Claims adjuster

Claims adjuster (claim adjuster), or claims handler (claim handler), investigates insurance claims by interviewing the claimant and witnesses, consulting police and hospital records, and inspecting property damage to determine the extent of the company's liability.[1] In the United Kingdom, Ireland, Australia, South Africa, the Caribbean and New Zealand the term loss adjuster is used. Other claims adjusters who represent policyholders may aid in the preparation of an insurance claim.

In the United States, a claims adjuster's duties typically extend to include the following elements:

  • Verify an insurance policy exists for the insured person and/or property. In general, these are written by the policy-holding insurance company.
  • Risk(s) of loss(es), or damages to property, culminating in the loss of property and or bodily injury.
  • After completing the above investigations, evaluate the covered injuries and/or damages that have been determined according to the coverage grants.
  • Negotiate a settlement according to the applicable law(s), and identify coverages for which the insured is covered, following best insurance practices.

A Claims adjuster or Public Adjuster does not, and should not, engage in the practice of law. While adjusting the claim does mean applying the loss circumstances to the insured's policy, it does not account for if and when there becomes an issue of coverage, which is a matter and practice of Law, and should only be engaged by a properly licensed attorney.

In casualty insurance the main type of coverages include but may not be limited to the following:

  • First party auto and other than auto coverages (sometimes referred to collision and comprehensive coverages) there are numerous types of first party insurance coverages for any kind of risk of loss or damages.
  • Third party liability for property damage of others property and bodily injury. (in law terms these are "tort" claims)

Classes

  • Claim service representatives (employed by the insurance company, or an independent adjusting company).

In the two first instances, and the fourth, the adjuster operates on behalf of the insurer.

Adjusters may handle "property claims" involving damage to buildings and structures, or "liability claims" involving personal injuries or third-person property damage from liability situations, such as motor vehicle accidents, slip and falls, dog bites, or alleged negligent behavior. Some adjusters handle both types of claims and are known as "Multi-Line" adjusters. Also "All Lines Adjusters" may handle "any" type of claim already identified and also include professional liability, Hospital Professional Liability, Excess Liability, Physicians and Surgeons Liability, Aircraft Liability/Hull, Inland Marine, Ocean Marine, Boiler and Machinery, as well as various types of Bond Losses.

For a percentage of the settlement amount, Public adjusters work exclusively for the policyholder. This means there should be no inherent conflict of interest when it comes to advocating on the policyholder's behalf to the insurance company.

An independent adjuster could be working for multiple insurance companies or self-insured entities. If licensed by state authority they represent pinnacle of property loss knowledge in their field; whether it be residential, vehicular, marine, etc.

An adjuster will frequently verify that coverage applies through an insurance policy, investigate liability for the damages caused, and make compensation to the injured person based on their emotional or physical property damages.

Specific duties include:

  • Notifying the insurer of a covered loss as defined under the policy of insurance
  • Responding to claims in a timely manner
  • Filing paperwork
  • Communicating with policy holders
  • Investigate liability
  • Assess damages
  • Research, detail and substantiate each aspect of the claim, including building damage, contents, and extra living expense claims.
  • Prepare a detailed damages report based on monthly updated insurance cost software for the purpose of making an offer of settlement to the insured.
  • If needed for specialty cost coding, negotiate with product/service providers on time and cost of repairs for the purpose of making an offer of settlement to the insured.
  • Ensuring accurate procedures
  • Protect the interest of the insurance company the adjuster represents, when dealing with claimants.
  • Computer skills with a high degree of proficiency.

Some states now require adjusters disclose to claimants whose interest specifically independent, staff and public adjuster represent, before they proceed with the policyholder.

Always check your local chapter of Licensed Public insurance adjusters, or state agency, in order qualify an adjuster is properly licensed and in good standing. Some of the state chapters are AAPIA and NAPIA. In Florida, the chapter is FAPIA.

