A liability adjuster investigates insurance claims to determine if they fall within policy terms, protecting the insurance company’s profitability. They are responsible for determining if a claim is legitimate and closing the case, including authorizing payment or defending a denial in court.
A liability adjuster works for an insurance company; when an insured or third party beneficiary makes an insurance claim under a policy, the liability adjuster investigates. He works to determine whether the circumstances fall within the terms of the policy. If the insurance company decides to deny the claim or tries to recover a policy payment from another responsible party, the liability adjuster will act as the company’s representative in lawsuits.
Insurance companies are in the business of managing risk. They profit when people take out policies and pay premiums, but they never need the insurance company to pay a claim. Conversely, every time an insurance company has to pay a claim, they lose their investment bet and their profits suffer. A liability adjuster is an insurance company’s investigative agent in the field. He is the person who ensures that the company only has to pay legitimate claims that fall under the exact terms of the policy.
An insurance policy is a contract between a company and the person who pays premiums. Insurance is a calculated gamble; therefore, the terms of the policy are extremely important in protecting the company’s profitability. Insurance companies will only pay a claim if it is covered by the terms of the contract. There is always a period of time between when a policyholder makes a claim and the company either accepts or denies the claim. The liability adjuster manages this period and decides whether the company should pay.
When a person calls their insurance company to file a claim, a liability adjuster is assigned to the case. The adjuster investigates the claim by collecting information from the insured and sometimes visiting the loss website. He establishes an investigation file and includes everything he learns about the case. Some people try to defraud insurance companies by lying about the details of an accident or other incident of loss; evaluators try to find out whether a claim is false or legitimate.
A liability adjuster not only determines whether the insured’s account of the loss is accurate, but must also determine whether the loss is covered. An adjuster must be an expert in the types of insurance coverage that are in use in their area of work. For example, if he normally works on homeowners insurance policy claims, he should know the legal parameters of the coverages normally included in these types of policies.
After the liability adjuster determines whether a claim should be paid or denied, he or she must do what is necessary to close the case. This could include authorizing a check or defending your decision to deny the claim on behalf of the company in mediation, arbitration or court judgment. The appraiser is also responsible for obtaining reimbursements from responsible individuals or their insurance companies.
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