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How Does Insurance Adjustment Work?

Fri Dec 8th, 2017 on     Insurance Claims,    

If you are making or have filed an insurance claim (whether for health benefits, disability benefits, liability coverage, etc.), your claim will be evaluated and ultimately processed by an adjuster.  Insurance claims adjusters generally work with teams of specialists to evaluate claims from beginning-to-end — the adjuster will then deny the claim, delay processing, or make an offer.

It’s important to note that insurance claims adjusters are not on your side.  In fact, one could reasonably argue that adjusters are in direct conflict with policyholders.  Fundamentally, a claims adjuster is negotiating on behalf of the insurer with the intent to minimize (or avoid) a payout.

Claims Adjusters — Responsibilities and Expectations

The responsibilities placed on claims adjusters vary from insurer to insurer.  Generally speaking, however, adjusters (and their teams, which may include specialists such as appraisers, claims examiners, investigators, among others) are expected to:

  • Evaluate the claim and review relevant documentation
  • Investigate criminal activity or fraud relating to the claim
  • Negotiate a settlement of the claim with the policyholder
  • Gather evidence
  • Connect with relevant parties (i.e., treating physicians, property managers, businesses, employers, etc.) to determine whether a claim is being accurately portrayed
  • Authorize the payment of a claim
  • Consult with attorneys
  • And more

Whether the adjuster decides to deny your claim, delay your claim, or make an offer — and the settlement amount that is actually offered — depends on a range of factors that include, but are not necessarily limited, to the availability of documentation giving rise to certainty in the damage calculation, the insurer’s position with regard to settling the claim, procedural issues in the claim filing, and more.

How an Attorney Can Help

Remember: insurers and their adjusters are not your allies.  They will take advantage of every opportunity to undermine your claims and minimize the payout that you’re entitled to.  As such, it’s important that you consult with an experienced insurance claim attorney who can give you a competitive edge when it comes to negotiations with the insurance company.  Further, if the insurer has wrongfully denied or delayed your claim, your attorney will work with you to challenge the denial and — if necessary — litigate a bad faith action against the insurer.

If you have made an insurance claim but have received a settlement offer that is far below expectation, the insurer may have acted wrongfully — or in bad faith — by refusing to fairly negotiate such settlement, and you may be able to challenge the amount through the internal administrative process, appraisal, or even through litigation (if need be).

Ver Ploeg & Marino has represented clients throughout the state of Florida in insurance-related disputes since 1995.  Our attorneys have a long track record of success in helping policyholders obtain a fair and adequate insurance payout.

Call (305) 577-3996 to connect to a Miami insurance claim lawyer here at Ver Ploeg & Marino today.  During your initial consultation, our attorneys will assess the circumstances surrounding your dispute and will work with you to determine how to move forward with recovery.

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