Claims adjustors must consider all aspects of insurance claims.
Insurance policyholders file a claim in the event they suffer a loss covered under the provisions of their policy. Auto insurance policyholders, for example, may file a claim if their vehicle is stolen or vandalized. The beneficiary of a life insurance policy may file a claim upon the death of the policyholder. Claims adjusters are responsible for completing the necessary steps to process insurance claims. Adjusters must consider many factors to ensure claims are handled efficiently as well as to ensure that the interests of both the insurance company and the policyholder are protected.
Validity of Claim
Claims adjusters must investigate the validity of an insurance claim. They must determine if a claim really happened and if so, to what extent. Adjusters are also required to interview witnesses and consult with other professionals to further evaluate the claim. In processing insurance claims, it is necessary to obtain proof to verify the events surrounding the incident. For instance, life insurance claims require a death certificate for payment to be released. Other forms of proof include police reports, repair receipts, hospital records or photographs that display damage to the insured's property.
Damage
It is necessary to identify the extent of the damage sustained when processing insurance claims. With property and casualty losses, such as automobile and homeowners claims, evaluating damage is usually straightforward. Loss due to a fire, flood or vandalism are pretty simple to recognize from the smoke and water damage or broken glass. What may not be apparent, however, is an insured's involvement in the fire, flood or vandalism. Claims processors must carefully consider the insured's behavior when evaluating damages.
Injuries
Policyholders who are injured or suffer medical emergencies file claims with their insurance company to pay medical expenses. Claims are also filed for illnesses. Claims processors must consider the extent of the injury or illness to rule out any attempts to fraud the insurance company. Processors must also consider if the amount approved for payment is appropriate for injuries sustained.
Estimates
Insurance companies utilize professionals to determine the costs associated with paying an insurance claim. These professionals evaluate the factors surrounding the claim and negotiate a settlement with the parties involved. Estimates must be reasonable compared to the extent of the damage or injuries. Also, policyholders are not required to rely solely upon the estimates of their insurance company. They are usually free to hire outside adjusters, at their own expense, to determine the cost of repairs or the amount of compensation for a loss.
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