Loss Adjusters: Your questions answered - Morgan Clark (2024)

Anyone who has been involved in a major insurance claim, such as a fire or flood at your home or business premises, will likely have come into contact with a Loss Adjuster. This guide will provide answers to frequently asked questions relating to the role of the Loss Adjuster in the insurance claim process.

Key facts:

• The Loss Adjusters’ role is to investigate and assess large or complex insurance claims.

• They are appointed by insurance companies to determine if the damage is covered by your policy and recommend an appropriate payout based on their assessment.

• Loss Adjusters work for the insurance company, not you. Their primary goal is to minimise the payout, not advocate for your best interests.

• It is crucial to be prepared when dealing with Loss Adjusters. Gather documents(receipts, proof of ownership, photos of damage), understand your policy, and answer questions honestly.

• Loss Adjusters are not the same as Loss Assessors. Loss Assessors work for you and help maximise your claim by negotiating with the Loss Adjuster and your insurance company.

What is a Loss Adjuster?

Loss Adjusters are professionals appointed by insurance companies to investigate and assess insurance claims, particularly those of a larger or more complex nature. Loss Adjusters play a crucial role in the claims process and are usually a claimant’s first point of contact after a claim is made.

The role of the Loss Adjuster

Insurance companies will appoint a Loss Adjuster to help assess large or complex claims – usually when the claim is above a certain value. As an impartial party in the claims process, the Loss Adjuster’s role is to establish whether the damage is covered by the insurance policy. They will also recommend the appropriate payment based on their assessment.

During their visit, the Loss Adjuster will record the extent of damage, take photographs, ensure the site is secure, and advise both the policyholder and the insurer on the best course of action. It’s likely they will also ask you for documents to help with the investigation, such as receipts, proof of ownership, and photographic evidence of the damage incurred.

Findings from these investigations will be presented in the form of a Loss Adjuster’s report. This report will include assessments on the amount being claimed for, whether the claim falls within the terms of the insurance policy, and whether the conditions of the policy have been met. The report will then be passed on to the insurance company to process your claim.

Loss Adjuster FAQs

Here, we address common concerns and questions surrounding the role of the Loss Adjuster. From insights into what they are looking for, to preparation tips and navigating their visits, we’ve got it covered.

Why do insurers appoint Loss Adjusters – couldn’t they assess claims themselves?

Insurers appoint Loss Adjusters for several reasons, despite being the ones responsible for claim payouts. These skilled professionals act as unbiased intermediaries, ensuring a fair and accurate assessment of claims. By engaging Loss Adjusters, insurers can rely on their expertise to thoroughly investigate the loss, assess the extent of damages, and determine appropriate compensation.

This impartial evaluation not only provides confidence to the insurer but also instils trust and transparency for policyholders throughout the claims process. Ultimately, the role of Loss Adjusters contributes to efficient claims management, mitigating potential disputes, and maintaining the insurer’s commitment to providing exceptional service to their clients.

A Loss Adjuster is coming to my house, should I be worried?

There’s no need to be overly worried if a Loss Adjuster is coming to your house. In fact, the presence of a Loss Adjuster can be beneficial in certain situations as it indicates that your insurance claim is being actively processed and investigated. It’s a standard procedure for insurance companies to appoint Loss Adjusters to assess the situation and gather relevant information firsthand.

How can I prepare for a Loss Adjuster visit?

Preparing for a Loss Adjuster visit can help ensure a smooth and efficient assessment of your insurance claim. Here are some steps you can take to prepare:

1. Prepare documentation

Collect all relevant documents related to the loss or damage you are claiming. This may include insurance policy documents, receipts, invoices, photographs, and any other supporting evidence. Having these documents organised and readily available will assist the Loss Adjuster in assessing your claim accurately.

2. Make a List of damaged items

Create a detailed inventory of all the items that have been damaged or lost. Include descriptions, approximate values, and any supporting evidence, such as purchase receipts or photographs. This list will help the Loss Adjuster understand the extent of your loss and ensure that nothing is overlooked during the assessment.

3. Document the damage

Before the Loss Adjuster arrives, take photographs or videos of the damaged areas or items. This visual evidence can serve as additional support for your claim and provide a clear record of the condition at the time of the loss.

