Reinsurance tutorials #17
What is a claims adjuster?
Claim adjusters are appointed by insurance companies to investigate a claim. It might be a property or bodily injury claim, a medical or life claim. Each type of claim requires a specialized claim adjuster.
The claim adjuster may be in-house (employee of the insurance company) or an independent provider hired by the insurance company.
During their investigation, claim adjusters will speak with the insured and interview the witnesses, collect and consult the police or hospitals reports, assess the damages, define if the damages are related to the claim, consult experts and providers, check that there is no fraud. They will release a report to the insurance company.
Some of the loss adjustment might be implemented using new technology and artificial intelligence. Drones are particularly interesting when it is difficult, or even impossible, to access the buildings because of flood or high chemical risk, for instance. Video conferences can also help to fasten the claim adjustment process.
The claim adjuster’s report resumes all the investigation process and findings, including pictures, invoices, providers’ quote, etc.; it includes the claim adjuster’s recommendations. The insurer will rely its compensation offer on this claims adjuster’s report. In a way, the claim adjuster is “the eyes” of the insurance company on the ground. If the insured refuse the offer of the insurer or contest the report, they can ask for a 2nd opinion.
As a consequence, the loss adjuster report is a key document to understand and assess the claim. It is usually listed as the documentation to be provided by the Ceding party to the Reinsurer.
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