Nevada Auto Accident Lawyer - Auto Accident Attorney

This page will give you an explanation of the job description and regular duties of adjusters, from an excerpt of a government report - Claims Adjusters, Appraisers, Examiners, and Investigators (FN1).

You may want to read the Personal Injury Law Introduction on our home page first. Then you can read about Car Accidents. You may also want to read about being cautious when you talk to an Adjuster from an Insurance Company. This article shows the normal duties of an insurance adjuster. Many adjusters are hard working and fair minded. However, some insurance companies may train their adjusters to get you to say or do something which can hurt your Nevada accident claim. If this happens, do not hesitate to call or email a Las Vegas Lawyer to help you maximize your recovery for the injuries you received in an accident in Nevada.

Nature of the Work

Claims adjusters, appraisers, examiners and investigators perform a wide range of functions, but their most important role is acting as intermediaries with the public. Insurance companies and independent adjusting firms employ adjusters, appraisers, examiners, and investigators to deal with the challenges they face, such as handling claims, interpreting and explaining policies or regulations, and resolving billing disputes.

Within insurance companies, claims representatives investigate claims, negotiate settlements, and authorize payments to claimants. When a policyholder files a claim for property damage or a hospital stay, for example, a claim representative must initially determine whether the customer's insurance policy covers the loss and the amount of the loss covered. They then must determine the amount to pay the claimant.

In life and health insurance companies, claim representatives typically are called claims examiners. Claims examiners usually specialize in group or individual insurance plans and in hospital, dental, or prescription drug claims. Examiners review health-related claims to see if the costs are reasonable based on the diagnosis. They check with guides that provide information on the average period of disability for various causes, expected treatments, and average hospital stay. Examiners will then either authorize the appropriate payment or refer the claim to an investigator for a more thorough review.

Claims examiners working in life insurance review the causes of death, particularly in the case of an accident, as most life insurance companies pay additional benefits if the death is due to an accident. Claims examiners also may review new applications for life insurance to make sure applicants have no serious illnesses that would prevent them from qualifying for insurance.

In property and casualty insurance, claims adjusters handle minor claims filed by automobile or homeowner policyholders. These workers contact claimants by telephone or mail to obtain information on repair costs, medical expenses, or other details the company requires. Many companies centralize this operation through a claims center, where the cost of repair is determined and a check is issued immediately. More complex cases, usually involving bodily injury, are referred to senior adjusters. Some adjusters work with multiple types of insurance; however, most specialize in homeowner claims, business losses, automotive damage, product liability, or workers' compensation.

Some clients may choose to hire a public adjuster. They perform the same services as adjusters who work directly for companies. Public adjusters assist clients in preparing and presenting claims to insurance companies and try to negotiate a fair settlement. They work in the best interests of the client, rather than the insurance company.

Claims adjusters primarily plan and schedule the work required to process a claim. They investigate 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. Claims adjusters and examiners may also consult with other professionals, who can offer a more expert evaluation of a claim. Some of these professionals include accountants, architects, construction workers, engineers, lawyers, and physicians. The information gathered, including photographs and written or taped statements, is included in a report that is then used to evaluate a claim. When the policyholder's claim is legitimate, the claims adjuster negotiates with the claimant and settles the claim. When claims are contested, adjusters may testify in court and refer claims to an investigator.

Auto damage appraisers usually are hired by insurance companies and independent adjusting firms to inspect auto damage after an accident and provide repair cost estimates. Auto damage appraisers are valued by insurance companies because they can provide an unbiased judgment of repair costs. Otherwise, the companies would have to rely on auto mechanic estimates, which might be unreasonably high.

Many claims adjusters and auto damage appraisers are equipped with laptop computers, from which they can download the necessary forms and files from insurance company databases. Many adjusters and appraisers are equipped with digital cameras, which allow photographs of the damage to be sent to the company via the Internet or satellite. There also are new software programs that can give estimates of damage based on the information input directly into the computer. These new technologies allow for faster and more efficient processing of claims.

Many insurance companies are emphasizing better customer service. One way they are achieving this is by offering access to claims services at any time. Most larger companies use call centers, staffed with customer service representatives. (See the statements on customer service representatives and insurance sales agents elsewhere in the Handbook.) These workers obtain information from policyholders regarding claims resulting from fire damage, personal injury or illness, or an automobile accident, for example. They primarily are responsible for getting the necessary information on a claim, such as specific details of an accident. Once the information is entered, the customer service representative forwards the claim to a claims adjuster or examiner. This allows the adjusters or examiners to concentrate on investigating the claim. However, claims adjusters and examiners working for small insurance companies may still answer phones and take claims information, and then handle the claims themselves.

When adjusters or examiners suspect a case might involve fraud, they refer the claim to an investigator. Insurance investigators work in an insurance company's Special Investigative Unit and handle claims in which a company suspects there might be fraudulent or criminal activity, such as arson cases, false workers' disability claims, staged accidents, or unnecessary medical treatments. The severity of insurance fraud cases can vary greatly, from claimants simply overstating damage on a vehicle, to complicated fraud rings, often involving many claimants, fraudulent doctors and lawyers, and even insurance personnel.

Investigators usually start with a database search to obtain background information on claimants and witnesses. Investigators can access personal information and identify Social Security numbers, aliases, driver license numbers, addresses, phone numbers, criminal records, and past claims histories to establish if a claimant has ever attempted insurance fraud. Then, investigators may visit claimants and witnesses to obtain a recorded statement; take photographs; and inspect facilities, such as a doctor's office, to determine whether it has a proper license. Investigators often consult with legal counsel and can be expert witnesses in court cases.

Often, investigators also will perform surveillance work. For example, in a case involving fraudulent workers' compensation claims, an investigator may carry out long-term covert observation of the subject. If the investigator observes the subject performing an activity that contradicts injuries stated in a workers' compensation claim, the investigator would take video or still photographs to document the activity and report it to the insurance company.

Read more about Accident Tips on our Vegas Injury Law site.

Contact Us For A Free Consultation On Your Auto Accident Claim

If you want a free evaluation of your Las Vegas car accident claim, contact David Matheny, Esq. (of the law firm of Dempsey, Roberts & Smith, Ltd) for a free personal injury consultation. We are located in Las Vegas, Nevada and we provide legal services for car accident claims (and many other injury claims) throughout the State of Nevada.