Claims adjuster - wikipedia Claims adjuster Jump to : navigation , search This article may require cleanup to meet Wikipedia 's quality standards . The specific problem is : Reads like it was written a decade ago by one person who is writing in a textbook with different style guidelines than Wikipedia 's and which lacks a neutrality policy entirely . Please help improve this article if you can . ( April 2009 ) ( Learn how and when to remove this template message ) Claims adjuster ( claim adjuster ) , or claims handler ( claim handler ) , investigates insurance claims by interviewing the claimant and witnesses , consulting police and hospital records , and inspecting property damage to determine the extent of the company 's liability . In the United Kingdom , Ireland , Australia , South Africa , the Caribbean and New Zealand the term loss adjuster is used . Other claims adjusters who represent policyholders may aid in the preparation of an insurance claim . In the United States , a claims adjuster 's duties typically extend to include the following elements : Verify an insurance policy exists for the insured person and / or property . In general , these are written by the policy - holding insurance company . Risk ( s ) of loss ( es ) , or damages to property , culminating in the loss of property and or bodily injury . After completing the above investigations , evaluate the covered injuries and / or damages that have been determined according to the coverage grants . Negotiate a settlement according to the applicable law ( s ) , and identify coverages for which the insured is covered , following best insurance practices . A Claims adjuster or Public Adjuster does not , and should not , engage in the practice of law . While adjusting the claim does mean applying the loss circumstances to the insured 's policy , it does not account for if and when there becomes an issue of coverage , which is a matter and practice of Law , and should only be engaged by a properly licensed attorney . In casualty insurance the main type of coverages include but may not be limited to the followings : First party auto and other than auto coverages ( sometimes referred to collision and comprehensive coverages ) there are numerous types of first party insurance coverages for any kind of risk of loss or damages . Third party liability for property damage of others property and bodily injury . ( in law terms these are `` tort '' claims ) Contents ( hide ) 1 Classes 2 Education 2.1 Working conditions 3 References Classes ( edit ) Claim service representatives ( employed by the insurance company , or an independent adjusting company ) . In the two first instances , and the fourth , the adjuster operates on behalf of the insurer . Adjusters may handle `` property claims '' involving damage to buildings and structures , or `` liability claims '' involving personal injuries or third - person property damage from liability situations , such as motor vehicle accidents , slip and falls , dog bites , or alleged negligent behavior . Some adjusters handle both types of claims and are known as `` Multi-Line '' adjusters . Also `` All Lines Adjusters '' may handle `` any '' type of claim already identified and also include professional liability , Hospital Professional Liability , Excess Liability , Physicians and Surgeons Liability , Aircraft Liability / Hull , Inland Marine , Ocean Marine , Boiler and Machinery , as well as various types of Bond Losses . For a percentage of the settlement amount , Public adjusters work exclusively for the policyholder . This means there should be no inherent conflict of interest when it comes to advocating on the policyholder 's behalf to the insurance company . An independent adjuster could be working for multiple insurance companies or self - insured entities . If licensed by state authority they represent pinnacle of property loss knowledge in their field ; whether it be residential , vehicular , marine , etc . An adjuster will frequently verify that coverage applies through an insurance policy , investigate liability for the damages caused , and make compensation to the injured person based on their emotional or physical property damages . Specific duties include : Notifying the insurer of a covered loss as defined under the policy of insurance Responding to claims in a timely manner Filing paperwork Communicating with policy holders Investigate liability Assess damages Research , detail and substantiate each aspect of the claim , including building damage , contents , and extra living expense claims . Prepare a detailed damages report based on monthly updated insurance cost software for the purpose of making an offer of settlement to the insured . If needed for specialty cost coding , negotiate with product / service providers on time and cost of repairs for the purpose of making an offer of settlement to the insured . Ensuring accurate procedures Protect the interest of the insurance company the adjuster represents , when dealing with claimants . Computer skills with a high degree of proficiency . Some states now require adjusters disclose to claimants whose interest specifically independent , staff and public adjuster represent , before they proceed with the policyholder . Always check your local chapter of Licensed Public insurance adjusters , or state agency , in order qualify an adjuster is properly licensed and in good standing . Some of the state chapters are AAPIA and NAPIA . In Florida , the chapter is FAPIA . IEA conducts certified online classes for people . The Insurance Institute of America also provides training leading to professional designations . Some states accept the Associate of Claims designation , and will waive the licensing examination , and grant a license by the state insurance commission . Some insurance carriers , and