How to Work with a Claims Adjuster to Get Your Claim Paid

Topics > Work with the Claims Adjuster

Working with an insurance claims adjuster is the core of getting a liability claim resolved. This person is not your advocate, your friend, or your enemy. They are an employee of the insurance company whose job is to investigate the claim, determine what their policyholder is liable for, and settle the claim for the lowest reasonable amount. Understanding this dynamic is the key to a successful outcome. Your goal is to present a clear, factual, and well-documented case that makes it difficult for them to justify denying or lowballing your claim.

Start by getting the adjuster’s direct contact information and claim number. Every conversation and piece of paper should reference this number. Your first discussion should be factual and brief. Stick to the basic who, what, when, and where. Do not speculate, admit fault, or offer a detailed opinion on injuries or damages. Simply state the facts as you know them. It is wise to let the adjuster know you are documenting your damages and will provide a full package. This sets a professional tone from the beginning.

Documentation is your most powerful tool. For property damage, this means photographs, repair estimates, and receipts. For injury claims, this means medical records, bills, and a diary detailing your pain, limitations, and how the incident has affected your daily life and work. Organize this information logically before sending it. Do not dribble documents to the adjuster piecemeal. Sending a complete, organized package forces them to review the full scope of your claim at once and demonstrates you are serious and prepared.

The adjuster will likely request a recorded statement. Be cautious. You are generally not legally required to give one, especially early on. If you choose to provide one, prepare as if for a job interview. Review the facts, keep your answers concise and on topic, and never guess. If you do not know an answer, say so. Remember, anything you say can be used to challenge your claim. It is often safer to decline a recorded statement and instead direct the adjuster to the evidence in your documentation package.

Negotiation is inevitable. The first settlement offer is almost always a starting point, not a final number. Do not react emotionally. Instead, respond in writing. Outline point-by-point, referencing your documentation, why the offer is insufficient. For example, “Your offer of $X for medical bills does not account for the future physical therapy outlined by Dr. Smith in the enclosed report.” This forces a factual counter-argument. Be reasonable but firm. Know the realistic value of your claim, which includes not just past bills but also future costs, pain and suffering, and lost wages.

Throughout this process, keep a log. Note every call with the adjuster’s name, the date, time, and a summary of what was discussed. Follow up important verbal conversations with a brief confirming email. This creates a paper trail and holds everyone accountable. If the adjuster is unresponsive, escalate to their supervisor. Persistence is required. Working with an adjuster is a business transaction. By being prepared, professional, and persistent, you shift the balance of power and significantly increase your chances of a fair settlement.

FAQ

Frequently Asked Questions

Avoid giving recorded statements without preparation, admitting any fault, speculating, or downplaying your injuries. Do not volunteer excessive personal history or discuss your emotional state casually. Never accept the first settlement offer immediately, as it is often a starting point for negotiation. Politely decline to answer questions you are unsure about and avoid saying “I’m fine” as this can be misconstrued. Stick to the basic facts of the incident.

First, ensure safety and document everything. Take clear photos/videos of the damage and the surrounding area. Get contact and insurance information from the other party. Report vehicle collisions to police. For contractor damage, notify the company in writing. Contact your own insurance company to report the incident, even if the other party is at fault. Avoid admitting fault or making speculative statements. Prompt, thorough documentation creates a strong foundation for your insurance claim or any necessary legal steps.

Negligence means someone failed to act with reasonable care, causing damage to your property. To prove it, you must show they had a duty of care, breached that duty, and directly caused your loss. For example, a driver running a red light and hitting your parked car is a clear breach. The core idea is fault based on careless action or inaction. It’s the most common legal basis for seeking compensation for damaged belongings, vehicles, or real estate when another person or business is at fault.

Initially, you or your health insurance are responsible for paying the bills to avoid damage to your credit and collection actions. If you have MedPay (medical payments) coverage on your own auto policy, that can pay first. Do not delay treatment expecting the other party’s insurance to pay upfront; they only pay as part of a final settlement. Your eventual liability settlement should reimburse you for these paid bills and cover any outstanding balances.