Ajustador

Navigating Legal Waters: The Crucial Role of Adjusters in Insurance Claims

Adjusters play a vital role in the legal landscape, especially in insurance claims relating to property damage or personal injury. An adjuster’s primary responsibility is to assess the damage and determine the compensation amount that an insurance company should pay. There are different types of adjusters: Company or Staff Insurance Adjusters, who work in-house for insurance companies; Independent Insurance Adjusters, who are hired by insurance companies to consult on specific cases; and Public Insurance Adjusters, who are hired by policyholders to independently represent their interests​​.

In personal injury or property damage cases, an adjuster’s evaluation can significantly impact the outcome of an insurance claim. They inspect the property, appraise the damage, and calculate the repair or replacement costs. Public Insurance Adjusters, in particular, offer a distinct advantage as they represent the policyholder’s interests, providing an independent assessment of the damage and assisting with the insurance claim process. This representation is critical as insurance companies’ adjusters primarily look out for their employer’s interests.

Adjusters’ roles have expanded over the years, with many needing to obtain separate defense counsel due to the increasing complexity and legal challenges in the insurance industry​​. In some instances, insurance companies have been found to act in bad faith when claims are denied based on an adjuster’s lack of knowledge of relevant case law or failure to conduct a complete investigation​​​​. These situations highlight the necessity for adjusters to be well-versed in current laws and diligent in their investigation and assessment practices.

Bad faith tactics by insurance companies, such as unreasonable delays in investigating claims or failing to conduct complete investigations, can lead to legal actions against them. This underscores the critical role adjusters play in ensuring fair and just handling of insurance claims​​.

When dealing with insurance claims, especially in complex cases, the assistance of a knowledgeable and experienced adjuster can be invaluable. They not only assess the damage but also help navigate the often complicated and laborious insurance claim process.