independent adjusting companies provide in house training certified by the state insurance commission . They must be pre-approved by the licensing division . An adjuster license is issued to those that pass the requirements . Education ( edit ) This article contains content that is written like an advertisement . Please help improve it by removing promotional content and inappropriate external links , and by adding encyclopedic content written from a neutral point of view . ( November 2017 ) ( Learn how and when to remove this template message ) Many insurance companies prefer their claims adjusters to have a 4 - year college degree preferably in business related fields . In the past , high school graduates have become claims adjusters by promotion from within the claims department . Since there are no college majors for claims adjusters , many states require a state certification in order to practice as an adjuster . States also require that a certain number of continuing education credits for claims adjusters are earned each year in order to maintain their license . This continuing education is achieved by attending seminars and online training from different claim adjuster educational resources . There are also professional designations that have become prevalent among claims adjusters ; for example , The American Institute for Chartered Property Casualty Underwriters awards the Chartered Property and Casualty Underwriter ( CPCU ) designation to experienced underwriters . Florida is one of the few states in the United States that has created specific designations for the licensing of insurance claims adjusters . The Accredited Claims Adjuster Designation , created by statute in coordination with Polk State College in 2002 , allows an individual to obtain the Florida All Lines Independent or Company license , without taking the state licensing exam . In some instances , such as with collapse insurance , courts have been involved in order to predicate a reasonable understanding of the guidelines of the policy in question . The meaning of terms such as `` collapse '' have undergone rigorous constitutional assessment . This leads to some ambiguity between what the law says and what is enforceable by modern mandates . The idea of `` Structural Integrity '' may not always be a universally understood term , but several articles have been published on the topic which suggests the field is evolving toward a continuity in terminology . For those interested in the claims adjustment field , in - depth study of legal principle is a necessity . Most states require licensed adjusters to continue their education through a `` continuing education '' requirement . Florida requires 24 hours of CE every two years . Working conditions ( edit ) Claims adjusters work long hours including work nights and weekends . Their work is appointment based and must revolve around the needs of clients . Staff adjusters are those who work for a specific insurance company and may either have a company office provided from which to work or , if they are a resident adjuster , work out of their home . Independent and public claims adjusters often work from home . They receive their work assignments daily by fax machine , email , or by checking into a designated website . Staff adjusters receive their assignments when they arrive at the office first thing in the morning . In the case of a severe natural disaster such as floods or tornadoes , or other catastrophe , independent and public adjusters travel to the area to supplement local adjusters . Often this requires the incoming adjuster 's presence in the field for days to weeks at a time . Catastrophe adjusters may spend days to weeks in a hotel or RV near the field of operations . Husband and wife teams often enjoy this type of work as it allows them to work and travel together to different parts of the country . Adjusters should become familiar with the reimbursement rules for each company with whom they work and track all expenses used in the line of work . Computer skills are essential , including keyboard skills . Most insurance companies store all documentation digitally . A digital camera is highly useful in documenting claims visually . Estimates , including auto and property losses , are prepared on computers connected to a corporate network . Laptop computers , pad , and other technologies make claims adjusting easier and consume less time . However , claims adjusting also requires a level of physical strength and stamina . Property adjusters , for example , are often required to operate a 50 - pound ladder and must stand , walk , kneel , crawl , and perform other physical demands as they investigate damaged property . References ( edit ) Jump up ^ US Dept of Labor , Bureau of Labor Statistics , Occupational Outlook Handbook , 2008 - 09 Edition , Claims Adjusters , Appraisers , Examiners , and Investigators Jump up ^ What Constitutes a Collapse Under A Property Insurance Policy ? The Brief . Vol. 29 , No. 2 ( Winter 2000 ) . American Bar Association . Robins , Kaplan , Miller & Ciresi , LLP Jump up ^ `` Insurance Coverage For Collapse - How It Has Changed and Why '' . Adjusters International . Retrieved 2010 - 08 - 11 . Jump up ^ `` Archived copy '' . Archived from the original on 2010 - 01 - 25 . Retrieved 2010 - 01 - 23 . Jump up ^ `` Florida Public Adjuster Continuing Education Update '' . FAPIA . Archived from the original on 2011 - 07 - 23 . Retrieved 2009 - 09 - 28 . ^ Jump up to : `` Claims Adjusters , Appraisers , Examiners , and Investigators '' . Occupational Outlook Handbook , 2008 - 09 Edition . Bureau of Labor Statistics , U.S. Department of Labor . 2007 - 12 - 12 . Retrieved 2008 - 06 - 19 . 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Question: who represents the insured in the investigation of a claim