An insurance adjuster is someone who investigates claims to determine how much (or if) your insurance company should pay you for damages/losses to your stuff or place.

What is an insurance adjuster, and what is a claim adjuster?

An insurance adjuster, also known as a claims adjuster, determines how much your insurance company should pay you if you make a claim.

Insurance claim adjusters can either be in-house reps or independent people hired by your insurer (or you!). They investigate issues like bodily injury, medical bills, and property damage.

Insurance adjusters help figure out a fair settlement, by:

  • Speaking with you
  • Assessing damages
  • Speaking with witnesses
  • Reading reports by officials – and more!

How insurance adjusters deal with claims

Zooming in a bit more, insurance claim adjusters start out by preparing a claim file – just like a lawyer would prepare a case file for trial. They plan to present this claim file to the insurance company and insured (that’s you).

Insurance claims adjusters include photographs and statements from people directly involved in the claim, along with testimonies from relevant experts. Then, the claims adjusters attach their personal recommendation on how much the insurer should pay.

For example: Let’s say your dog bit someone and they leave you with a hefty medial bill. Before your insurer agrees to help pay, they may send over a claims adjuster to take pictures of your place, talk to any witnesses and neighbors, consult with your dog’s vet, and maybe even speak with an independent dog trainer.

Example of how insurance adjusters handle claims

Let’s say your neighbor’s tree fell into your yard, damaging your fence and roof at the same time (double whammy!).

Who’s gonna pay? And how much?

It isn’t up to you or your insurer; it’s something the insurance claims adjuster will decide.

The insurance adjuster will come to your place (or will arrange for someone to come to your place), take pictures, assess the damage, speak with you and your neighbor, and may also interview witnesses, consult with fencing and roofing experts. They’ll wrap all of this up into a report with a monetary recommendation of how much your insurer should pay.

Advances in technology and claims adjusters

Claims are one of the touchier subjects in insurance. Although insurance is meant to be a social good, it’s also a business run by real companies with very real bottom lines.

And while most insurance companies have claims adjusters doing the heavy lifting on all types of claims, there are some companies using technology and artificial intelligence to automate parts of the claims process, which is changing the business model of insurance.

At Lemonade we have instant claims – if a claim filed by a policyholder meets our requirements, our claims bot, AI Jim, will pay it out immediately! Users simply open the Lemonade app and submit their claim along with any relevant docs. If the claim is instantly approved, our AI will pay the claim in 3 secs. If the claim is more complex, it’ll go to straight to a human adjuster.

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