The Compact Book of Adjusting Liability Claims Fourth Edition: A Handbook for the Liability Claims Adjuster

The Liability Claims Adjuster

The insurance adjuster is seldom, if ever, mentioned in an insurance policy. The strict wording of third party liability policies set the obligation to prove a claim that entitles the insured to defense or indemnity of a claim against the insured by an injured third party.

Over a century ago insurers determined that to properly deal fairly and in good faith with their insureds, an insurance claims professional was needed to thoroughly investigate claims made against the insured, work with the insured and a third party claimant to resolve claims without litigation and properly protect the interests of the insured.

Adjusting liability insurance claims requires skill, patience, knowledge of insurance, basic knowledge of tort and contract law, and knowledge and experience as an investigator.

For an adjuster to properly and effectively perform the duties of a liability claims adjuster as an employee or agent of an insurer, he or she must be capable of effectively dealing with the following basic obligations:

1. To understand the law of torts as applied in the state where the adjuster works.
2. To understand the law of contracts as applied in the state where the adjuster works.
3. To understand sufficient medical terminology to be able to evaluate claims of bodily injury.
4. To understand the costs to repair or replacing damaged real or personal property.
5. To understand how to read and apply the terms and conditions of a liability insurance policy to a particular fact situation developed by his or her investigation.
6. To understand how to thoroughly investigate all claims assigned.
7. To conduct an investigation of every claim assigned fairly and in good faith with an intent to find coverage for the loss presented by the insured.
8. To gather documentary evidence that will help complete the thorough investigation of a claim against an insured.
9. To have the background and knowledge of the community so the adjuster can evaluate the settlement value of the claim against the insured.
10. To be able to effectively, fairly and in good faith negotiate with claimants and lawyers to resolve bodily injury or property damage claims asserted against an insured.
11. To ascertain that the insurer pays promptly all claims the insurer owes under the contract.
12. To resist and recommend against payment of all claims the insurer does not owe under the contract of insurance.
13. To resist and recommend against payment of anything to a claimant who is part of a fraudulent claim scheme.