Working with the insurance adjuster after a car accident

Who the adjuster works for#

One crash can produce claims with two or more insurers, and each assigns its own adjuster. The difference between them shapes every conversation you have.

The Texas Department of Insurance puts it simply: the adjuster works for the insurance company paying the claim. That is true of your own insurer's adjuster too. On an uninsured motorist claim, for example, your own insurer stands where the at-fault driver's insurer would have, and its adjuster may question fault and the value of your injuries in the same way.

Some adjusters are insurer employees; others are independent adjusters hired by the insurer for a claim. Either way, they act for the insurer.

What an adjuster does with your claim#

An adjuster's work usually follows the same order, though steps overlap:

• Confirms coverage. Was the policy in force, was the driver covered, and what are the policy limitsPolicy limits. The most an insurance policy will pay for one claim or one accident, no matter how large the losses are. Glossary?
• Investigates fault. The adjuster reads the police report, looks at photos and vehicle damage, talks to drivers and witnesses, and may ask for a recorded statement.
• Evaluates the losses. For an injury claim, that means medical records, itemized bills, proof of lost income and how the injury affected daily life.
• Makes a decision. The adjuster accepts or denies the claim, in whole or part, and makes an offer, often after receiving a demand letter. Our claim process overview shows how these stages fit together.

Complete documents and key points in writing make each of these steps easier to check. If you cannot work with an adjuster, the Texas Department of Insurance notes that you can ask the company to assign a different one.

Claim-handling deadlines#

Every state regulates how insurers handle claims. Many states' unfair claims practices laws are modeled on two documents from the National Association of Insurance Commissioners (NAIC): a model act listing unfair practices and a model regulation with deadlines.

The model act lists practices it treats as unfair. One of them is "not attempting in good faith to effectuate prompt, fair and equitable settlement of claims submitted in which liability has become reasonably clear". In plain terms, once it is reasonably clear that the insurer's customer is liable, the insurer is expected to try in good faith to settle promptly and fairly. The act also expects an insurer that denies a claim or offers less to promptly give a reasonable and accurate explanation of the basis for a denial or a compromise offer.

The model regulation sets these timelines:

States adopt their own versions, so the real deadline depends on where the claim is handled. California's Fair Claims Settlement Practices Regulations are a useful example because they protect people claiming on their own policy and people claiming against someone else's policy. A California insurer must acknowledge a claim, send forms and start investigating within 15 days, answer a claimant's letters within 15 days, and accept or deny the claim within 40 days of receiving proof of claim. If it needs more time, it must say so in writing and repeat that notice every 30 days.

Texas takes a different approach: its prompt-payment deadlines cover only claims on your own policy, with 15 days to acknowledge and start investigating. Our Texas guide has the details.

When an insurer breaks these rules, the state can take action, and some states also let policyholders recover extra damages for bad faithBad faith. An insurer's unreasonable refusal or delay in paying a valid claim. Many states allow extra penalties for it. Glossary handling. What you can do depends on your state's law.

Keeping a claim log#

Adjusters keep detailed notes of every contact. A claims checklist published on the District of Columbia insurance regulator's website reminds consumers of exactly that, and suggests keeping your own running list of names, dates and notes.

A log can be a notebook or a spreadsheet. For each contact, record:

After an important call, a short email confirming what was agreed creates a written record: "Thank you for speaking with me today. As discussed, you will send the rental authorization by Friday." Keep copies of every letter and email you send and receive.

Reservation of rights letters#

A reservation of rightsReservation of rights. A letter in which an insurer says it will keep handling or defending a claim while keeping the right to deny coverage later, for example because of a possible breach of the policy. Glossary letter means the insurer is handling a claim but is not yet agreeing that the policy covers it. Insurers send these when there is a coverage question, such as whether the driver was allowed to use the car, whether the car was being used in a way the policy excludes, or whether the crash was reported late.

These letters usually go to the insurer's own customer. For you as the injured person, a reservation of rights on the at-fault driver's policy is a warning that the insurer may later deny coverage, which could leave you looking to other sources, such as your own uninsured motorist coverage.

Some states require insurers to tell the injured claimant. In Virginia, a liability insurer that sends its customer a reservation of rights letter must notify the claimant or the claimant's lawyer within 45 days. If it does not, the insurer waives that coverage defense, to the extent of the claim.

If your own insurer sends you one, read it closely. It names the policy terms the insurer is relying on, and you may want to ask a lawyer what it means for your claim.

How to complain to your state insurance department#

Every state has an insurance department that takes consumer complaints at no charge. The NAIC describes the usual process:

1. Try the insurer first. Ask for the adjuster's supervisor or the claims manager, and put your concern in writing.
2. Gather your records. Collect your policy and claim numbers, the letters and emails, and your claim log.
3. Find your state's department. The NAIC website has a directory of state insurance departments, and our state guides cover each state's rules.
4. File the complaint. Most departments accept complaints online, by mail or by phone. Give a factual timeline, quote the policy language if you can, and say what outcome you want.
5. Wait for the insurer's answer. The department sends the complaint to the insurer, which must respond. If the insurer acted improperly, the department can require it to correct the problem.
6. Keep your deadlines. A complaint does not pause the time limit for filing a lawsuit.

In Texas, for example, the Department of Insurance help line is 800-252-3439.