ABOUT LOSS ADJUSTING
What is a Loss Adjuster?
A professional person that is appointed by Insurers to investigate and report on the facts of a claim incident and the Insurers liability in that claim according to the insurance contract. They are professionally qualified with insurance and investigative acumen to interpret an insurers liability in a claim.
When is a Loss Adjuster needed?
Insurers will often appoint a Loss Adjuster on high value or complex claims. Loss Adjusters may call for expert reports assisting with the determination and quantification of the claim. Expert reports are often annexed to the Loss Adjusters report.
Loss Adjuster vs Assessor
The term Assessor is commonly used in the motor industry and are often found at panel beating workshops or assessment centres to assess and quote on the damage sustained to a motor vehicle. Loss Adjusters are more commonly appointed to property damage, liability, and non-motor claims.
Loss Adjuster vs Public Adjuster
A Loss Adjuster is an agent of the Insurer as they are contracted by Insurance companies to investigate and report on the facts of an insurance claim.
A Public Adjuster can be approached by aggrieved insurance clients to contest an insurance claim outcome firstly with the Insurer or in court if not resolved.
Where does the role of a Loss Adjuster begin and end?
A Loss Adjuster is appointed when a claim is above a certain threshold or of a complex or specialist nature. The Loss Adjuster will arrange with the Broker and Insurer to meet, inspect and confirm the facts of the incident. This is then verified through his investigation process and may be confirmed with the use of experts where needed.
Thereafter a Loss Adjuster prepares and submits reports to the Insurer confirming the facts and quantum of the claim. Once the Loss Adjusters final report is submitted his function has ended. It is the Insurer who decides whether to accept or reject an insurance claim.
There are cases where Insurers may ask the Loss Adjuster to continue with oversight and management of repairs or negotiations depending on the service level agreement and relationship with the Insurer.
Does a Loss Adjuster reject a claim?
No, the Loss Adjuster investigates and reports on the facts of a claim. The Loss Adjuster may recommend a settlement method such as repair, replace or settle a claim to the Insurer and may comment on the Insurer's liability in terms of the Insurers contract to confirm whether the cause of the claim is insured or not in terms of the contract. However, the decision to accept or reject the claim always lies with the Insurer.
What is the proficiency required of a Loss Adjuster?
A Loss Adjuster needs to be proficient in interpreting, insurance policy wording; contract law; insurance principles; chain of evidence; investigation techniques; use of experts and report writing.