4. Be prepared to provide detailed information

During the visit, the Loss Adjuster may ask you questions about the circ*mstances surrounding the loss or damage. Be prepared to provide accurate and detailed information regarding the incident, such as the date, time, cause, and any relevant events leading up to it. Providing a clear and consistent account will help the Loss Adjuster in their assessment.

5. Keep a record

Take notes during the visit, documenting any discussions or observations made by the Loss Adjuster. This record can be helpful if any discrepancies or issues arise later in the claims process.

6. Ask questions

If you have any concerns or questions about the claims process, don’t hesitate to ask the Loss Adjuster for clarification. They are there to assist you and provide guidance, so make sure to seek any necessary information or advice.

7. Cooperate and be honest

It’s important to cooperate fully with the Loss Adjuster and provide honest and accurate information. Attempting to misrepresent the facts or exaggerate the extent of the loss can have negative consequences on your claim.

Following these steps will make dealing with a Loss Adjuster much easier and ensure the assessment of your insurance claim proceeds smoothly and accurately.

What does a Loss Adjuster look for?

By understanding what Loss Adjusters typically look for during their investigations, you can better prepare your claim, provide the necessary documentation and evidence, and present your case in a comprehensive and organised manner. Be transparent, cooperative, and responsive throughout the process, as this can contribute to a more efficient evaluation and potentially result in a fair settlement. During their visit, a Loss Adjuster will typically look for the following:

Extent of Damage: The Loss Adjuster will examine the damage or loss that you have claimed. They will assess the severity and extent of the damage, evaluating how it aligns with the details provided in the claim.

Cause of Loss: The Loss Adjuster will investigate the cause of the loss or damage. They will gather information from you and any other relevant parties involved to determine the circ*mstances surrounding the incident. This investigation helps in establishing whether the loss is covered under your insurance policy.

Policy Cover: The Loss Adjuster will review your insurance policy to understand the specific terms and conditions related to the claim. They will verify if the claimed loss falls within the policy cover and determine any limitations or exclusions that may apply.

Documentation: The Loss Adjuster will examine the supporting documents you provide, such as receipts, invoices, photographs, and any other evidence. They will assess the accuracy and relevance of the documentation to validate the claimed loss.

Pre-existing Conditions: The Loss Adjuster will assess whether any pre-existing damage or conditions existed prior to the incident. They may review historical records, maintenance reports, and prior claims to determine if there were any ongoing issues or neglect that contributed to the damages. Understanding the status of the property before the loss event helps Loss Adjusters differentiate between new and pre-existing damages.

Repair and replacement estimates: The Loss Adjuster will assess the cost of repairs or replacements necessary to restore the property to its pre-loss condition. They may obtain estimates from contractors or industry professionals to determine the reasonable and customary costs associated with the required work. The Loss Adjuster’s objective is to ensure that the settlement amount adequately covers the necessary repairs or replacements.

Mitigation efforts: The Loss Adjuster will look for evidence of any mitigation efforts undertaken by the policyholder to prevent further damage or mitigate the loss after the incident. This includes actions such as securing the property, arranging emergency repairs, or hiring professionals to prevent additional harm. Demonstrating proactive steps taken to minimise the loss can positively impact the Loss Adjuster’s assessment.

Overall, Loss Adjusters conduct a thorough examination to establish the validity and accuracy of the claim, ensuring that the compensation provided falls within the terms of your insurance policy. Their goal is to assess the loss objectively and fairly, protecting the interests of both the policyholder and the insurance company.

What questions do Loss Adjusters ask?

Loss Adjusters typically ask a range of questions during their assessment of an insurance claim. The specific questions may vary depending on the nature of the loss or damage being claimed, but here are some common questions you can expect from a Loss Adjuster:

Questions about the incident:

• What was the cause of the loss e.g. fire, flood, theft, or other?
• Can you provide a detailed description of how the loss or damage occurred?

• When did the incident take place?
• Were there any witnesses to the incident?
• Have you reported the incident to the relevant authorities, such as the police or fire brigade?
• Were you present at the time of the incident?
• Did you take any actions to minimise the loss or protect your property?
• Do you have any personal injuries or health concerns resulting from the incident?

