Welcome to the world of insurance. While you have been involved in the sense that you pay for insurance products (Car, home, life, etc.) you may not have had the misfortune of dealing with a claim on your insurance policy. The first point of contact for nearly everyone is the front line person assigned to your file (usually called a “claim”). Your claim will have a person who has three specific roles. They go by various titled, perhaps the insurance company you’re dealing with refers to them as a insurance claims adjusters, claim representative, or insurance adjuster. No matter which title they go by, this person has three main roles

1. Investigate

The investing role involves determining the facts of the case. Who is involved? What happened? What is the damage? The information collection stage is important and the insurance adjuster is not always in the best position to gather all the required information. Odds are, you will have a version of the events that happened, background information about relevant aspects of the claim, and leads which may help the insurance adjuster complete their investigation.

2. Assess

An adjuster will make determinations about the information acquired during the investigation. The determinations made are not final, nor are they the law. Sometimes the information relied upon is incorrect or incomplete. In other circumstances, the information conclusions drawn from the information are simply illogical or unsupported. You should speak to an accident and injury lawyer about information and evidence. A lawyer is well-positioned to help you support your claim. Oftentimes, a lawyer is able to work through a roadblock between two parties and steer the matter towards a fair resolution.

3. Pay claims

Paying the claim can mean many things. Payments can be divided into two categories: first-party benefits, and third party benefits. First party benefits include weekly income benefits, medical payment, and rehabilitation services. First party benefits are often a source of frustration for many people dealing with an insurance company because the system can work slowly and the steps to obtain benefits can be complex. The second group of benefits, third party benefits, include bodily injury claims. This claim is payment of money made by the at-fault driver (really the insurance company who insured the driver) to the injured person.

What is the difference between my adjuster and the adjuster from the other company?

The investigation and assessment done by an insurance adjuster will depend on their role. A first pay adjuster will look to provide you with information to access benefits and will attempt to determine what benefits are reasonable for your claim. The adjuster in this circumstance will attempt to limit benefits when no further benefits are required (usually because you have returned to work or are back to your pre-accident health). A third party claim adjuster, however, will be more focused on the validity of your claim and the evidence to support payment to you. Ultimately, the third party claim adjuster seeks to reduce the amount they must pay to a claim made against their insured. This does not mean, however, that the third party adjuster will be rude, or unfair. They, like your lawyer, have a job to do and have their own policies and procedures to follow. If you have concerns about an adjuster or the progress of your file, you should speak to a lawyer.

Interesting in the law and licensing requirements for insurance adjusters in Nova Scotia? Learn more here.