An insurance adjuster is a person who investigates claims to determine how much (or if, at all) your insurer should reimburse you for damages/losses to your stuff or place.
What is an insurance adjuster and what do they do?
An insurance adjuster, also referred to as a claims adjuster, determines how much your insurance company is on the hook for when you, the policyholder, make a claim.
They can either be an in-house representative or an independent person hired by your insurer (or yourself) to investigate issues ranging from bodily injury to medical bills and property damage.
Adjusters help figure out a fair settlement by speaking with you, assessing damages, speaking with witnesses, reading reports by officials, and more.
How adjusters deal with claims
Zooming in a bit more, adjusters start out by preparing a claim file – just as a lawyer would prepare a case file for trial – to present to the insurance company and insured (that’s you).
They include photographs and statements from those directly involved in the claim, testimony from relevant experts and attach their personal recommendation on how much the insurer should pay.
For example: Say your dog bit someone and they leave you with a hefty medial bill. Before your insurer agrees to help pay, they may send a claims adjuster your way 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 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?
Well, it isn’t up to you or your insurer; it’s something the insurance claims adjuster will decide.
The 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 to get an outside estimation of similar damage, etc. 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 a human adjuster.