Adjuster / Claims Adjuster
What Is a Claims Adjuster?
An adjuster, or insurance claims adjuster, is the person who reviews your claim when something goes wrong. Their job is to figure out the details of what happened, see how your coverage applies to the situation, and decide how much the insurance company should pay.
Some adjusters work in-house for an insurance company, and some work on their own or for a third party. Either way, they’re there to do the “adjusting” — balancing the amount of money owed on your claim versus the actual loss amount.
What Does a Claims Adjuster Do (or Not Do)?
Here are some things claims adjusters do:
- Investigate the claim: Gather facts, photos, and evidence of the loss
- Check your policy: Confirm what’s covered and for how much
- Calculate the payout: Make a recommended estimate for the loss
- Communicate next steps: Keep you in the loop by requesting extra information from you and letting you know what the claim payout will be
Here’s what they don’t do:
- Set your price or sell coverage (your underwriter and agent are responsible for that)
- Change policy terms or promise coverage beyond what the policy allows
- Act as your personal advocate
- Do repairs or pick contractors
- Pay for excluded losses or amounts above limits or after deductibles
What Is the Role of a Claims Adjuster When I File a Claim?
When you file a claim, your claims adjuster will guide you throughout the process. They’ll let you know what information they need from you, and then they’ll work to figure out how much your insurer will pay.
While they aren’t your personal advocates, they do have a responsibility to be accurate and professional. Bottom line? They ensure you get the coverage you signed up for. Think of them as referees, working on everyone’s side to make a fair call on the claim for you and your insurer.
Insurance Claims Adjuster vs. Underwriter: What’s the Difference?
TL;DR: An underwriter creates the rules of the game (your policy). The adjuster enforces the rules during the game when a call (claim) is in question.
| Aspect | Claims Adjuster | Underwriter |
|---|---|---|
|
When you meet them |
After a loss (you file a claim) |
Before a loss (when you apply for or renew coverage) |
|
What they do |
Determine what the claim should pay |
Decide what coverage to offer and at what price |
|
What they work on |
Your specific incident |
Your policy (limits, exclusions, and premiums) |
|
Main role |
Verify damage, confirm coverage, and calculate payout |
Match risk to the right coverage and set fair pricing |
|
Reviews |
Photos, receipts, estimates, police/fire reports, and your policy terms |
Application, operations, prior claims, location, revenues, and safety controls |
|
Asks you for |
Proof of loss, inventories, repair bids, and timelines |
Business details, COIs, loss runs, equipment lists, and payroll/revenue info |
|
Typical output
|
Claim payment or denial with a clear explanation |
Quote, policy with limits, deductibles, and endorsements |
|
How it affects you
|
The claim payout you receive |
Sets the premium and what’s covered |
|
Example |
Fire damages your studio; the adjuster inspects and values the loss
|
You start a business; the underwriter prices your policy and adds endorsements |
Additional Resources
- How to file a claim with Insurance Canopy (it’s easy!)
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