Loss Adjusters: Your questions answered

Anyone who has been involved in a major insurance claim, such as a fire or flood at their home or business premises, will have likely come into contact with a Loss Adjuster. This guide will provide answers to the frequently asked questions relating to the role of the Loss Adjuster in the insurance claim process...

What is the role of the Loss Adjuster?

In most simple terms, a Loss Adjuster is an insurance professional. Their job is to investigate insurance claims on behalf of the insurer once they reach a certain size. The Loss Adjuster plays a crucial role in the insurance claims process and is usually the first person you will come into contact with from the insurance company after a claim is logged.
The Loss Adjuster will typically visit your property within a few days of the claim being initiated by the insurance company. The purpose of this visit is to obtain all the necessary facts, in order for your insurance company to determine whether the claim is valid and ensure the amount paid to you is correct, in accordance with your policy. This information is presented to the insurance company in the form of the Loss Adjuster’s report.

During their visit, the Loss Adjuster should also advise which safety and security measures should be undertaken to mitigate any further loss, and offer advice regarding repair works to the property.

My insurance company is sending out a Loss Adjuster, should I be worried?

Once the extent of the damage requires the appointment of a Loss Adjuster, they will visit your property. At this point, it is common practice for many policyholders to seek their own representation in the form of a Loss Assessor (often know as an independent or public Loss Adjuster). A Loss Assessor works for you, not the insurer, and will manage all aspects of your insurance claim from start to finish.

Click here to understand the difference between Loss Adjusters and Loss Assessors.

What is the Loss Adjuster looking for?

The first duty of the Loss Adjuster is to establish whether the insurance company is liable under the terms of your insurance policy, and if so, to what extent. The Loss Adjuster will typically review the following things:

• That adequate insurance is in place to cover the loss
• That all conditions and endorsements in the policy have been met
• That the loss or damage to the property falls within the terms of the policy
• That the amount being claimed for is reasonable
• That only valid items are included in the claim

Ultimately, the Loss Adjuster will be looking to establish the cause of the incident and whether the damage suffered as a result, is covered by the insurance policy.

Is there anything I can do to help the Loss Adjuster speed up the process?

The following information may come in useful when meeting the Loss Adjuster for the first time:

• Receipts for any emergency repair works that were carried out following the incident
• Proof of ownership of high value lost or damaged items (receipts, photographic evidence of damaged items etc.)

It is important that you do not throw anything away until the Loss Adjuster has inspected the property and all items have been accounted for. If you dispose of something that cannot be accounted for, you may not be able to claim for it.

Who pays the Loss Adjuster’s fee?

The Loss Adjuster’s fee is paid by the insurance company who instructs them. Their fees are paid as part of the insurance claim.

If the Loss Adjuster is paid by the insurance company, how can they be impartial when reviewing my claim?

Codes of conduct set out by The Chartered Institute of Loss Adjusters (CILA), General Insurance Standards Council (GISC), and The Association of British Insurers (ABI) require that Loss Adjusters operating in the UK do so impartially.

However, some policyholders have difficult experiences in dealing with Loss Adjusters by themselves…

“Due to the poor experience with the Loss Adjuster, we never thought that we would have our house returned to the condition before the incident happened, but Martin excelled in his quest to do exactly that. Morgan Clark provided a professional service with reassuring advice throughout what only can be described as the worse experience of our lives. With their help we were given back our home with minimal input from ourselves. Without their help we don’t think we would have received our house back to the standard that we now have. We cannot fault the service we received from them. Thank you.” – Mr Milan

 

What can I do if I am unhappy with the conduct of the Loss Adjuster?

If you have a complaint about the conduct of a Loss Adjuster, you can submit a complaint to the Chartered Institute of Loss Adjusters (CILA) – their complaints procedure is explained here.
It is important to note that the Chartered Institute of Loss Adjusters has no jurisdiction concerning the settlement of insurance claims – such issues should be raised directly with the insurance company. A complaint can be escalated to the Financial Ombudsman should you not find a resolution with the insurance company.

Will hiring my own Loss Assessor annoy the Loss Adjuster?

Appointing a Loss Assessor to handle a claim on your behalf is commonplace and will help ensure a resolution is met in an efficient and timely manner. With this in mind, there is no reason a Loss Adjuster should deter you from seeking your own representation during the claims process. In fact, many Loss Adjusters actually have recommended Morgan Clark Loss Assessors to their clients, as it allows them to communicate with a fellow professional, which makes the claims process run more smoothly.

If you find yourself in a position where the Loss Adjuster is trying to dissuade you from using a Loss Assessor, you should question their motives – this could be because they want to save the insurer money by settling your claim as cheaply as possible.

What can I do if my claim is rejected/repudiated?

There are certain circumstances under which the information collected by the Loss Adjuster can result in your claim being rejected. An insurance policy is essentially a contract between you and your insurer, and if you don’t keep your end of the deal, then that contract is broken, and the insurer is not obliged to pay out.

For instance, this could be the result of you providing incorrect information to the insurer when you first took out the policy, the incident being caused by a lack of due care on your part, or if the insurer has adequate evidence to suspect the claim is fraudulent.

If you have had a claim rejected but believe it should not have been, there are steps you can take to try and reverse the decision:

• Review your insurance policy documents carefully to check the information is factually correct and all of the questions are answered honestly and to the best of your knowledge. After doing this, and providing you feel you still have a case, you may wish to submit a formal complaint to your insurer in writing.

• Appoint a Loss Assessor to review your policy documents and deal with your insurer and their Loss Adjuster on your behalf.

• If you are still unhappy with the outcome having filed a formal complaint with your insurer, you are within your rights to take your complaint to the Financial Ombudsman Service. However, this can only be actioned following either a ‘final response’ from your insurance company, or if you don’t receive a response from them after eight straight weeks. If you appoint a Loss Assessor, they will likely do this for you.

In summary, Loss Adjusters work for the insurance company, while Loss Assessors work for you, the policyholder. You can read more about the differences between Loss Adjusters and Loss Assessors here.