The insurance claims adjuster is the insurance company employee who is charged with investigating the facts of a car accident and negotiating a settlement of the claim. In the insurance context, the word “adjust” means to determine or settle a claim or to assess a loss or damage. In investigating a claim, the plaintiff’s lawyer and the insurance adjuster are both doing the same things; they are trying to figure out what happened and what the claim is worth.
An insurance company opens a claim file upon hearing either from its insured that he/she was in an accident, or upon hearing from the injured person (or from a person whose car was damaged) that its insured allegedly caused an accident. Once the file is opened, the insurer will assign it to an adjuster.
Once an insurance adjuster is assigned a claim, the first thing that he/she wants to do is to get the insured driver’s version of the facts. The adjuster will read the driver’s written accident report that was submitted to the insurance company (if the driver filed one), and will often call up the driver to hear the driver’s story firsthand. (Learn more about being interviewed by a car insurance adjuster.)
But experienced adjusters understand that their insureds are not always telling the truth. They know that simply because their driver says that the accident happened in a certain way does not mean that the accident happened that way. Good adjusters know when to believe their driver and when not to believe their driver.
The adjuster will then request the official records -- the police report and the accident reports that the drivers filed with the state department of motor vehicles, if such documents exist. The police are not called in every accident, and not all drivers submit accident reports to their department of motor vehicles, even though most states’ laws require them to do so.
The first letter to the claimant or to the claimant’s lawyer is usually a generic letter that identifies the adjuster, provides the applicable policy limits (if the accident occurred in a state that requires the insurer to provide the policy limits), and asks the claimant or the lawyer to provide all documents relating to the claimant’s damages. These documents are customarily medical records, medical bills, proof of earnings, and proof of property damage.
The adjuster will likely have already investigated you by this time! Insurers have various claims databases, and adjusters can access these databases to determine whether the claimant has ever filed a personal injury or property damage claim before. A good adjuster these days will also spend a few minutes on Google just checking you out. The adjusters want to know who they are dealing with and also want to dig up any dirt on you that they can.
In a personal injury claim, the adjusters spend a lot of time and energy making sure that they have all of the medical records and bills relating to your claim. The adjusters want to get as many medical records as they can in the hopes that the records will reveal something about you that they can use to lower the value of the case. Further, adjusters don’t like waiting for you or your lawyer to send them your medical records and bills. They never trust plaintiffs to send them everything; they always prefer to get the records themselves. So they usually will send the injured person a medical authorization that will allow them to request the medical records themselves.
Do not sign such an authorization unless your lawyer tells you that you should. If you do not have a lawyer, do not sign a medical authorization for the insurance company. Different authorizations say different things, and you do not want insurance companies digging up your medical records and talking to your doctors.
Insurance adjusters will usually ask that an injured person give a tape recorded statement describing the accident and his/her injuries. As a general rule, giving such a statement in a car accident case will not help you if you do not have a lawyer. If you do not have a lawyer, you should not give a tape recorded statement to the insurer no matter what the adjuster says. Learn more about how your recorded statement can be used against you.
Once the adjuster has all of your medical records and bills and all of the other information that he/she needs to value the case, he/she will put a value on the case and try to settle it. If you don’t have a lawyer, the adjuster will generally ask you how much you want to settle the case. Don’t give a number first. Ask the adjuster how much he/she will offer to settle. Then you have to negotiate. Negotiation is not easy. If you were in a car accident and have any questions about what the insurance adjuster is doing in your case or are having any problems trying to settle the case, you should contact a car accident lawyer immediately.