Claims Adjuster

Claims Adjuster


Tallahassee, FL

Female, 27

I worked at an insurance company, in claims, from March of 2011 to August 2013. (I'm now 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!

SubscribeGet emails when new questions are answered. Ask Me Anything!Show Bio +


Ask me anything!

Submit Your Question

41 Questions


Last Answer on September 24, 2013

Best Rated

Thanks for answering my first question and for doing this Q&A! Do insurance companies ever hire private investigators to spy on a person to see if he's just faking his injury to get a settlement?

Asked by Jackie almost 11 years ago

Hi Jackie!

As far as I know (I've only worked for 1 insurance company to date), most insurance companies have a special invesigation unit for claims in which they suspect foul play of some sort. This unit is usually comprised of retired police officers, detectives, that kind of thing. If an insurance company suspects that a claimant is exaggerating or faking an injury, I have heard of the adjuster referring the claim to that special unit to do surveillance on the claimant to see how their supposed injury truly affects them when they go about their day to day business. Have I every had a claim like that? no. But I have heard of it.

Is that explanation Ed Norton's character gives in Fight Club about how car makers determine whether they'll do a vehicle recall accurate? (That they'll leave an unsafe car on the road if the recall would cost more than paying the injury claims?)

Asked by 1strule almost 11 years ago

Hi 1strule,

As much as I hate to admit it: I have absolutely no idea. I've only ever handled personal lines insurance claims, and it sounds like this one falls totally outside my area of experience. I would imagine an adjuster who works in commercial claims would have a better idea of whether or not thats true, but all my colleagues are in the same boat as me.

My gut tells me, however, that that is either exaggerated or totally false. Injury claims are biiiiiiggggg liabilities, whether its a personal or commercial auto policy.

Even though I assume insurance companies can't charge different rates to people of different races, are stats kept internally on that stuff, and care to share to confirm / dispel some, um, common stereotypes?

Asked by TonyTony about 11 years ago

Hey Tonytony!

I, personally, have never heard of that. The premium a driver is charged is determined by a myriad of factors: the state they live in, their driving history, whether they have a loan out on their vehicle, among many other  things. 

And as far as stereotypes go, in auto accidents I don't believe in them anymore, haha. Sometimes everyone's a crappy driver.

Are there some cases where NO ONE'S at fault? Say an airplane part falls from the sky, a car swerves to avoid it, and hits another car. Complete freak accident / no way to foresee. Does the US insurance system REQUIRE the assignment of SOME fault?

Asked by Tif718 about 11 years ago

The short answer? It depends...

This is where you get into the territory of difference of opinion between adjusters. Some would say that even though it's not that first car's fault that some random object same into their path, they were still negligent in that they failed to maintain control of their vehicle and hit the other car. And how would you feel if you were in that second car? There you are just driving along when this other car comes out of nowhere and damages your vehicle. And if the adjuster assigned to your claim says, well, in this case no one's at fault, it was a freak accident, you're still stuck using your collision coverage to get your vehicle fixed, and you still have to pay your deductible, even though you contributed in no way to this accident!

That being said, there are some claims in which no one is at fault, but these are claims that usually fall under comprehensive coverage: you hit a deer, or hail damages your vehicle. When a claim like that is assigned to us we don't label any party at fault (although I have jokingly assigned 100% fault to the deer before. Oh that's right, we're a bunch of cut-ups in the insurance biz, haha). But as you may have gleaned, neither of those examples involve 2 vehicles.

Now that I think of it, there is one other example I can give you: it's called the 'act of God' defense. This doctrine usually applies to property claims: i.e. a big ass storm comes through your 'hood, and a tree on your property falls into your neighbor's yard and damages their fence/shed/whatever. When that claim gets filed with your insurance, we work to determine whether that tree was healthy prior to it falling, and if it was diseased, whether you as the insured knew it and neglected to take care of the hazard on your property. If that tree had green leaves, was totally healthy, then we would deny liability to your neighbor's damage. In short, it was an "act of God" that that tree fell, there was no way to foresee on the insured's part.


Hope this answers your question!

What are some tips that can save people money on their car insurance that aren't widely known?

Asked by dipsy about 11 years ago

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 have a really bad driving record; not telling us you're married: a lot of times that'll save you money!; saying that you live in a different state: As you can imagine, insurance in Florida and New York is extremely expensive. Some people will claim they live in Georgia, or Jersey, so they can get cheaper rates. Don't do that!

If the insurane company confirms that a Material Misrepresentation has occurred, they can cancel your policy for the entire period you had it, pay back all your premium, and you would not have coverage for the claim that you filed. And in a lot of cases, its extremely difficult to get another insurance policy after that kind of fiasco, and sometimes its even more expensive!

If there's a rear-end collision, is the driver in the back automatically liable? Can "the guy in front of me stopped too suddenly" ever be a legitimate excuse?

Asked by JessP about 11 years ago

Well, I can never say 100% YES, every single time! But honestly? 99 times out 100, yeah, I've assigned 100% liability to the rear vehicle. Why? Well, because technically if you were maintaining a safe distance for conditions, you should have been able to stop in time to avoid the collision. What if the guy in front of the front car stopped suddenly? And they were able to stop but you were not? 

Hope this helps JessP!

When two drivers both do something wrong - let's say one runs a red light, but the other guy is driving 100mph, who is at fault? Don't some States have a system where you're not allowed to divvy fault up, but it's all or nothing by law?

Asked by DomNJ about 11 years ago

Hi DomNJ! What you're talking about is a negligence doctrine, which varies by state. In the state of Florida (as well as Kentucky and Mississippi) we have whats called "pure comparative": after a liability adjuster completes their investigation, they divide up fault by percents (although a lot of the time it's 100% one person's fault or the other, or 50/50) In Florida, what percentage you're found NOT at fault, thats the amount of your damages you can get back (or subrogate) from the other party (usually via their insurance company). So, lets say that you are in an accident in which you're found 50% at fault. This means that you can get back 50% of your damages back from the other insurance company (50% of your deductible, and then your insurance company can pursue to get 50% back of what they paid to repair your car). 

here are some other negligence doctrines:

Contributory: Alabama. If you contributed at all, even 1%! to the accident, you are barred from recovering any of your damages. Sorry, Charlie.

"Not as great as": Geogia, Tennessee, Arkansas: If you are 50% or more at fault, you're outta luck. 49% or lower though, and you can pursue for reimbursement.

Those are the main ones I'm familiar with from working in the southeast,

Hope this answers your question!