Adjuster

What is an insurance adjuster?

When a person with a home insurance policy experiences a loss, they’ll submit a claim to their insurance company. The adjuster is the person who investigates that claim on behalf of the insurance company. Adjusters are also known as insurance adjusters or claims adjusters — they’re all the same thing. You may also hear of a claims examiner. Examiners are essentially higher-level adjusters with greater authority.

Insurers have to do their due diligence when it comes to paying out on claims. Otherwise, they might end up paying claims that fall outside of the policy’s coverage or claims that are fraudulent in nature. This would use up all of the funds that the insurance company needs for legitimate claims, eventually causing the company to go out of business. Then no one would have insurance.

To avoid this, insurance companies hire adjusters to investigate claims and help arrive at settlements that are fair to both the insurer and the insured. The adjuster communicates with the insured throughout the claims process on behalf of the insurance company.

There are a number of certifications that a claims adjuster might need. In Canada, each province and territory has its own insurance regulator. In most cases, insurance adjusters are licensed by these regulatory bodies. They need to have the right license for the province in which they’re working, especially in the case of independant adjusters. Some exceptions exist if the insurance adjuster is employed by, and only handles claims for, a single insurance company.

Adjusters in Canada may also earn any number of other insurance certifications, like the Chartered Insurance Professional (CIP) designation, for example.

What does a claims adjuster do?

The life of an adjuster is a busy one.

When an insured person files a claim with their insurance company, that claim will be assigned to an adjuster. The adjuster will then start a claim file and collect the necessary details. They need to deliver a report to the insurance company that explains everything about the claim and how much the insurer should pay to settle it. The adjuster will also analyze the insurance policy to determine which parts of the claim are or are not covered.

In order to make an accurate and fair determination of the settlement amount, the adjuster needs to gather a lot of information. During their investigation, they’ll visit the site of the damage, interview claimants and witnesses, review police reports, consult with relevant experts, or anything else they need to do to get the full picture. If you’re submitting a claim, the more details you can provide your adjuster, the better; you’ll save them time trying to track things down, and they’ll be able to settle your claim faster.

Along the way, the adjuster will often be able to help the insured take necessary steps like obtaining repair estimates and selecting professional contractors.

Once they’ve concluded their investigation and determined the cause of the loss and the extent of the damage, they will report all of that information to the insurance company along with a recommended settlement amount. The adjuster tries to determine the amount that covers the insured loss, no more and no less.

That’s an example of the work of a home insurance adjuster. But of course, there are adjusters throughout the insurance industry. Particularly within property and casualty insurance (which includes home and car insurance), the role of an adjuster doesn’t change much. For example, a car insurance adjuster will investigate the details of a car accident, research the replacement value of vehicles, or help their customer arrange repairs for their car.

Of course, sometimes things don’t go perfectly smoothly; it can be hard to figure out the precise cause of a loss, or sometimes the insured won’t agree with the adjuster’s settlement amount. The adjuster also functions as a negotiator. Even though they’re working for the insurer, they want to make sure that both sides are content with the settlement. It’s a delicate balance.

An adjuster may handle claims differently depending on the insurance company (or insurer) they work for. For example, some adjusters may be authorized to pay out small claims quickly, under express settlement processes. For example, at Square One, many small claims can be handled using our online claims process. Larger, more complex claims still require some legwork, but most of Square One’s claims in Canada are settled within 60 days.

What is an independent adjuster?

We’ve only briefly mentioned the differences between an insurance company’s adjusters and independent adjusters. Ultimately, there isn’t a huge difference for the customer.

Insurance companies usually have in-house adjusters, but they’ll also often outsource the adjusting process to independent adjusters. Independent adjusters are third parties who perform adjusting services on a freelance basis. If an insurance company issues policies in an area where they don’t have an office (a very common occurrence), they’ll hire an independent adjuster to handle claims coming from that area.

Apart from working on a freelance basis, independent adjusters pretty much function the same way as in-house adjusters. They investigate claims, speak with claimants, file reports, and determine how much the insurer should pay to settle the claim.

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