WHY USE AN ADJUSTER?

STATEMENT OF THE PROBLEM

When an insured suffers a loss, it is the responsibility solely of the insured to file and perfect a claim for insured damages. Insurance policies and Insurer’s claim procedures define the method for filing and perfection of the claim. The insurance policy claim basis is established by a contract of adhesion; that is, a contract in which the Insured does not have a voice in the terms. The insurer’s internal claim procedures are developed unilaterally and may or may not be established in the insurance policy. Therefore, at the outset of the claim process, the insured is at a distinct disadvantage.

Among the many responsibilities of an Insured, when making a claim, is the responsibility to make a finding with respect to values of property and income. The value to be found is Actual Cash Value and, under certain circumstances, Replacement Cost.

Property depreciation is a significant adjustment factor with insufficient authoritative guidelines. The finding of value is a combination of fact and opinion.

SELF REPRESENTATION v PROFESSIONAL REPRESENTATION

Insureds may represent themselves when finding value and in discussions with the Insurer. Self-representation is a learning process similar to a teacher-student relationship where the claimant reacts to instruction from the Insurer.

An Insured may obtain professional representation and delegate the responsibility to find value and communicate with the Insurer. Such a representative is a Public Adjuster.

The Insurer, during the course of claim processing, may engage independent Adjusters, Appraisers, Accountants, Technical Experts and Attorneys. Can an Insured who represents himself have equal or superior capabilities?

The adjusting problem may be stated as the difference between self-representation and professional representation and the financial position which results from the disadvantage of self-representation.

The valuation problem may be stated as the selection and execution of a method or methods of finding Actual Cash Value and Replacement Cost. During the course of the claim adjustment, the self-represented claimant will face controversies in damages and values. Selection of the correct representative will afford balance between the interests of Insureds and Insurers.

The Insured’s goal should be to have equal or superior representation to that of the insurance company. Professional representation elevates the role of the Insured to one of action rather than reaction.

PROFESSIONAL REPRESENTATION

Professional representation includes the inspection, observation, evaluation and documentation of damaged property and income. The documentation includes the representative’s report which is the basis for the Proof of Loss. The Insured’s representative confers with the Insurer’s representative and appropriate adjustments are made.

The insurance Policy specifies certain filing deadlines as well as responsibilities, all of which require due diligence. Many of the responsibilities of an Insured may be delegated to a Public Adjuster.

There are many benefits in selecting a professional representative. These include the opportunity to discuss strategies in confidence, the ability to continue business without concern for the detail of claim requirements, the removal of doubt about correct adjustment and the financial results of being well represented.