Claims Adjuster

Claims Adjuster

lllawnchair

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!

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41 Questions

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Last Answer on September 24, 2013

Best Rated

i was in a eating in a business and a guest tripped and fell on my table,the table broke and the table and the customer fell on me at the time i thought i was ok but now im hurting can the establishment be liable for my medical and my clothes

Asked by janet over 10 years ago

Hi Janet,

Possibly? I honestly don't know for sure, since I only handled auto claims and personal property claims (no commercial). Depending on how long it took you to feel any pain and whether or not you've sought treatment for any injuries, you may be able to request reimbursement for medical costs. 

Is the "jump in front of delivery vehicle / sue his employer" scam still popular?

Asked by TonyTony about 11 years ago

Hey again TonyTony!

Haha, again, I've never heard of that. I've never had a claim like that. In my experience, delivery drivers (if you're talking about pizza/newspapers/that kind of thing) don't usually have insurance through their employers.

Seems to be a lot of confusion between what people are covered for vs. what they *think* they're covered for. How much of this do you think is caused by customers' ignoring of the fine print, vs. insurance policies being really confusing/unclear?

Asked by shogunn about 11 years ago

Hi shogunn!

In my opinion it's 50/50. As I've said before, insurance is a complicated business. Our contract language is admittedly pretty dry. Here's the main reason why: One of the aspects of an insurance contract is that it is a contract of adhesion. This basically means that we, as the insurer, write the terms of the contract and you, as the insured, do not have the ability to negotiate that language. In layman's terms, you take it or leave it (this is not the same as choosing the limits of your coverage, which of course you have control over). Now, although watching a snail push an acorn may be more interesting than reading through your policy documents, if you pulled up your current auto contract and read it, you may notice that we actually try to make it as unvague as possible. Why? In the event that we deny a claim and you, as the insured, think... well, that it's bullshit, you can file a 'bad faith' claim against your insurance company, and basically take us to court. Now, who do you think the judge will favor in this instance? The big company that wrote the contract? Or you, the insured, who had to 'take it or leave it'? Having vague policy language has caused insurance companies in the past to pay out a LOT of damage in lost 'bad faith' cases, so it's a constant battle to make the language as CLEAR as possible. Unfortunately, we have yet to find a way to turn our contract into a veritable page turner.

For those shopping for insurance: this is where agents can come in handy. They can break down for you exactly what covers what pretty well, so you have at least a basic understanding of what coverage you should have on your policy. Or you can ask me! 

To conlude, in my personal opinion, at the end of the day insurance is a contract. Why would you not try to understand the details before you sign on the dotted line?

What responsibilities do witnesses to an accident have? If I see a car crash, do I have a legal responsibility to wait around for the cops? What if one of the reasons the crash happened was because a car was swerving to avoid me?

Asked by Tyalor about 11 years ago

As far as I know (remember, I ain't a lawyer!), witnesses do not have any responsibility to stay at an accident scene to talk with the police. Do I think it's a good idea? Yeah. You, as an unbiased party, can either defend or refute a driver's description of what happened. As you can imagine, sometimes people are less then honest in terms of admitting fault at the scene, so it definitely helps a liability adjuster determine fault if they've got your information and can get a statement from you.

If an accident happened because a vehicle was trying to avoid you, then I would answer your question with another question: What were you doing wrong?? ; ) lol, j/k. But seriously, if you think you contributed to an accident, what does the good samaritan in you think is the right thing to do? Yeah, you know...

I always wondered whether I could leave my car in a bad neighborhood with the keys still in it and then file a claim when it inevitably gets stolen. It technically DID get stolen, right? Even though I kind of "facilitated" it.

Asked by jofredab almost 11 years ago

Hi Jofredab! Sorry it's taken me so long to answer your question; for some reason the insurance biz has been busy lately!

Here's the rub with your particular example: intentional act. Most personal lines insurance policies have an exclusion for first party coverages (collision, comprehensive) and third party coverages (property damage, bodily injury) f it is discovered that the loss was some how intended by the insured. (Much like how suicide is often an exclusion for benefits on a life insurance policy). Another example that I actually have seen before:

Lets say you are in a very um... for lack of a better word, volatile romantic relationship. Lets say that you cheat on your significant other, or they suspect you of cheating, it doesn't really matter, the point is, they're PISSED. And in order to get some kind of carthartic revenge, they take a crowbar to your benz. Now, to get your car fixed you file a comprehensive claim on your auto insurance, and they take care of it. How do they get your money back? 

Under normal circumstances (ie, it was an accident in the true sense of the word), your insurance company would file a claim on your spurned lover's insurance and pursue that company for reimbursement (or subrogation as we call it). But this kind of claim would most likely be denied, as it was an intentional act. So instead, your insurance company refers the claim to an external collections agency to pursue the tortfeasor personally.

Bottom line is, don't lie to your insurance company. Never a good idea.

 

Hope this answers your question!

Is working in insurance fun? What type of personality do you think is the best fit for what you do?

Asked by Jackie about 11 years ago

Well, Jackie, if I'm being honest? NO! It's boring, repetitive and stressful. Afterall, what 5 year old says, 'When I grow up, I wanna be a CLAIMS ADJUSTER! Yeeeaaaayy!' That being said, it takes all kinds to make the world go round. I work with people who have been with this particular company for decades, and they seem very content.

In Florida especially, there's a lot of problems with insurance fraud. I think someone who's detail oriented and very into the investigative nature of claims would thrive in this environment. And there is a certain part of me that does enjoy the customer service side of my job. I help people understand their coverages and provide them a sense of comfort during a very tumultuous experience. Car accidents are never convenient, and they are guaranteed to be stressful, so I do get a sense of satisfaction out of helping my insureds through the process. So if that floats your boat, you may enjoy my job too.

Hope this answers your question!

I have a collector car that has damage to the front bumper. The repair shop said the replacement stripes would not match the rest of the car due to age of the existing stripes on the hood and trunk. Should I be able to claim new stripes for the car?

Asked by Rob almost 11 years ago

Hi Rob,

I know that collector cars often have specialty insurance policies due to their age and intrinsic value. I have not dealt with claims involving those kinds of policies, so I can merely speculate as to the specifics of what is covered. That being said, most of the time your auto insurance is not for claiming upkeep and/or maintenance on your vehicle. Usually you are only covered for damage to your vehicle that's caused by a 'covered loss', i.e. an accident involving another vehicle, fire/hail/water damage, etc. In most personal lines auto policies there is an exclusion for first party coverages (collision, comprehensive) if the auto is damaged due to wear and tear (also freezing, and damage as the result of a war, fun facts!). I would say that most likely that kind of upkeep is not covered under your auto policy, but you always wanna read through your policy documents just to be sure. Hope that helps!