IEA conducts certified online classes for people. The Insurance Institute of America also provides training leading to professional designations. Some states accept the Associate of Claims designation, and will waive the licensing examination, and grant a license by the state insurance commission. Some insurance carriers, and independent adjusting companies provide in house training certified by the state insurance commission. They must be pre-approved by the licensing division. An adjuster license is issued to those that pass the requirements.

Education

Most insurance companies prefer their claims adjusters to have a 4-year college degree preferably in business related fields. In the past, high school graduates have become claims adjusters by promotion from within the claims department. Since there are no college majors for claims adjusters, many states require a state certification in order to practice as an adjuster. States also require that a certain number of continuing education credits for claims adjusters are earned each year in order to maintain their license. This continuing education is achieved by attending seminars and online training from different claim adjuster educational resources. There are also professional designations that have become prevalent among claims adjusters; for example, The American Institute for Chartered Property Casualty Underwriters awards the Chartered Property and Casualty Underwriter (CPCU) designation to experienced underwriters.

Florida is one of the few states in the United States that has created specific designations for the licensing of insurance claims adjusters. The Accredited Claims Adjuster Designation, created by statute in coordination with Polk State College in 2002, allows an individual to obtain the Florida All Lines Independent or Company license, without taking the state licensing exam.

In some instances, such as with collapse insurance, courts have been involved in order to predicate a reasonable understanding of the guidelines of the policy in question. The meaning of terms such as "collapse" have undergone rigorous constitutional assessment.[2] This leads to some ambiguity between what the law says and what is enforceable by modern mandates. The idea of "Structural Integrity" may not always be a universally understood term, but several articles have been published on the topic[3] which suggests the field is evolving toward a continuity in terminology. For those interested in the claims adjustment field, in-depth study of legal principle is a necessity.

Most states require licensed adjusters to continue their education through a "continuing education" requirement.[4] Florida requires 24 hours of CE every two years.[5]

Working conditions

Claims adjusters work long hours including work nights and weekends. Their work is appointment based and must revolve around the needs of clients.[6]

Staff adjusters are those who work for a specific insurance company and may either have a teams often enjoy this type of work as it allows them to work and travel together to different parts of the country. Adjusters should become familiar with the reimbursement rules for each company with whom they work and track all expenses used in the line of work.

Computer skills are essential, including keyboard skills. Most insurance companies store all documentation digitally. A digital camera is highly useful in documenting claims visually. Estimates, including auto and property losses, are prepared on computers connected to a corporate network. Laptop computers, pad, and other technologies make claims adjusting easier and consume less time. However, claims adjusting also requires a level of physical strength and stamina.

Property adjusters, for example, are often required to operate a 50-pound ladder and must stand, walk, kneel, crawl, and perform other physical demands as they investigate damaged property.[6]

References

  1. ^ US Dept of Labor, Bureau of Labor Statistics, Occupational Outlook Handbook, 2008-09 Edition, Claims Adjusters, Appraisers, Examiners, and Investigators
  2. ^ What Constitutes a Collapse Under A Property Insurance Policy? The Brief. Vol. 29, No. 2 (Winter 2000). American Bar Association. Robins, Kaplan, Miller & Ciresi, LLP
  3. ^ "Insurance Coverage For Collapse - How It Has Changed and Why". Adjusters International. Retrieved 2010-08-11.
  4. ^ "Archived copy". Archived from the original on 2010-01-25. Retrieved 2010-01-23.CS1 maint: archived copy as title (link)
  5. ^ "Florida Public Adjuster Continuing Education Update". FAPIA. Archived from the original on 2011-07-23. Retrieved 2009-09-28.
  6. ^ a b "Claims Adjusters, Appraisers, Examiners, and Investigators". Occupational Outlook Handbook, 2008-09 Edition. Bureau of Labor Statistics, U.S. Department of Labor. 2007-12-12. Retrieved 2008-06-19.
Bachelor of Liberal Studies

The purpose of the Bachelor of Liberal Studies (BLS) degree is to provide students with a solid multidisciplinary preparation in the Humanities, Natural Sciences, Social Sciences and the Arts, subsequently allowing them to pursue careers in education, business, government, and other such fields. The goal of a liberal studies major is to train students to communicate effectively, both orally and in writing, to develop skills in critical thinking and problem solving, and to imbue critical thinking with ethical thought. Liberal studies provides students with opportunities for an extensive study of the liberal arts and sciences and for a broad understanding of various academic fields of interest.

