What Does an Insurance Adjuster Do and Why Does it Matter?

April 5, 2022 General

What Does an Insurance Adjuster Do and Why Does it Matter?

If you or a loved one have been injured in an accident here in Louisiana, you are entitled to seek compensation for personal injuries and for any damage to property. Most personal injury cases are settled and resolved through a claim made against one or more insurance policies. When that happens, an important role is played by the insurance adjuster assigned to the claim. However, what does an insurance adjuster do? Here is a brief synopsis. Note that many of the activities described below are done concurrently. But, it is useful to break the tasks out separately for clarity.

Investigate the Claim and Prepare a Report

First, that adjustor investigates the claim. Essentially, the adjuster is seeking to determine what happened and how any injuries or property damage occurred. These issues are important for determining if there is insurance coverage (for which the insurance company is liable) and for assessing fault. Tasks here include:

  • Talking to the policyholder
  • Visiting the site of the accident
  • Interviewing any persons injured and/or making claims against the insurance
  • Interviewing witnesses
  • Requesting and examining documents and other evidence like photos and video
  • Requesting and evaluating medical records and other records related to loss

During this process, the adjuster is preparing a report which will eventually be finalized. The report will be used by the insurance company as the basis for an assessment of whether the claim should be paid and, if so, how much should be paid.

Determining if There is Coverage

 As noted, one key issue that must always be determined is if there is insurance coverage. Many insurance policies have exclusions and another language that might exclude the particular accident from coverage under the policy. Part of what an adjuster does is make an initial determination if coverage exists. If there is no coverage, then the insurance claim will be denied. Tasks here include reviewing the insurance policy and making sure that the policy is valid. For example, the adjuster will make sure that the policyholder paid the required premiums.

Determining the Value of the Claim 

As noted, part of the fact investigation is obtaining and reviewing documentation related to the loss such as medical records, cost of repairs and the like. From this, the adjuster will make an initial determination of what should be paid under the insurance policy. This initial determination will also include an estimate of what should be paid for non-quantifiable damages like pain and suffering if injuries are involved.

Making a Settlement Offer

Often, adjustors are also responsible for officially extending the initial settlement offer (although many times this comes from different personnel at the insurance company). If the adjuster makes the initial offer, there may also be a brief period of negotiation with the legal counsel for the claimant if the claimant thinks the offer is insufficient or erroneous.

Claimants are not required to accept a settlement offer and can file suit in a court of law. We, here at Mansfield, Melancon, Cranmer & Dick LLC., believe that a claimant should not accept an initial settlement offer without seeking the advice of experienced Louisiana personal injury and insurance attorneys.

Our Attorneys Can Help

For more information, contact the Louisiana personal injury lawyers at Mansfield, Melancon, Cranmer & Dick LLC. We have a proven track record of success handling many types of Louisiana personal injury cases including car accidents, boating accidents, motorcycle accidents, premises liability accidents, and cases involving nursing care facility abuse/neglect. Contact us by calling one of our offices: New Orleans at (504) 500-1108, Baton Rouge at (225) 612-0800, or Lafayette at (337) 409-0003. You can also request a free consultation by using our “Contact Us” page.