Loss adjusters investigate insurance claims arising out of losses such as fires, car accidents and burglaries, commercial property, fire, flood or catastrophic event. Adjusters determine the amount of damage or loss covered by the insurance policy. Adjusters make recommendations regarding payment of benefits, based on the coverage noted on the insurance policy and negotiate payment and settlement. Loss adjusters also:
Ensure that those who have suffered a loss receive all of the benefits and assistance to which they are entitled.
In disputed claims, may also be required to investigate the cause of the loss – how a fire started, why a plane went down, etc.
Investigate, negotiate and settle a variety of claims in an efficient manner and in compliance with a variety or requirements.
Conduct witness interviews, take statements and consult with police, fire brigade, emergency services, government agencies and specialists.
Report in a variety of ways – in writing, through e-mail or on-line, and must present or report on these findings, propose solutions and negotiate settlements and agreements with third parties, clients or other concerned parties.
Inspect and/or evaluate damages when required, estimate costs or commercial value, examine reports or other documents, evaluate losses, establish claims guidelines and quantifying settlement amounts.
Participate in private and/or mandatory mediation, settlement meetings, settlement conferences, pre-trails, court proceedings and other dispute resolution methods as required.
Loss adjusters are often hired by insurance companies, government services or independent adjusting firms. They can even be hired by Insured’s who suspect their Insurance company may not be acting in good faith. Adjusters can engage the services of Licensed Private Investigators, accident reconstructionists and many others.
In Australia to become qualified a student must study and successfully complete the Nationally Recognised Qualification FNS51415 – Diploma of Loss Adjusting
Some examples of roles within this field are: personal injury (workers compensation, motor vehicle accident) , claims representative, accident benefits claims adjuster, field claims representative, business interruption, claims examiner, marine insurance coordinator, catastrophe adjusters, claims assistant, physical damage claims representative, claims specialist, online adjuster, road adjuster, property or liability adjuster, technical service representative and call centre agent.
Claims service is what people buy when they pay their insurance premium. Every insurer, for competitive reasons, wants their product to be the best it can be. Add to this the fundamental principle of treating people fairly and in good faith, and the need for capable loss adjusters widens. If something is worth insuring there is a high expectation of fair and equitable calculation of loss should it occur.
Claims “processing” using statistics / predictive models and managed by artificial intelligence is common today. Yes that is great for minor car bingles and specialist fashion retail store inventory matters. When the individual circumstance of the Insured’s unique claim are complex and costly e.g million dollar plus turnover businesses the Insured wants what they paid for in terms of risk protection.
Insurers want to know what their costs will be; with that knowledge, they can try to fix adjusting costs based on averages and predictable parameters. Insurance does not function well in this environment: it requires what is appropriate in each and every unique situation. Pigeon-holing eliminates the need for “adjusting” and turns the claims experience into “processing.” There is a huge difference between adjusting and processing, at the Australian Security Academy you can learn to be a qualified Loss Adjuster.