Brent Dickson

Brent E. Dickson (born July 18, 1941) is an Indiana attorney. He was a Justice of the Supreme Court of Indiana from January 6, 1986 to April 29, 2016, and was Chief Justice of the Court from 2012 to 2014. He retired from the Indiana Supreme Court on April 29, 2016.Born in Hobart, Indiana, Dickson is a graduate of Purdue University (B.S. 1964), and the Robert H. McKinney School of Law (J.D. 1968), where he attended the evening division while working full-time as an insurance claims adjuster.

He practiced law in Lafayette from 1968 to 1985 and became the senior partner in the law firm of Dickson, Reiling, Teder & Withered. He was appointed by Governor Robert D. Orr to replace retiring Indiana Supreme Court Justice Prentice W. Dixon. The appointment began January 6, 1986, and he was retained by election in 1988.

Curtis Henderson

Curtis Henderson (September 28, 1926 - June 25, 2009) was a pioneer in the practice of cryonics.

Dan Fabian

Dan Fabian (born June 28, 1954) is a Republican politician in Minnesota and a member of the Minnesota House of Representatives who represents District 1A, which includes all of Kittson and Roseau counties, as well as portions of Marshall and Pennington counties in the northwestern part of the state.

Don Cody

Donald William "Don" Cody (born March 28, 1936) is a business owner and former political figure in Saskatchewan. He represented Watrous from 1971 to 1975 and Kinistino from 1978 to 1982 in the Legislative Assembly of Saskatchewan as a New Democratic Party (NDP) member

He was born in Pilger, Saskatchewan, the son of Edward Cody and Rosella Wirtz, and was educated there. Cody then worked as a telegraph operator for the Canadian Pacific Railway. In 1961, he married Joan Eileen Germsheid. From 1963 to 1967, he worked as a claims adjuster for Saskatchewan Government Insurance in Regina. Then, Cody was claims examiner and Saskatchewan claims supervisor for Co-op Insurance Services Ltd.Cody was defeated by John Gary Lane when he ran for the Qu'Appelle seat in the provincial assembly in 1975. He served in the Saskatchewan cabinet as Minister of Co-operation and Co-operative Development and as Minister of Telephones. He was defeated by Bernard Boutin when he ran for reelection to the provincial assembly in 1982.After leaving politics, Cody moved to Prince Albert, where he became the owner of Buns Master Bakery. From 1994 to 2003, he was mayor of Prince Albert. He also served as chair of the board for Saskatchewan Government Insurance.The former mayor of Prince Albert is also known for his Drinking and Driving conviction. Cody was arrested March 26, 2003, at his house for being suspected of impaired driving. The police did not immediately charge Mr. Cody which ultimately led to accusations of a cover up. During the trial, the courts heard that he had been pulled over and two constables took him to the police station for a breath sample. Of note was the sample wasn't taken and he was instead driven to the home of then- police chief John Quinn.Cody was only charged after police from Regina were called in to investigate. Mr. Cody testified during his trial that he had been drinking that day, but wasn't impaired. As a result the former chief Quinn and two senior officers were suspended immediately after the case became public. Mr. Quinn later resigned. The officers, Staff Sergeant Kelly Liebrecht and Inspector Norm Bergen, each faced a charge of obstruction, as well as a combined 15 charges under the Police Act.Cody held the mayor's seat from 1994 to October 2003.Currently, Cody serves as the elected Councillor for Prince Albert Ward 4.

Double Indemnity (film)

Double Indemnity is a 1944 film noir crime drama directed by Billy Wilder, co-written by Wilder and Raymond Chandler, and produced by Buddy DeSylva and Joseph Sistrom. The screenplay was based on James M. Cain's 1943 novella of the same name, which originally appeared as an eight-part serial in Liberty magazine, beginning in February 1936.

