Two types of losses:
- First Party – referred to as ‘own damage or direct damage’ claims. These claims involve only the insured and the insurer.
- Third Party – is known as liability coverage. Claims arise from your legal obligation to others and involve someone or something that is not party to the contract.
Types of adjusters:
Telephone adjusters – salaried employees of insurers, adjust a large volume of claims that do not require face – to – face interviews. A telephone adjuster will speak with an insured get the details of loss then send an appraiser or a contractor out to assess the damage.
Staff adjusters – salaried employees of insurers who investigate, negotiate and settle claims. They will usually have the authority to settle claims up to a certain dollar limit.
Independent adjusters – work for many insurers on a fee basis. They are compensated based on the amount of time spent on a claim and usually have limited authority to settle claims on behalf of a company.
Public Adjusters – work on behalf of insured’s during a claim. They are paid a percentage of the insured settlement but are not permitted to operate in all provinces.
There are licensing requirements for all types of adjusters.
Adjusters functions: Interviewing insured’s, third parties, witnesses, police and other experts. They are responsible for investigating all details of a claim and establishing the cause of the loss. Then a value must be agreed upon with the insured who must prove the amount of loss. Detailed adjusters files are necessary for successful litigation.
Investigating a Loss
The Claims Manager or Superintendent is responsible for the functioning of an insurers claims department.
A loss is reported to the insurer. Coverage is confirmed. The claims is opened and assigned a claim number. The claim is routed to the appropriate type of adjuster. The insurer must make a decision regarding the use of staff adjusters or independent adjusters. The decision will depend on the insurers stance regarding insurance fraud. The adjuster once appointed will verify the damage took place in the manner stated, verify the extent of the damage, keep the claims department informed. A claims examiner will be appointed for every claim. They will oversee that claim and work with the adjuster to bring it to a satisfactory conclusion.
