NCJ Number
84279
Date Published
1981
Length
11 pages
Annotation
The nature and function of insurance and the role, qualifications and training, and job performance requirements and hindrances of the insurance claims adjuster are discussed, along with the principles and practice of claims adjustment.
Abstract
Once a claim has been presented, the insurer's claims adjuster must investigate the facts surrounding the loss, determine the extent of damage, and either negotiate a settlement or equitably adjust the loss to its correct value. It is incumbent on the insurer to make certain that the terms and conditions of State-approved policy forms are not violated by a claims adjuster during the adjustment process; therefore, in addition to a rigorous field training program, the claims adjuster is usually required to participate in a series of intensive inhouse or institutional courses covering investigative techniques, insurance law, torts, contracts, agency law, common law bailments, damages, and insurance policy provisions and interpretations. Claims adjusters must also recognize their limitations in complex claims and draw upon the knowledge and resources of appropriate specialists who can provide the information needed. In conducting any claims investigation, the most important task is to ascertain whether or not the loss resulted from a peril covered under the policy and occurred while the policy was in force and that the insured, in the case of first-party claims, had an insurable interest. The next step is to collect and interpret the facts to determine if the claim is meritorious. The claims adjuster must be careful at all times to abide not only by formal law but the ethical principles established by authoritative industry bodies.