The film stars Fred MacMurray as an insurance salesman, Barbara Stanwyck as a provocative housewife who wishes her husband were dead, and Edward G. Robinson as a claims adjuster whose job is to find phony claims. The term "double indemnity" refers to a clause in certain life insurance policies that doubles the payout in rare cases when death is caused accidentally, such as while riding a railway.

Praised by many critics when first released, Double Indemnity was nominated for seven Academy Awards but did not win any. Widely regarded as a classic, it is often cited as a paradigmatic film noir and as having set the standard for the films that followed in that genre.

Deemed "culturally, historically, or aesthetically significant" by the U.S. Library of Congress in 1992, Double Indemnity was selected for preservation in the National Film Registry. In 1998, it was ranked No. 38 on the American Film Institute's list of the 100 best American films of all time, and in 2007 it placed 29th on their 10th Anniversary list.

Insurance

Insurance is a means of protection from financial loss. It is a form of risk management, primarily used to hedge against the risk of a contingent or uncertain loss.

An entity which provides insurance is known as an insurer, insurance company, insurance carrier or underwriter. A person or entity who buys insurance is known as an insured or as a policyholder. The insurance transaction involves the insured assuming a guaranteed and known relatively small loss in the form of payment to the insurer in exchange for the insurer's promise to compensate the insured in the event of a covered loss. The loss may or may not be financial, but it must be reducible to financial terms, and usually involves something in which the insured has an insurable interest established by ownership, possession, or pre-existing relationship.

The insured receives a contract, called the insurance policy, which details the conditions and circumstances under which the insurer will compensate the insured. The amount of money charged by the insurer to the Policyholder for the coverage set forth in the insurance policy is called the premium. If the insured experiences a loss which is potentially covered by the insurance policy, the insured submits a claim to the insurer for processing by a claims adjuster. The insurer may hedge its own risk by taking out reinsurance, whereby another insurance company agrees to carry some of the risk, especially if the primary insurer deems the risk too large for it to carry.

Janelle Asselin

Janelle Asselin is an American former comic book editor and writer, known for creating the now-defunct publishing company Rosy Press. Currently, Asselin works as a claims adjuster and resides in Omaha, Nebraska.

Jeff Tobolski

Jeff Tobolski is a member of the Cook County Board of Commissioners representing the 16th district which includes all or parts of the suburbs Franklin Park, Northlake, Stone Park, Melrose Park, Maywood, Hillside, Westchester, Brookfield, North Riverside, Berwyn, Riverside, Cicero, Stickney, Forest View, Lyons, La Grange, Summit, Countryside, McCook, Bedford Park and the Archer Heights neighborhood in the City of Chicago.

Jerry Torr

Gerald R. Torr (born November 28, 1957) is an American politician. He is a member of the Indiana House of Representatives from the 39th District, serving since 1996. He is a member of the Republican Party.

John Floyd Thomas Jr.

John Floyd Thomas Jr. (born July 26, 1936) is an American serial killer, serving a life sentence without the possibility of parole convicted of the murders of seven women in the Los Angeles area during the 1970s and 1980s, and suspected by police of 10 to 15 more.

June Lazenby Green

June Lazenby Green (January 23, 1914 – February 2, 2001) was a United States District Judge of the United States District Court for the District of Columbia.

Low and Behold

Low and Behold is a 2007 film by director Zack Godshall. It was produced by Sidetrack Films. The film uses neorealistic and documentary techniques interwoven with actors in fictional narrative story into a post-Hurricane Katrina ravaged New Orleans. The film won Best Narrative Feature at the International Rome Film Festival and the Best Feature award at the New Orleans Film Festival.The story follows Turner Stull (played by Barlow Jacobs), a young insurance claims adjuster who arrives in New Orleans after Hurricane Katrina. Turner finds it difficult to deal first hand with the pain and personal loss in the claims he must file. Eventually he meets a free-spirited local man named Nixon (played by Eddie Rouse) who is looking for his lost dog. Nixon and Turner agree to help each other and form an unlikely friendship along the way.

