Working with an insurance adjuster

An insurance claims adjuster investigates a claim, decides what the policy covers and sets the amount the insurer will pay. Your own insurer's adjuster owes you the duties in your policy and your state's claims rules, while the other driver's adjuster works for their customer, not you. Be cooperative and factual with both, keep everything in writing, read every estimate line by line, and ask for the reason and policy provision behind any decision you disagree with.

Who you will deal with

On a straightforward claim you may only ever speak to one person and an app. On a larger claim, the person who looks at the car may not be the person who decides what is paid. Ask who has authority to approve the estimate.

Your adjuster versus theirs

With your own insurer, you have a contract. Policies typically include a duty to cooperate: report promptly, give truthful information, make the car available for inspection, and provide documents the insurer reasonably requests. Refusing can jeopardize the claim.

With the other driver's insurer, you are a claimant, not a customer. You generally have no contractual duty to give them a recorded statement, though they may need some information to accept liability. If you were injured, it is common to let a lawyer handle communication with the other insurer. If you do talk to them, stick to facts you know, and do not guess about speeds, distances or your injuries.

How estimates work

The adjuster's estimate is the insurer's starting position, not the final word. Several rules in the NAIC's model claims regulation, which many states have adapted, are worth knowing:

• You get a copy. If a partial loss is settled from a written estimate prepared by or for the insurer, the insurer must give you a copy.
• The estimate must be workable. It must be enough to allow repairs "in a workmanlike manner."
• If your shop's estimate is higher, the insurer must either pay the difference or name at least one shop that will do the repairs for the insurer's amount.
• Deductions must be explained. Betterment or depreciation deductions must be itemized and documented, and the model limits wear-and-tear deductions to $1,000.
• No unreasonable travel. The insurer cannot require you to travel an unreasonable distance to get an estimate or a repair. California defines that as more than 15 miles in cities of 100,000 or more and 25 miles elsewhere, and requires first-party inspections within six business days of the claim notice (10 CCR 2695.8).

Shops often find more damage once the car is taken apart. They send a supplement to the insurer, which reviews and approves it. That is normal and does not mean the first estimate was wrong.

Practical habits that help

1. Get the adjuster's direct contact and the claim number at the first call.
2. Write it down. After every phone call, send a short email summarizing what was agreed and any deadline. Keep a log with dates and names.
3. Send documents in one place. Use the portal or a single email thread so nothing gets lost. The after-accident checklist and information form lists what to collect.
4. Ask "what do you still need from me?" at each step. Many delays come from a document nobody asked for clearly.
5. Read before you sign. A release usually ends your claim for the damages it lists. Do not sign one for injuries until you know the extent of them.
6. Be calm and specific. "The estimate omits the rear sensor bracket on line 14" moves faster than "this estimate is too low."

When you disagree

Disagreement is normal and does not have to become a fight. Escalate in steps:

1. Ask for the basis in writing. For a denial, the NAIC model requires a written denial that cites the specific policy provision, condition or exclusion. California requires the denial to state the legal and factual basis and tell you that you can have the matter reviewed by the state insurance department (10 CCR 2695.7).
2. Bring evidence, not adjectives. A competing estimate, OEM repair procedures, photos, or comparable vehicle listings on a total loss.
3. Ask for a supervisor or claim manager if the adjuster cannot move.
4. Use the policy's dispute tools. For disagreements about the amount of a loss, most policies have an appraisal clause. See how to negotiate a total loss settlement for total losses.
5. Complain to your state insurance department. It can ask the insurer to respond formally.
6. Get legal advice for injury claims, large losses, or if you suspect bad faith. A licensed attorney in your state is the right source for specifics.

If the claim was denied outright, the next guide to read is how to appeal a denied car insurance claim.

Red flags

• Pressure to settle fast or sign a release on the spot, especially after an injury.
• Being told you must use a particular repair shop. Many states prohibit insurers from requiring this; see choosing a repair shop: direct repair programs and your rights.
• A third-party insurer telling you to file with your own insurer just to avoid paying when fault is clear. The NAIC model and California's rules discourage this.
• Deductions with no itemization or explanation.

Key takeaways

• Your adjuster works for your insurer, which owes you contractual duties; the other driver's adjuster works for them.
• Cooperate fully with your own insurer; with the other driver's insurer, share facts but you generally owe them no recorded statement.
• Insurers in states following the NAIC model must give you a copy of their estimate and explain any deductions.
• Keep a written record of every call and decision, and escalate step by step when you disagree.