¿Qué hacen los ajustadores de seguros?

  • By:Seth Knudsen

Well it depends on which type of insurance adjuster you are talking about.

There are a three main types of insurance claims adjusters, which are as follows:

  1. Staff Adjuster: A staff adjuster works full-time for one insurance adjuster firm exclusively and is responsible for determining coverage of claims.
  2. Independent Adjuster: Independent adjusters work as contractors for multiple insurance firms or third-party administrators. They often work with catastrophe claims and will travel to the impacted areas after major weather events or emergencies.
  3. Public Adjuster: Public insurance adjusters work directly on behalf of policyholders (the claimant). They help businesses or individuals file insurance claims if a proposed settlement seems unfit from an insurer.

In general terms an insurance claims adjuster “staff adjuster” conducts investigations into claims covered by an insurance policy. They will investigate, analyze, and determine the extent of the insurance company’s liability concerning personal, casualty, or property loss or damages, and attempt to effect settlement with claimants.

The job performance of insurance staff adjusters is judged not only by how little of the insurance company’s money they spend in settlements but also by how quickly they settle claims.

 Most small loss to mid-range loss adjusters get 20 even as high as 100 new claims a month across their desks and on a rare occasion even higher than 100 claims per month. Large loss adjusters see fewer claims per month because of the size and complexity of each larger dollar value claim. They have to settle as many claims as they get—known as “clearing” or “closing” a claim file—each month just to stay even. Their performance is also rated on how many claims they can personally settle without having to involve supervisors or insurance company lawyers.

The staff adjuster is an hourly or salaried employee of the insurance company.

An Independent adjuster is a hired liaison for the insurance company who has a contract with them to do an investigation into the claim. They normally are under another business name and their business card will reflect that company name not the insurance company name.  In many cases an independent adjuster is used as a field representative of the insurance company to meet the homeowner, inspect the damages and write up an estimate of repairs. In my experience the insurance company doesn’t give an independent adjuster much if any authority to say something is covered or can be paid on. They are just there to write their “report/assessment” which is just their opinion of the claim.

An Independent adjuster is paid through billable hours that he/she says they spent working on that one specific claim assignment/job by the insurance company.

Public insurance adjusters are hired by policyholders most of the time homeowners, renters, and business owners who have insurance policies. A public adjuster is an advocate for the policyholder by presenting the claim in the most favorable light for their client. They will write estimates, gather documents, work with restoration contractors, restoration vendors, and most importantly correspond/negotiate with the staff or independent adjuster to come to an agreed settlement for their client the policyholder.

Public insurance adjusters are paid a fee in the form of a percentage from the policyholder normally 10% some times higher or lower depending on the complexity and or size of the claim. They normally are not paid until the settlement check(s) are issued by the policyholder’s insurance company.

Under the regulation of the State Department of Insurance, you have the right to receive a fair adjustment on a claim. The insurance company is obligated to compensate you for your covered loss(es). Please note that each claim is different and if you feel that you have received an unfair settlement from your insurance company, then you should seek the help of a public adjuster or legal counsel.

Each claim is unique in its own right. Words presented above may not reflect or agree with your personal situation.

Claim Ally is public insurance adjusting firm for those who have suffered a first party claim.

This is strictly the opinion of those who work with or in Claim Ally. Claim Ally Does Not practice law nor does it give legal advice.

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