Insurance adjusters evaluate insurance claims to assess how much a claim is worth. Insurance adjusters who handle personal injury claims will review the injured person’s medical records, injuries, out of pocket expenses and lost wages to assign a numerical range to the settlement value of a case. If the injured person is represented by an attorney, the injured person’s (claimant) attorney will submit a demand package to the insurance adjuster to review all of this information. Often there is a dispute over the value of the claim, which sometimes leads to the claim being litigated.
Additionally, insurance adjusters will determine if the claim is covered by their insured’s policy. This is done at the beginning of the case. For example, sometimes a police report will contain insurance information that turns out to be the wrong insurance carrier. This would be a reason for a coverage denial.
Insurance adjusters will sometimes ask for recorded statements or examinations under oath of either their insureds or from the third party is who is making a claim against their insured’s policy. Insurance adjusters often request these statements when they detect fraud is involved with the claim or to deny coverage. If requested, these statements are required if being made through a first party policy (PIP insurance or uninsured motorist coverage). Refusing to give either of these statements may result in breach of contract and denial of coverage.
Just like any other occupation, there are insurance adjusters who are reasonable to deal with and those who can make your life difficult. If you have been injured in an accident, you are better off letting an attorney speak to the adjusters for you.
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