Behind the scenes of an insurance claim

By Crawford Frazer

When you file a health, life, home or auto insurance claim, it might be hard to tell what happens behind the scenes. While you wait for a payout, adjusters, examiners and appraisers at your insurance company go to work on your claim and play a major role in determining whether your policy will cover a loss -- and just how much compensation you'll receive.

Claims adjusters

When you file a claim for damage to your car or home, the claims adjuster is the one who assesses the damage, according to the Insurance Information Institute. Through detailed inspections and interviews, the adjuster determines how much the insurance company should pay.

An insurance claims adjuster likely will interview you and others involved, and may take pictures, shoot video and use other methods to keep records, according to the U.S. Bureau of Labor Statistics. For example, if you claim to have a medical condition as the result of an auto accident, the adjuster may consult with a physician who can evaluate the claim. The adjuster might interview an engineer or architect for property damage assessments.

Most often, adjusters work for insurance companies and might even side with the insurer in a dispute. However, in some property loss disputes, you can hire a public adjuster, who will work on your behalf.

Claims examiners

In some respects, examiners have a similar function to adjusters. They also review claims, but examiners concentrate on making sure the proper guidelines are followed, according to the Bureau of Labor Statistics.

This role can run the gamut from reviewing claims applications for accuracy to comparing a medical claim to a general guide for treatment for that condition. If, for example, a person filed a claim for treatment of a back injury, the examiner would determine what the common treatments were for others who also suffered back injuries. In fact, examiners often work for health and life insurance companies. Sometimes, examiners review life insurance applicants in advance to determine if they are high-risk.


In broad terms, you could say that adjusters determine what happened and examiners determine how a particular case fits with standard procedures for similar cases. Meanwhile, the appraiser's role, according to the Insurance Information Institute, is to determine the value of the damaged item in a claim.

Many appraisers are auto damage appraisers, according to the Bureau of Labor Statistics. After inspecting a damaged vehicle, the appraiser will estimate the cost of repairs and then give that information to the adjuster.

There is some overlap in the roles of adjusters, examiners and appraisers. But doing your best to work with them and communicate with your insurance company can speed up your insurance claim.

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