What You Need to Know About Dealing with Insurance Claim Adjusters

Get the inside story on dealing with insurance adjusters to boost your personal injury compensation. Here’s what you should know before filing your claim.

Sooner or later, most of us end up dealing with an insurance adjuster. The average American driver will be involved in three or four car accidents during their lifetime.¹

Besides auto accident claims, people are injured by falls, dog attacks, defective products, and many other causes. These situations often involve filing a claim with an insurance company.

The most common types of insurance claims are settled out of court. Most property damage claims and many minor injury claims can be settled without a lawyer – if you know how to deal with insurance adjusters.

We give you an inside look at what motivates insurance claim adjusters and how to deal with their tricks.

Types of Insurance Claim Adjusters

Insurance claim adjusters go through extensive training before they’re allowed to handle injury or property damage claims. Many states require insurance adjusters to meet specific licensing or certification requirements.

Every adjuster working for an insurance company also receives ongoing training on the company’s policies and procedures for handling claims.

Adjusters are generally trained to:

  • Investigate accidents
  • Determine fault for the accident
  • Calculate the claim’s value according to company protocol
  • Negotiate and settle claims with accident victims

Adjusters fall into three basic categories:

  • Staff Adjusters: Most claim adjusters are “staff” adjusters, meaning they are employees of the insurance company. As employees, their paycheck and bonuses depend on how well they perform their job, including how well they protect the insurance company’s bottom line.
  • Independent Adjusters: Insurance companies often hire independent, freelance adjusters for big surges in claims, like after a natural disaster. Independent adjusters work for the insurance company and follow the same rules as staff adjusters.
  • Public Adjusters: Many states recognize “public adjusters” who are hired by individuals to help with their claims, usually for big property losses filed as homeowner’s insurance claims. Public adjusters work for the claimant, not the insurance company. Public adjusters are not qualified to help with personal injury claims.

Car Accident Claim Adjusters

Depending on the circumstances of your vehicle accident, you could have to deal with adjusters from up to three separate divisions of an insurance company:

  • Personal injuries resulting from auto accidents
  • Property damage to vehicles and their contents
  • Vehicles considered total losses (when a car is “totaled”)

Within moments of notifying the at-fault driver’s insurance company of an accident, one or two adjusters are assigned to your claim. You will be provided with a claim number and will hear from the adjusters soon after your claim is filed.

Notify Your Auto Insurance Company

Most auto policies have a “notice and cooperation clause” that means you agreed to let them know about any accident and cooperate with their investigation.

Your insurance company is required to defend you against lawsuits from anyone else involved in the crash, so long as you haven’t violated the notice clause.

In no-fault insurance states, you must turn to your own auto policy for injury coverage.

Some people prefer to file a first-party claim with their insurance company to take care of their vehicle repairs under their collision coverage. In turn, their company will recover the costs from the at-fault person’s insurance carrier.

Working with your own insurance company is often easier than dealing with the adjuster from the at-fault driver’s insurance company. Using your no-fault PIP coverage for injury claims, or your collision coverage for vehicle repairs, means you won’t have to prove the other driver caused the accident.

As much as you’d like to have your claim settled quickly, for a high amount, it probably won’t happen when you file a liability claim against the other driver’s policy.

First Contact with the Adjuster

Shortly after notifying the at-fault driver’s insurance company of the accident, you’ll hear from the adjuster assigned to your injury claim. The adjuster may call or write, and may even offer to meet with you at your home.

In your first contact, the adjuster will probably request your recorded statement and ask you to sign a release for access to your medical records. Don’t be fooled by a pushy adjuster. You are not legally required to give a statement or sign the insurance company’s medical release form.

Before you agree to meet the adjuster in person, give a recorded statement, or sign anything, be very sure you are ready to handle your injury claim without a lawyer.

If you’ve recovered from relatively minor injury claims, only missed a few days from work, and liability is clear, you can probably reach a fair settlement by dealing directly with the insurance adjuster.

If you’ve been seriously injured, might have lingering effects from your injuries, or could share some of the blame for the accident, you should consult an attorney.

You have the right to hold off giving a statement until you’ve contacted a personal injury attorney for advice.

If you choose to give a statement, you must be careful. You’ll be bound by what you say in the statement. If you’re not ready, politely tell the adjuster you need a few days. Never give a recorded statement while you are tired, upset, in pain, or taking pain medications.

Anything you say to the adjuster can be used against you, and the adjuster is trained to trick you into saying the wrong things. Know what to watch out for when giving a recorded statement.

Be just as careful when it comes to medical release forms. Insurance companies often use “standard” forms that allow them to get copies of all your medical and mental health records going back five or ten years.

The adjuster will search your records for preexisting injuries or other conditions they can use as an excuse to reduce your claim value. You or your attorney can prepare an alternate release that limits the insurance company to medical records directly related to your accident injuries.

Open Lines of Communication

Tell the adjuster you’ll continue treatment and keep them updated on your progress. You do not want to discuss any settlement offers until you’re fully healed or released from treatment by your doctors.

Ask the adjuster to send you a letter confirming your conversation and that you reported the claim. If you don’t already have it, get the claim number.