Michael Shackleford

Michael Shackleford, (May 23, 1965 in Pasadena, California, United States), also known as "The Wizard of Odds" – a title taken from Donald Angelini, is an American mathematician and an actuary, best known for his professional analysis of the mathematics of the casino games. He is also an adjunct professor of actuarial science and mathematics at the University of Nevada, Las Vegas. He became interested in the mathematics of gambling at a young age, specifically after reading John Scarne's Guide to Casino Gambling.Shackleford discovered his affinity for mathematics when he first began to study algebra in school at approximately 11 years old. He described how math had become something new and interesting, which is where his path toward becoming the Wizard of Odds begins.

He first entered the workforce as an employee of Knotts Berry Farm in Buena Park, California handling fast food services. His next job was at Disneyland in Anaheim where he was responsible for custodial duties around the amusement park.

Following his stint in amusement parks, Shackleford held a job at a warehouse, the Santa Barbara Airport and various clerical positions. His career aspirations these days include continuing to educate people about the gaming industry as he has done since 1998.

Prior to launching his websites, he was a government actuary in Baltimore making a comfortable living. It took him approximately one year to convince his wife that going into business for himself within the gambling industry as the Wizard of Odds was the right thing to do. He gave up his GS-14 government salary and he began work on the odds-driven content he has become so well known for today.Today Shackleford is best known for his websites, The Wizard of Odds and The Wizard of Vegas, which contain analyses and strategies for hundreds of casino games. He received a great deal of attention in 2002 shortly after moving to Las Vegas when he published a paper where he released rankings of slot machine payout percentages, widely considered secretive or unavailable, to show which Las Vegas casinos set their nickel machines with the best and worst payouts. The Time Out Las Vegas referred to the survey as groundbreaking. This paper was referenced by Palms Casino Resort to advertise their competitive payouts.Prior to the sale of his website, Michael Shackleford was amidst a financial struggle as WizardofOdds.com failed to generate a profit. LatestCasinoBonuses owner, Joshua Chan, approached him with an offer to purchase the site. A sale of this type would normally be based on an earnings multiplier for the previous 18–36 months.

After a period of negotiation, an offer from a higher bidder and a rejected $1.6 million proposal, Chan brought in two partners to present a new $2.35 million offer, which Shackelford accepted. WoO was then under new ownership with The Wizard himself remaining on board to create additional content across not only WoO but other sites within the LCB Network. Chan now holds the majority share at 65% while his partners have taken 25% and 10% stakes respectively.

The Wizard sites were sold on September 19, 2014 for $2.35 million to LCB Network.Shackleford also analyzes new games for game developers and casinos. His most notable clients include Hilton, Realtime Gaming, Playtech, and Shuffle Master. He is the author of Gambling 102: The Best Strategies for All Casino Games (Huntington Press, 2005). Previously, he was an Adjunct Professor of Casino Math at the University of Nevada, Las Vegas and a contributing editor to Casino Player magazine.

Michael Shackleford has been known to bring media attention to unfair gambling practices, such as case #2008-7136L before the state Gaming Control Board, against the Stratosphere Casino for failing to pay a sportsbet. Another example is his detailed investigation into allegations of cheating by Absolute Poker after they were brought to his attention by an anonymous source September 24, 2007.Shackleford is periodically consulted on gambling issues outside of Nevada. In 2010 Pittsburgh Live requested a consult on whether the gaming companies in Pennsylvania would tighten their blackjack rules.Every year, professional gambler, Max Rubin holds the famed Blackjack Ball, a secret and invitation-only event, where the winner is given the title of “The Best Gambler in the World.” Rubin’s love for the game led to the creation of the Blackjack tournament where participants are quizzed with gambling trivia and mathematical questions plus a second series of tests where their skills are put to the test (card counting, signaling, etc.). The 2011 winner was Michael Shackleford where he beat Anthony Curtis to take the title.Before changing careers, Shackleford worked as a claims adjuster and later as an actuary for the United States Social Security Administration from 1992 until 2000. His main responsibility there was estimating short-term costs and benefits of Social Security law changes. But, he was best known for researching the most popular baby names for each year since 1880. The results of this research have been published in many books, newspapers, and magazines, and the Social Security Administration now officially publishes a new list every year of the previous year's most popular names, along with all the previous years' names.Shackleford's interest in a broader variety of mathematics topics is shown by his collection of recreational math puzzles and problems.Shackleford resides in Las Vegas, Nevada with his wife and three children.

