insurance company. This means public adjusters are incentivized to secure the highest possible settlement on behalf of their clients because their performance directly impacts their compensation.

In order to protect policyholders, the State of California Department of Insurance requires that public adjusters are licensed, bonded, and tested. This measure is taken to ensure that the adjuster complies with all state rules and regulations as well as conducts themselves in an ethical manner.

Most importantly, unlike the following two types of insurance adjuster, public adjusters are the only adjusters who represent the policyholder’s interests. 

If you’re wondering whether you should hire a public adjuster, check our blog post “Four Signs You Might Need A Public Adjuster”

 

Type 2 – Company Adjusters

Company Adjusters are employed by insurance companies to represent their interests and negotiate claims on their behalf rather than that of the policyholder. The insurance company compensates the company adjusters, and thus they represent the company’s interests.

When you file a homeowner’s insurance claim, whether in response to water damage, fire damage, theft, or otherwise, the company adjuster is the one who receives and reviews it. Unlike a public adjuster, the company adjuster goes over your claim in search of ways to reduce your settlement payment.

Company adjusters work on behalf of the insurance provider to:

• Determine whether the claim is covered by your policy
• Investigate the details of the claim
• Interview the claimant, witnesses and other relevant parties
• Ensure the claim is not fraudulent
• Negotiate the lowest possible settlement amount
• Authorize final settlement payments

Since they are directly employed by the insurance provider, company adjusters are incentivized to find details within your claim and policy which justify paying you the lowest possible settlement. An adjuster who consistently negotiates lower settlements for claims assigned to them are an asset to an insurance company and are rewarded accordingly. Moreover, the State of California Department of Insurance does not individually license or test company adjusters.

If you are a home or business owner filing an insurance claim, the important thing to understand is that company adjusters are working against your own interests and their job consists of finding ways to decrease your final settlement payment. Also, because they are employed by the insurance provider, they should never charge a fee to the policyholder.

Type 3 – Independent Adjusters

Independent Adjusters are not formerly employed by the insurance company, but they are hired to represent their interests. The easiest way to understand the difference between a company and individual adjuster is that the latter is an independent contractor, or outside hire, brought in by the insurance company to assist with individual claims.

Don’t be misled by this slight difference in terminology. Even though they are not directly employed, Independent Adjusters perform similar duties and share the same objective as company adjusters; to find ways to reduce your settlement payment. Their compensation is also based on their ability to do so.

Thus, even though their title includes the word “independent”, these adjusters do not have a neutral stance in the claims process and are still working to reject or reduce your settlement. As with company adjusters, independent adjusters should never charge the policyholder a fee for their services.

Final Thoughts

Insurance companies often assign multiple adjusters to a single claim, so it is important to know which adjuster is working in what capacity. You should always keep in mind who you are speaking with during the claims process and remain aware of who’s interests they represent.

If your insurance company is giving you a hard time and refusing to cover your losses, your insurance claim could probably benefit from the assistance of a public adjuster. Hiring a public adjuster to help negotiate your claim often leads to higher settlement payments.. Interested in learning more? Check out our article “When Should I Hire a Public Adjuster?“!

Avner Gat, Inc. has 17+ years of experience as a public adjuster in Los Angeles and Southern California. We protect homeowners from the games and fine print that insurance companies are known for.

To speak with one of our experienced public adjusters about your claim, call us at (818) 917-5256 or fill out the contact form below and let us know how we can help you!