engleski

The role of claims investigator and adjuster

In the event of a loss, policyholders submit claims, or requests for payment, as compensation for their loss. Adjusters, examiners, and investigators work primarily for property and casualty insurance companies, for whom they handle a wide variety of claims for property damage, liability, and bodily injury. Their main role is to investigate the claims, negotiate settlements, and authorize payments to claimants. They must determine whether the customer’ s insurance policy covers the loss and how much of the loss should be paid to the claimant. Although many adjusters, appraisers, examiners, and investigators have overlapping functions and may even perform the same job, the insurance industry generally assigns specific roles to each of these claims workers. When adjusters or examiners suspect fraud, they refer the claim to an investigator. The bigger the market the more suspected fraud and false claims are present. Property/casualty insurance fraud cost US insurers $31 billion in 2002. For that reason paper deals with US data and statistic which provides better understanding and the role of investigators dealing with fraud. In USA, adjusters, appraisers, examiners, and investigators held about 241, 000 jobs in 2002. Insurance carriers employed nearly 60 percent of claims adjusters, appraisers, examiners, and investigators ; more than 20 percent were employed by insurance agencies and brokerages, and private claims adjusting companies. Around 2 percent of adjusters, appraisers, examiners, and investigators were self-employed, while more than 14, 000 jobs were held by auto damage insurance appraisers. Continuing education (CE) in claims is very important for claims adjusters, appraisers, examiners, and investigators because new laws and court decisions that frequently affect how claims are handled. Investigators must often consult with legal counsel as they can be expert witnesses in court cases. Knowledge of computer applications also is extremely important. Also, examiners working on life and health claims must be familiar with new medical procedures and prescription drugs. An appraiser must know how to repair vehicles in order to identify and estimate damage, and technical skills are essential. For adjusters and examiners, continuing education is important because of the continual introduction of new technologies and repair techniques.

claim; damage; fraud; adjuster; appraiser; examiner; investigator

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