Milton Bobbit

"Milton Bobbit" is the eighteenth episode of the first season of the American crime drama The Blacklist. The episode premiered in the United States on NBC on March 31, 2014.

Public adjuster

A public adjuster is a professional claims handler/ claims adjuster who advocates for the policyholder in appraising and negotiating a claimant's insurance claim. Aside from attorneys and the broker of record, state licensed public adjusters can legally represent the rights of an insured during an insurance claim process. Their technical expertise and ability to interpret sometimes ambiguous insurance policies allow property owners to receive the maximum amount of indemnification for their claims. Although seen many times as adversarial by the Carriers, public adjusters do (almost always) substantially increase the settlement value of the loss. Many professionals, and persons who are either incapable due to education, age, or physical impairment, choose public adjuster representation to guide them through the process and minimize the time which must be spent to perfect their claim. Most public adjusters charge a percentage of the settlement like general contractors who add (10/10) to the total repair cost to cover overhead and reasonable profit. Primarily public adjusters prepare detailed scope and cost estimates many times using experts in the fields of remediation, toxicology, and construction engineers to prove their loss. Public adjusters also provide insurance policy interpretation to determine covered and uncovered items and to negotiate with the insurance Carrier to a final and fair settlement.A public adjuster is a representative of the policyholder who advises, manages, and submits a claim to the policyholder's insurance company.

There are three classes of insurance claims adjusters: staff adjusters (employed by an insurance company or self-insured entity), independent adjusters (independent contractors hired by the insurance company) and public adjusters (employed by the policyholder). "Company" or "independent" adjusters can only legally represent the rights of an insurance company.Outside the United States adjusters are commonly called (or translated into English as) "insurance loss assessors" (or simply "loss assessors") and staff adjusters or independent adjusters are called or translated as "insurance loss adjusters" (or simply "loss adjusters"). However, there is a clear distinction between a loss adjuster, who works on behalf of an insurance company, and a loss assessor who works on behalf of a policyholder.

Scott McDonald (curler)

Scott McDonald (born May 8, 1986 in Mississauga, Ontario) is a Canadian curler from London, Ontario. He currently skips a team on the World Curling Tour.

Tax assessment

Tax assessment, or assessment, is the job of determining the value, and sometimes determining the use, of property, usually to calculate a property tax. This is usually done by an office called the assessor or tax assessor.

Third-party administrator

A third-party administrator (TPA) is an organization that processes insurance claims or certain aspects of employee benefit plans for a separate entity. It is also a term used to define organizations within the insurance industry which administer other services such as underwriting, customer service. This can be viewed as outsourcing the administration of the claims processing, since the TPA is performing a task traditionally handled by the company providing the insurance or the company itself. Often, in the case of insurance claims, a TPA handles the claims processing for an employer that self-insures its employees. Thus, the employer is acting as an insurance company and underwrites the risk. The risk of loss remains with the employer, and not with the TPA. An insurance company may also use a TPA to manage its claims processing, provider networks, utilization review, or membership functions. While some third-party administrators may operate as units of insurance companies, they are often independent.Third-party administrators also handle many aspects of other employee benefit plans such as the processing of retirement plans and flexible spending accounts. Many employee benefit plans have highly technical aspects and difficult administration that can make using a specialized entity such as a TPA more cost effective than doing the same processing in house.

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