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Mon September 8, 2008
 
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CLAIMS / ADJUSTERS / INVESTIGATION
Also See:

TERMINOLOGY
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Claims adjuster
An individual who acts on behalf of, or is employed by, an insurance company to settle claims.


Adjustment bureau

An organization that provides loss adjustment services to insurers. It is used to supplement staff adjusters and by insurers that do not employ their own staff adjusters.

 

Claim adjustment

The process used by an insurer to evaluate and settle a claim. This includes determining whether and to what extent the loss is covered by the policy, determining the cause of loss, and valuing the loss.

 

Claim agent

A claims representative of an ocean marine insurer, located in ports and cities throughout the world, whom a claimant can contact in the event of a loss or damage to an insured shipment.

 

Field adjuster

A claims adjuster who works outside the office. Field adjusting is principally used for claims for real property damage, automobile physical damage, and auto liability property damage. Most liability, workers' compensation, and casualty claims are handled by inside adjusters, who may use outside adjusting firms if any field investigation is needed.

 

Independent adjuster

An organization or a person, hired by an insurer, who is paid a fee for settling claims.

 

Inside adjuster

A claims adjuster who works almost exclusively inside the office and completes the claim adjustment process by telephone and mail. This form of adjusting is commonly used on third-party liability and workers' compensation claims.

 

Public Adjuster

An individual who acts on behalf of, or is employed by, a claimant to represent its interests in the claims settlement process.

 

Staff adjuster

An individual employed by an insurance company to settle claims with or for policyholders of the company.

 

Third-party administrator (TPA)

A claims administrator or insurance company that processes claims on behalf of a self-insured organization or multiple employer welfare arrangement or manages workers' compensation claims for an employer. The administrator is a third party because it is neither the self-insurer nor an insured (claimant or payee). Services may include processing claims (including audits, adjusting, and negotiating settlements), record keeping, self-insurance certification, and notification of excess insurers.

INSURANCE DEFINITIONS

For definitions of various forms of insurance refer to Insurance Marketplace (Rough Notes)

ADJUSTERS
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OMBUDSERVICE
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OTHER RESOURCES INCLUDING INVESTIGATORS
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