Questions about the property:

• What is the property’s type, size, age, construction materials, and are there any unique features?

Questions about damage to the property:

• What areas or items have been affected by the loss or damage?
• Can you describe the condition of the damaged items before the incident?
• Do you have any photographs or videos of the pre-loss condition?
• Are there any pre-existing damages that may impact the assessment?

Questions about the value and documentation:

• Can you provide receipts, invoices, or any other supporting documentation for the damaged items?
• How did you determine the value of the lost or damaged items?
• Are there any items that require expert assessment or valuation?

Questions about the policy:

• What is your policy number, effective dates, and specific coverage provisions?

Questions about repairs:

• Have you taken any steps to prevent further damage or mitigate the loss?
• Have you obtained repair estimates or quotes for the damaged property?

These are just some possible questions a Loss Adjuster may ask. The purpose of these inquiries is to gather accurate and detailed information to assess the validity and extent of the claim. It’s important to provide honest and complete answers to the best of your knowledge during the discussion with the Loss Adjuster.

How do Loss Adjusters get paid?

The services of a Loss Adjuster are paid for by the insurance company, and the Adjuster is employed by an external company rather than working directly for the insurer.

Are Loss Adjusters impartial?

Although the Loss Adjuster’s services are paid for by the insurance company, the Adjuster does not work directly for the insurer. The Loss Adjuster has no stake in the claim and should be able to provide an impartial view; however, that doesn’t mean they won’t want to act in the insurance company’s best interests. The insurer is unlikely to appoint the same Adjuster again if they are unhappy with the results, so it is in the Loss Adjuster’s best interests to keep the settlement fees as low as possible.

What is a Public Loss Adjuster?

A public Loss Adjuster, also known as a Loss Assessor, is a trained professional who works on behalf of policyholders (individuals or businesses) to handle insurance claims. Unlike a Loss Adjuster who is employed by the insurance company, a public Loss Adjuster is independent and represents the interests of the policyholder.

Public Loss Adjusters are experts in insurance policies and claims processes. They assist policyholders in navigating the complex procedures involved in making and negotiating an insurance claim. Their main role is to ensure that policyholders receive a fair and equitable settlement from their insurance company.

Read more about the key differences between Loss Assessors and Loss Adjusters.

Will hiring a Public Loss Adjuster (Loss Assessor) annoy the Loss Adjuster?

Hiring a Loss Assessor is a common practice and should not annoy the Loss Adjuster. While it is true that the roles of a Loss Assessor and a Loss Adjuster may overlap to some extent, they serve different parties and have different objectives.

A Loss Assessor is hired by the policyholder to represent their interests and ensure a fair and equitable settlement from the insurance company. Their primary goal is to advocate for the policyholder and maximise the claim settlement.

On the other hand, the Loss Adjuster works for the insurance company and is responsible for evaluating the claim on behalf of the insurer. They assess the validity, extent, and value of the claim, aiming to ensure that the insurance company pays out an appropriate amount based on the policy terms and conditions.

While the presence of a Loss Assessor may introduce an additional layer of communication and negotiation between the policyholder and the insurance company, it is a legitimate and common practice. Loss Adjusters are typically accustomed to working with Loss Assessors and dealing with their involvement in the claims process.

What can I do if my claim is rejected/repudiated?

There are certain circ*mstances under which the information collected by the Loss Adjuster can result in your claim being rejected. To find out more about the actions you can take in this scenario, pleaseread our guide; Insurance claim rejected? What to do next.

What to do if you are unhappy with the conduct of the Loss Adjuster

All Loss Adjusters should conduct themselves in a polite and professional manner, but if you are unhappy with the conduct of a Loss Adjuster during the claims process, there are several things you can do:

Firstly, you can voice your concerns to the Loss Adjuster, the Loss Adjusters’ employer, or speak to your insurance company. Loss Adjusters will be working to very strict service level agreements and insurers will want to know if their service is falling short.

Secondly, you may also consider appointing a Loss Assessor to represent your interests and ensure a fair resolution.

It is helpful to maintain a record of all communication, correspondence, and documentation related to your dissatisfaction with the Loss Adjuster. This evidence can be helpful in supporting your case and demonstrating the efforts you have made to address the issue.