“I’m the one who dismisses your claim.”
When someone asks what I do to make a living, it’s my go-to line at a cocktail party. It’s not technically accurate, but I laugh. Most people don’t know what the insurance adjuster is doing and very few want a detailed explanation. So I learned to shorten it and drift the conversation into something more accessible, like pictures of cats and dogs.
But the line reveals something true. The adjuster stands between policy language and people’s expectations. And these two things rarely match. While the insurance agent sells the insurance contract, the adjuster evaluates the claim to determine whether the insurance company should pay for the loss or injury, and, if so, how much to determine based on the terms of the insurance contract.
“Exactly what do I pay for my premiums?”
This is one of the most common questions I get. Usually, it’s just after explaining that something is not covered.
Often annoyed observations follow. “I paid my premium for 10 years. This is my first claim – my sump pump failed – and you denies it.”
That’s a general situation. Policyholders believe they have full coverage, and sometimes they call it a “all risk” policy. Their agents may have described it that way. However, all insurance contracts have exclusions and floods are one of the most frequently misunderstood.
In this case, the policy did not include specific approval for sump pumps or water backups, so the loss was not covered. In the states available, its coverage is optional and usually adds only a small cost to the premium. But even if it’s an option, many people choose low-cost policies without understanding what they’re giving up. You probably won’t be able to find approvals for all exclusions in the policy, but by reviewing the options you can fill these coverage gaps as much as possible.
I can understand. Insurance contracts are legally binding contracts written in highly technical language. Exclusions are scattered. Approval can remove coverage you thought you had. Sublimits caps payments for certain losses, even if many are displayed on the declaration page. However, the adjuster can only be paid based on the policy purchased.
Policyholders can avoid this surprise by asking specific questions when purchasing or updating their policies. Don’t ask, “Is this covered?” listen, “What’s not covered?” and “What approvals or optional coverage is available? Flood, mold, ordinances, laws, and service lines coverage are the most commonly excluded or limited areas. Knowing that in advance will help you determine whether a low premium is worth the potential out-of-pocket costs later.
“My lights will be off.”
The adjuster meets people at the worst moments of life: fire, shipwreck, storm. No one wants to see us coming.
I handled the claims of a woman who had a completely lost semi-tractor trailer a week before Thanksgiving. Her total claim was $60,000, but it took her until February to pay her. She began calling before Christmas and told me that her children wouldn’t have a gift under the tree. Her heat had been stopped. She lived in Pennsylvania. By February, when I finally received permission to write a check, she had been kicked out of her home.
The insured had not paid the mortgage for three months. She didn’t have the money to buy a new truck so she could make a living.
After hanging up I cried at my desk. If I could pay her myself, I would have. But that’s not how the process works. And the longer it takes, the more frustrating the policyholder becomes.
I couldn’t tell her that I was doing everything I could behind the scenes trying to escalate her claims as soon as possible.
I couldn’t say I agreed that the delay was unnecessary or that her frustration made sense. I had to become a pro with a gentle tone. I had to sing a company song.
First-party claims the insured generally believes we are not paying enough. Third-party claims the insured wants us to deny the other party’s claim. Then there’s pressure from inside. Managers need speed. The executives think we are too generous.
And while everything may seem digitally streamlined, the billing payment process is nothing. Large losses require multiple levels of approval. Payment requests may be sent from the adjuster desk to the supervisor, then to the manager, and then to the department head (add each step). Once approved, the funds release will return to the chain.
Insurance can provide valuable financial protection, but like many financial products, it can move slowly. Maintaining robust emergency funds can help keep your head above the water if you are late in paying your bill. Paying close attention to requests from the adjuster, providing detailed documentation and discussing the estimated claim timeline will help you prepare these situations before they become dire.
Threats from angry policyholders
Most people are surprised to find out that insurance adjusters are under threat. I received multiple 25 years later. My husband and father both receive more, but more, the coordinators who have more time on the field.
One man said to me completely: “You better bring a gun. I don’t have a knife in this fight,” I was the other side of the phone. He hadn’t seen me yet.
Some adjusters pull ladders onto the roof during inspection – because the claimant has knocked them down. Others simply call a colleague before visiting the site to let someone know where they are.
My husband once needed a sheriff escort to inspect the damage from the storm. My father was chased by his property at the muzzle. These were not strangers. They were angry, scared, policyholders looking for someone to take charge.
It’s shocking, but not uncommon.
Most adjusters won’t hurt anyone. I’m not looking for reasons to deny the claim. We work under a lot of pressure – sometimes we are truly afraid of our safety.
Most of the time, anger really isn’t about us. These threats arise because the policy did not cover the losses and the person did not recognize it. But I did not write a policy. I did not write exclusions. I did not create a sublimit to limit payments.
This brings back to the importance of clarifying coverage terms and restrictions when purchasing or updating your policy. There’s nothing too many questions. A thorough understanding of your policy will make the billing process more efficient for you and your adjuster.
How to improve the odds of a smooth claims process
You can’t always avoid the stress of claims, but you can take steps to make the process smoother:
- Read your policy now – not later. Look at exclusions, sublimits, and support. If you don’t know what something means, ask your agent to explain it.
- Take photos before loss occurs. Document your home, vehicle and major belongings. If something happens, you’ll be happy what you did.
- Honest and accurate. A small exaggeration or missing details can delay or complicate your claim.
- Keep receipts and records. Repairs, upgrades, temporary fixes – save everything. The more documents you have, the easier it will be to evaluate.
- Ask me a question. If something doesn’t make sense, your adjuster can walk you around it. Ask extra questions today and avoid confusion tomorrow.
The adjuster is human
People don’t usually consider their regulators emotional. However, the line between professionalism and personal tension is often thinner than it looks.
It’s easy to assume that the adjuster hasn’t called you because the adjuster is indifferent. But the $60,000 bill took three months to approve, so perhaps the kids are helping families who missed Christmas. Maybe they just got off the phone someone threatened them. Or maybe they’re trying to put it together after a rough morning with their teen step-son-in-law, who’s going through particularly difficult stages.
The adjuster is expected to be neutral, professional and efficient. But we are human too. We carry the loss of others all day, then go home and carry our own.
So no – when you say it’s unfair, we cannot agree with you. You can’t say, “You’re right, this should be covered.” You cannot speed up payments or rewrite rules.
But that doesn’t mean we don’t feel it.
