When you purchase an insurance policy, your agent is someone who will guide you through the process, explain your coverage, choose the right limits, and help you answer questions along the way. A sense of trust can be formed between the policyholder and his agent, especially if he has been with an agent for a long time.
So, after an accident or loss, it may be surprising when you suddenly realize that you are working with a whole new person Insurance adjuster. To help policyholders better understand both insurance business coins, we discuss the life cycle of insurance contracts with agent Shannon Martin and adjuster Chantal Roberts.
Chantal: When I first connected with Shannon, it was because she interviewed me for an article about insurance. Somewhere in the hour of conversation, we realised that even people in the industry don’t always understand what other departments are doing. So we teamed up to provide insight into the roles of adjusters and agents, explaining how roles connect and how they differ.
I want to buy insurance
Shannon: This task is within the agent’s scope of work. Depending on your insurance company, there may be one agent or broker that handles the policy from end to end. Buy policy online Or with a sales agent.
My goal as an agent is to help potential and current policyholders purchase and maintain policies that meet their needs. I can ask questions, explain coverage options, assist with paperwork, process payments, and answer most other questions.
Agents advocate for policyholders, but also represent insurance companies. This is a balancing act that does not always feel unfair to policyholders. During the sales process, we act as the first line of underwriting for the insurance company. Most of the initial conversations with potential policyholders focus on determining whether someone meets the insurance company’s criteria for insurability. For example, if you live in a state where we do not provide compensation, or if there is a high-risk incident in your driving record, we recommend contacting another incident. Auto insurance company.
Once you know that it’s likely that you can provide a policy for you, the conversation will move on to counseling. I will help you understand the financial protection that makes the most sense to your needs and adjust your policy to work On your budget.
I would like to change the coverage type and limit
Shannon: This is also the job of an agent. When making a call to change coverage or limits, I will help you guide these adjustments based on your current needs and goals. See how these updates affect both financial protection levels and premiums, even if you change your address or add new drivers and vehicles.
Depending on the carrier and agent, these transformations can go very differently. This is where quality customer service is more important than you Insurance fees.
For example, let’s say you trade in your car and pay cash for something new. Your old car was an old model car Liabilities only compensation. Your new car is in use, but only one year old. Tell the agent: “Keep all coverage the same. There’s no change.” If your agent simply reflects the old restrictions without asking questions, they did technically what you requested. The transactions are fast and your rates are pleasantly low. But have they served in your best interests?
If you just paid $20,000 in cash for your car, you will need collision compensation. It’s always your right to reject coverage, but I want you to realize what that means and where potential coverage gaps can expose you. Unfortunately, not all agents are guaranteed to be this thorough. That’s why it’s always a good idea to be clear about what’s covered when purchasing or changing your insurance policy.
I want to submit a request
Shannon: If you’re in a fender bender or the storm is damaging your roof, reaching out to your agent is completely natural File a claim. But the situation is about actual claims instead of a conversation about hypothetical loss, so that’s all I can do. I can:
- Please let us know if your policy is active
- Provide a copy of the policy agreement
- I provided a copy of my ID card
- Accept payments on time
- Contact the claim adjuster
Depending on the company guidelines, I may be able to confirm what Coverage Type And the limit you are paying for, but it does not guarantee compensation for an accident or loss that just happened.
Chantal: When a claim is reported, it is assigned to the adjuster. That’s where I come in.
My job as an adjuster is to investigate losses, review details, review the policy and determine whether compensation applies. I collect documents, ask questions, and sometimes consult underwriting or other departments if clarification is required.
While claims generally fall under the responsibility of the adjuster, a good agent can be a valuable partner. In the claim for one property I handled Declaration page We listed one address, but the field evaluator reported that the damage occurred elsewhere. Based on the documents, the loss appeared to have occurred on an uninsured property.
I called the agent to give them a heads up. They explained that the county recently updated its 911 addressing system, changing the number of streets. The properties were the same, but the address had changed. The agent provided a letter confirming the changes, approved the policy correctly, and the billing has advanced. Without that conversation, the insured would have received a denial letter for expertise.
I have a question as to why my claim was rejected
Chantal: a Claims will be rejectedit is my responsibility as an accorder to explain why. That explanation is not merely a formal letter. This should include a breakdown of which parts of the policy apply (or not), the facts used to make that decision, and what options remain.
But be honest – when people receive a denial, they don’t always call the adjuster first. They often call their agents.
Therefore, it is practice to notify the agent before a denial is issued. A good agent is a trusted advisor. If they know that the claim is denied, they can prepare for the conversation, answer basic questions, and even help the policyholder get the documents they need for an appeal or review.
Sometimes, agents catch things I didn’t – Missing Approvalold binders that have not been updated or even misread how the policy is applied. It doesn’t happen often, but when it’s done I want that feedback. The purpose of insurance is to pay for the covered losses rather than stroke my ego.
If you have any questions about rejection, reach out to the adjuster first. We are people who have built up our resolve and we need to explain how we reached that decision. But it can also help with involving agents. Especially when it leads to better understanding, updated coverage, or both.
How do agents and adjusters work together?
Shannon: Agents and adjusters do not normally work side by side, but they may help agents support the adjusters by providing context and documentation. As your agent, I can help coordinators by providing the latest Policy informationcheck effective dates for coverage or clarify any recent changes you have made to your policy. Conversely, the adjuster can sometimes loop through us if we discover a coverage gap that we want to address in the future.
Chantal: In one case, the homeowner experienced a flood after heavy rain, and agents reported that the flood was “covered.” Unfortunately, the losses were attributed to the retreat and overflowing of city sewers. This policy has overflowed, particularly by eliminating water from the sewer system. Homeowners had no other flooding policies or approvals covering this type of loss.
The agents were doing their best, but their explanations were too broad. The agent understood when I walked through the details of the loss and showed where the exclusion was applied. They were still irritated – and so were the insured – but we were able to readjust our expectations and take everyone to the same page.
Adjusters and agents play a variety of roles, but when we work together, we create a smoother and more informed experience for policyholders. I’ve always believed in looping through the agent’s loop early, especially when the billing is complicated or heading towards denial. Agents provide background, help manage expectations, and act as a stable point of contact. That’s important – agents may remain the same for years, but the adjusters that handle the bill may differ depending on the billing, location, or staffing type at the time.
If you don’t know where to start with a complaint or question, an agent is often a great first call. And if your question relates to a particular loss or denial, the adjuster assigned to that claim will explain what is in the file and how the policy was applied.
