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Claims Adjuster

Claims Adjuster
Name:lllawnchair
Location:Tallahassee, FL
Gender:F
Age:27
I worked at an insurance company, in claims, from March of 2011 to August 2013. (I'm not back in grad school) I've got experience determining liability (or fault) in 7 states in the southeast US, as well as injury (Personal Injury Protection or PIP) claims in Florida.

**Disclaimer!** I am NOT qualified to give legal advice, so don't ask!

Find me online: My website
Last Answer: 9/24/13 Subscribe to this Q&A | Sort by:
Q
Have you ever seen an instance where an insurance company technically didn't HAVE to pay a claim, but they did so for compassionate reasons?
A

Hi Bearish!

Truthfully, I had to think on this one for a while. To provide some context: I was nearly positive that I did have an example for you from my non-injury liability days, but you get soooo many claims in that department that I just can't remember the details of all of them (on average: 5-10 new claims a day). I wracked my brain over the weekend, asked some of my colleagues, but I couldn't think of a perfect example for you. This was as close as I could get:

As you may know, most auto insurance companies offer towing and labor (like a AAA membership) as an optional coverage on their personal lines policies. I had a claim in which my insured got a flat tire on her BMW, and used her towing coverage to get the vehicle moved to a shop where they could replace the
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Q
What are some tips that can save people money on their car insurance that aren't widely known?
A

Hi Dipsy!

The cost of your car insurance depends on a whole lotta factors: the state you live in, where in that state you live (urban, suburban, rural), the kind of vehicle you drive, your driving history and the history of any other listed driver on your policy. 

The best I can say is, don't lie on your application. Bad, bad idea. If you do, you risk the insurance company finding out if/when you file a claim, and then you would be investigated for "Material Misrepresentation". What that means: whether knowingly or not, you misrepresented yourself as an applicant to the insurance company, and because of that they were not able to appropriately assess your premium. Exampes I've seen: not listing a resident relative as a driver on your policy because mayhaps they
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Q
Do you work solely with auto-related claims, or all kinds of other claims?
A

Nowadays, yes. I handle injury claims that arise from auto accidents (whether the party in question is a driver or passenger in a vehicle, or a pedestrian or bicyclist hit by a vehicle) in the state of Florida.

However, prior to this position I work in non-injury liabilty claims. Still mostly auto accidents, but I did get the occasional property liability claim. During that tenure I handled claims in 7 states in the southeast: Florida, Georgia, Arkansas, Kentucky, Tennessee, Mississippi, and Alabama.

Thanks for popping my question cherry slowgrind! 

Q
What's the most underhanded trick in an insurance company's playbook?
A

Hi 7estelle!

To be honest I don't know what you mean. Insurance is a highly regulated industry. We don't really have the ability to be 'underhanded'. Allow me to refer to my answer to shogunn's question on 4/7/2013. Because insurance is a contract of adhesion, the ball is in our court to set the terms of the policy, and because of that we better make those terms clear! If we don't, it's a huge money and time suck to go to court, and we wanna avoid that as much as possible. And once you sign on the dotted line, you are bound to pay your premium just as we are bound to provide you up to the limits on your policy in the event of a covered loss (another biz term for you: this concept is deemed aleatory, meaning exchange is not equal, i.e. the amount you pay in premium is waaaaay lower
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Q
What percentage of claims get denied? What's usually the reason for them getting denied?
A

That's a sticky question because claims adjusters don't attach the same meaning to that term that you might. When I 'deny' a claim, it's most likely because there is no coverage available for the insured, usually because their policy is cancelled or they don't have the necessary coverage on their policy.

Examples:

1) You file a claim for damage to your vehicle that was caused by a hail storm. This damage is specifically covered under "comprehensive coverage". When I review the coverages on your policy, if you opted to not have comprehensive on your policy, then there would be no applicable coverage, and then I would (sadly!) deny it.

2) Let's say that you are unable to make one of your payments (whether monthly or every 6 months, however you have it arranged)
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Q
Do you have a set schedule for how to compensate for the loss of bodyparts? Like a foot is $2M, a finger is $300,000, paralysis is $1.5M, etc?
A

The short answer? No. Every claim is taken on a case by case basis.

And now, a longer answer for you! The injury claims I handle are Florida specific and coverage specific. As I'm sure you can imagine, insurance is an extremely complicated and red-tape heavy business, so any time you file a claim you're almost guaranteed to talk to at least 3 different adjuster, all of which handle different aspects of the claim. Me, for example, I handle Personal Injury Protection (PIP) coverage. This is your primary injury coverage if you're injured in an accident and you are insured in the state of Florida (Kentucky and Maryland and Texas have this coverage as well, but it is a state-dictated coverage, so the rules are different for each state, depending on the statute on the books). 9 times
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Q
Do you ever personally feel bad for the people whose claims you have to deny, even though it's your job?
A

I would say 75% of the time, yes, because I think a lot of people just don't understand the basics of insurance: what and how much coverage you should have and how the claims process works. I myself didn't know jack about insurance before I started working in the industry. The ones I feel worst about are claims involving a delivery driver. A lot of people don't realize this, but if you work as a delivery driver (pizza, newspapers or magazines, whatever!) and you get in an accident, most of the time you will not have coverage for that loss. It's an exclusion that's written into a lot of personal lines auto policies. And we're talking a denial on both damage to your car and damage to the other person's car, if you're at fault.

But the other 25% of the time, I don't feel bad, because
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Claims Adjuster [...continued]