Following this conversation, you will probably receive a Reservation of Rights letter from the insurance company. The letter says that although the insurance company has agreed to discuss the claim with you, they haven’t officially accepted liability for the accident or your injuries.

You’ll get lots of letters and notices from the insurance company. Create a claim file to organize your paperwork related to the accident. You want everything at your fingertips when it’s time to begin negotiating a settlement.

While continuing treatment, keep the adjuster up to date by sending copies of your medical bills, out-of-pocket expenses, and statement of lost wages. Your adjuster is likely handling dozens of claims at the same time. By maintaining contact and sending documentation, you’re acting in good faith and reminding them of your claim.

Working with the Adjuster on Car Repairs

Unless you’ve decided to let your insurance company take care of your car repairs, you’ll need to work with an adjuster from the at-fault driver’s insurance company. While it may not be the same adjuster who contacted you about your injury claim, they do work together, so be careful of what you say.

Many insurance companies will suggest using their “preferred” auto repair shop to have your car fixed because they’ve negotiated special rates with that shop.

Take your car to a repair shop you trust. So long as the repair shop charges reasonable rates, the insurance company should accept them.

Think about the kinds of parts that will be used to repair your car. Insurance adjusters want to settle your claim for as little as possible, including what they’ll pay to fix your car. The adjuster may only authorize repairs with “after-market” parts instead of “OEM” parts unless you speak up.

  • OEM stands for Original Equipment Manufacturer. Your vehicle’s manufacturer makes OEM parts. They are the same as the parts that originally came with your vehicle. OEM parts are more expensive but should be warrantied to be as good as the original part.
  • After-Market parts are any vehicle parts that don’t come straight from the vehicle’s manufacturer. After-market parts cost less than OEM parts. After-market parts can just as good, if not better than OEM parts, but not always.

You have the right to ask the at-fault driver’s insurance company to cover the cost of a rental car while your car is in the shop. The adjuster may pay the rental car agency directly or ask you to submit rental receipts for reimbursement.

Unless you insist on an out-of-the-way rental car company, the adjuster should take care of rental expenses, so you aren’t paying out-of-pocket.

Handling Negotiations with the Adjuster

Good settlements don’t just happen. You and the adjuster have a mutual interest in settling your claim promptly and fairly, but each of you will have different ideas of what’s fair.

You want to be fully compensated for your damages, and the adjuster wants to close out your claim as quickly and cheaply as possible.

Once you’ve completed medical treatment for your injury, you can begin the step-by-step negotiation process with the adjuster.

You’ll need to convince the adjuster that their insured was at fault for the accident and that you suffered measurable injuries because of their insured’s negligence. Consider using an Injury Claim Negotiations Checklist to help you stay on track.

Calculate the value of your injury claim by adding up your medical bills, out-of-pocket expenses, and lost wages. Add one or two times that amount to account for pain and suffering. The final total is a reasonable amount to demand for compensation.

Write a detailed settlement demand letter that explains who caused the accident, why they should pay for your damages, and the amount of money you want for compensation.

Assemble a Settlement Packet that includes your demand letter along with proof of the at-fault person’s negligence and liability, and documentation of your injuries. Mail the packet to the adjuster, then wait for a response.

Getting to a Final Settlement

Adjusters have different negotiating styles. Some may act like they’re doing you a big favor, and others may seem sympathetic and friendly. Watch out for the friendly ones. The adjuster is not your friend.

Claims adjusters appreciate dealing with claimants who are prepared, polite, and who base their settlement demands in reality. If you fit that mold, you’ll increase your chances of getting a higher settlement in a shorter period of time.

Be prepared to politely reject a very low settlement offer after your initial demand. Always work down from your demand, a little at a time. The adjuster will work up from their first low-ball offer. With patience and persistence, you should arrive at an acceptable settlement amount.

When you reach an agreement, send a follow-up letter confirming the amount and terms. Carefully review the final settlement agreement before signing, to confirm the terms match your verbal agreement.

When the Adjuster Won’t Cooperate

Rest assured that up until you’ve signed a settlement agreement, you have the right to speak to a personal injury attorney about your insurance claim.

Most insurance adjusters will work with you to settle a claim when you’ve got good documentation and are asking for a reasonable amount of money.

Unfortunately, not all adjusters are equally professional and competent. Some even stoop to using bad faith practices. If the adjuster lets your claim languish, or won’t negotiate your claim in good faith, don’t hesitate to protect your interests.

Sometimes hiring a personal injury attorney is all it takes to get a difficult adjuster to pay attention and offer a fair settlement.

Most injury attorneys don’t charge for their initial consultation. There’s no cost to find out what an experienced attorney can do for you.

Video: Dealing with Insurance Adjusters

Insurance Adjuster Questions & Answers

Charles R. Gueli, Esq. is a personal injury attorney with over 20 years of legal experience. He’s admitted to the NY State Bar, and been named a Super Lawyer for the NY Metro area, an exclusive honor awarded to the top five percent of attorneys. Charles has worked extensively in the areas of auto accidents,... Read More >>