Anyone filing an insurance claim should prepare for dealing with an insurance claims adjuster. Insurance companies exist to make money; they are for-profit businesses that collect premium payments and lose money when they must pay out on claims. However, they have a legal obligation to process claims in good faith, and insurance claims adjusters are an integral part of this process.

What Does a Claims Adjuster Do?

A claims adjuster reviews a policyholder’s claim, assessing the full scope of the policyholder’s coverable damages, and weighing those damages against the terms of the policyholder’s coverage. An insurance company does not have any obligation to pay anything beyond the scope of a policy. The claims adjuster’s job is to minimize the insurance company’s financial obligation to the claimant by looking for any and all reasons to deny coverage or reduce the claimant’s settlement amount.

When a policyholder files a claim, the insurance carrier will review the claim and assign a claims adjuster to work on it. The claims adjuster may contact the policyholder by phone for an initial negotiation, but most meetings with claims adjusters happen in person.

Preparing for the Claims Process

It is always advisable to hire a car accident attorney in West Virginia before filing an insurance claim. An attorney can help you draft a strong initial demand letter that fully explains the scope of your damages. The letter offers valid available evidence, and minimizes the chances of the claims adjuster attempting to downplay your claim. An attorney can also help you prepare for the initial phone conversation with an adjuster and subsequent meetings.

The insurance company will send a claimant a notice of reservation of rights after the claimant files his or her claim. This document generally stipulates that the insurance company reserves the right to refuse payment on your claim if it does not meet their criteria for coverage and the insurance company intends to investigate your claim. A claimant’s initial demand letter should include the amount sought and the claimant’s justification for filing the claim.

Tips for Negotiation

Meeting with an insurance claims adjuster can be daunting; this individual is a major deciding factor in how much coverage a claimant receives after filing an insurance claim.

  • The first phone negotiation generally includes each side providing the strengths and weaknesses of their arguments. The claimant explains how and why his or her damages fall within the scope of coverage, and the claims adjuster responds by attempting to minimize the insurance company’s financial obligation to the claimant under the terms of the policy. Consider hiring an attorney to help you prepare for this initial conversation.
  • Never accept the first offer. The insurance claims adjuster will likely offer a lowball settlement offer at first, and you should be aware that this is typically an attempt to convince you to accept less than the insurance company owes you. Whenever you accept a settlement offer, you sign away any right to pursue further coverage for the same event. Accepting a low offer or accepting too soon could lead you to lose a significant amount of coverage allowed under your policy.
  • Be honest and concise. Never lie or exaggerate to an insurance claims adjuster, and never offer more information than necessary. Answer all insurance claims adjusters’ questions honestly and as concisely as possible. Emphasize the strongest points of your claim but do not fall into the trap of claiming your damages are more severe than they are.
  • Confirm your settlement in writing. Once the claims adjuster makes an acceptable offer for coverage in your claim, make sure the claims adjuster can provide a written confirmation of the settlement, including the total amount, the damages covered, and any and all relevant dates in the claim.

Dealing with an insurance claims adjuster is rarely an enjoyable experience. The claim payout process can be slow, and these conversations can add stress on top of an already difficult situation. The right attorney can make a significant difference in the outcome of any negotiations with insurance claims adjusters.