The Claims Adjuster Works for the Insurance Company, Not You

Topics > Work with the Claims Adjuster

When you file a liability claim, the first person you deal with is the claims adjuster. Most people assume this person is there to help them get paid. That assumption is wrong and can cost you thousands of dollars. The adjuster is an employee or contractor of the insurance company. Their performance review is based on how much money they save the company, not how much they pay you. Every conversation, every document request, every question they ask is designed to minimize the payout. Understand that from the start and you will handle every interaction differently.

The adjuster’s job is to investigate the claim and decide whether the company must pay. They look at your policy, the facts of the accident, the damage, and your injuries. But they also look for reasons to deny, reduce, or delay. They are trained to spot gaps in your story, pre-existing conditions, missed deadlines, or any technicality that shifts blame onto you. A friendly tone, a sympathetic nod, even a comment like “I know this is hard” is not empathy. It is a technique to lower your guard. When you relax, you talk more freely. That is when you say something that can be twisted into an admission of fault or an exaggeration of damage.

Do not give the adjuster a recorded statement without first talking to a lawyer. Many adjusters will ask for one within days of an accident. They say it is “standard procedure” or “to speed up the claim.” It is neither. That recording is a legal document that can be used against you in court or in settlement negotiations. The adjuster will ask open-ended questions like “Tell me what happened” and then let you ramble. Any inconsistency, even one caused by shock or memory lapse, becomes evidence that you are unreliable. If you say “I think I was going about 30 miles per hour” and later a reconstruction expert says 25, the adjuster will argue you were speeding. The polite but firm answer is, “I will provide a written statement after I have reviewed everything with my attorney.” You have that right. Use it.

When the adjuster asks for documents, give only what is directly relevant. If they request medical records, specify a date range that covers only the injury from the accident. Do not hand over your entire medical history. They will comb through it looking for a backache you had five years ago, then argue that your current injury is a pre-existing condition, not caused by the claim event. The same applies to repair estimates. If you have a damaged bumper, do not send photos of the entire car. The adjuster will zoom in on a scratch that has nothing to do with the accident and claim you are trying to get free bodywork.

Keep a written log of every contact with the adjuster. Write down the date, time, and what was said. If they make a promise over the phone, follow up with an email that says, “Per our conversation on [date], you agreed to send me the claim forms by Friday. Please confirm.” This creates a paper trail. If the adjuster later denies making that promise, you have proof. Insurance companies rely on verbal agreements that disappear when it is time to pay. Do not let that happen to you.

Never accept the first settlement offer. The adjuster knows most people are desperate for money or just want the headache to end. The first number is almost always low. It is a test. If you accept it, you waive your right to ask for more. Before you sign anything, get your own estimates. If the claim involves a car, take it to three independent repair shops. If it involves injury, get a second opinion from a doctor who is not connected to the insurance company. Compare those numbers to the adjuster’s offer. If there is a gap, do not just complain. Present the evidence. Write a letter that says, “My doctor’s estimate for follow-up care is $X. Your offer does not cover that. Please re-evaluate based on this documentation.” Be specific and factual. Do not get emotional. The adjuster deals with angry people all day. Anger does not move them. Data does.

If the adjuster stalls or ignores you, do not just wait. Send a polite but firm follow-up every week. Document the delay. If the delay becomes unreasonable, file a complaint with your state insurance commissioner. That complaint gets the company’s attention fast. You can also ask to speak to the adjuster’s supervisor. Supervisors have authority to approve higher settlements. But do not escalate until you have a solid paper trail showing you acted professionally and the adjuster did not.

Remember that you are not obligated to answer every question the adjuster asks. If they ask something that seems irrelevant or intrusive, say “I need to discuss that with my lawyer first.” Do not guess. Do not volunteer. The adjuster is not your helper. They are the gatekeeper of the money you are owed. Treat the process like a business negotiation. Keep emotions out. Stick to facts. Get everything in writing. And never, never forget who the adjuster really works for.

FAQ

Frequently Asked Questions

The calculation looks at your earnings history to establish a reliable average. Gather your pay records for a meaningful period before the injury (e.g., 6-12 months, or the year-to-date). Add up all your earnings—including regular pay, overtime, bonuses, and commissions—then divide by the time period to find your average weekly wage. This average rate is then multiplied by the number of work weeks you missed due to the injury.

Product liability holds manufacturers, distributors, and sellers responsible for injuries caused by defective products. Claims generally fall into three categories: design defects (inherently unsafe from the start), manufacturing defects (an error made during production), and marketing defects (inadequate warnings or instructions). You don’t necessarily need a direct contract with the manufacturer to make a claim. If a product is unreasonably dangerous and causes injury during normal use, the company in the supply chain can be held liable for the resulting harm.

Your ability to claim damages depends heavily on your state’s laws. In “comparative negligence” states (the majority), you can still recover money, but your compensation is reduced by your percentage of fault. If you were 30% at fault, you get 70% of your damages. In a few “contributory negligence” states, being even 1% at fault can completely bar you from recovery. Always report the accident to your insurer; they will handle the negotiation with the other party’s insurance based on these legal frameworks.

You have a strict legal deadline, called a statute of limitations, to either settle your claim or file a lawsuit. This timeframe varies by state and by the type of accident (e.g., vehicle vs. contractor negligence), but it is commonly between one and three years from the date of the injury. Missing this deadline almost always forfeits your right to any compensation. It is critical to confirm your state’s specific deadline and begin the process promptly.