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What is Insurance Adjusting?

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  • Written By: Mary McMahon
  • Edited By: O. Wallace
  • Last Modified Date: 05 June 2018
  • Copyright Protected:
    2003-2018
    Conjecture Corporation
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Insurance adjusting is an important part of the insurance industry. It involves investigating insurance claims to confirm that they are valid and to determine the amount of the payout which will be issued by the insurance company. Insurance adjusting is performed by people known as insurance adjusters or claims adjusters. These insurance professionals can work for the insurance company, as independent contractors, or for the claimant, depending on the situation.

When an insurance company writes a policy, it includes the terms for claims made on that policy. If a claim is filed, insurance adjusting comes into play. Sometimes, this job is very easy. With a health insurance policy, for example, the adjuster can quickly determine if the claimed service is covered, and issue payment to the claimant. However, insurance adjusting can also get more complicated, as for instance when someone makes a liability claim against an insurance policy which may require more subjective evaluation.

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Investigation of a claim can include interviews with the claimant and people involved, along with consultations with professionals. The insurance adjuster may also travel to investigate the claim. For example, after a car accident or house fire, the insurance adjuster will want to see the damage, take photographs, and make assessments of the expenses involved in restoration, replacement, or repair. During the course of the investigation, the adjuster looks for signs of fraudulent activity or other activity which could violate the terms of the policy, determining not only how much should be paid out, but whether or not the insurance company should pay out at all.

In many cases, the insurance adjusting process results in a decision which is satisfactory to all parties. Sometimes, however, the claimant may dispute the findings, and file an appeal. Claimants can also hire their own claims adjusters, using these professionals to build a case against the insurance company to convince it to pay out on a denied claim or to increase the amount of a payout.

A career in insurance adjusting requires some training and experience. A college degree is not required, but strongly recommended, and many claims adjusters come from a background in an industry like contracting, auto body repair, or the law. They can use their experience to evaluate claims fairly and accurately. Many nations also require claims adjusters to take exams, creating a licensing policy which ensures that in addition to knowing how to evaluate claims, insurance adjusters are also familiar with insurance law.

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