A loss adjuster is an insurance claims specialist who might represent the policyholder or the insurance company. They tend to be members of the Chartered Institute of Loss Adjusters and progress through the examination process to chartered status.
Loss adjustment is the calculation of the amount payable for a claim after application of policy limits, sums insured, excesses and occasionally under-insurance penalty (Pro-rata Average).
A loss assessor is usually a claims handler who will not be qualified and could only be engaged by a policyholder.
There are a few differences here that are pertinent, however both offer a similar role. Chartered Loss Adjusters are regulated and held to a higher standard than loss assessors who, as a rule, are not. Chartered Loss Adjusters are independent and can be retained to work on behalf of either the client or the insurer. Any financial report put together by a loss adjuster would need verification and validation, whereas a report created by a Chartered Loss Adjuster does not. Historically, until 2000 most chartered loss adjusters (employed by the larger adjuster companies) used to represent the insurer. The Royal Charter enables a qualified loss adjuster to represent the policyholder or the insurer. Consequently, smaller practices of loss adjusters and individuals now choose to represent the claimant and not the insurer. In this way the Policyholder, at his/ her own expense can engage a professional loss adjuster.
A loss adjuster is paid by his/her instructing principal, either the policyholder or the insurance company.
Many insurers do not employ direct claims investigators and prefer to outsource to adjusting companies either local to the incident or with experience of the particular type of claim.
A chartered loss adjuster may be engaged to either represent the insurance company's interest in his/her investigations into the policy liability and validate the amount claimed - or represent the policyholder in establishing the full scope of the available policy cover and present the supported claim to the insurer and their representative. The issue of independence is subjective. The loss adjuster is paid by their principal (the insurer or the policyholder) and will obviously attempt to protect the interests of their client.
Until the mid 1990's a chartered adjuster could maintain their independence of their insurer principal. That changed and in effect the insurer's adjuster will represent their best interests and by the same token a chartered loss adjuster representing the policyholder will protect their client's honest intent within the terms of the policy wording.
Chartered Loss Adjusters are subject to the terms of a Royal Charter. The Chartered Institute of Loss Adjusters operates an Etiquette committee that would investigate any allegation of impropriety against a qualified member. The CILA also provides guidance on good practice to part and unqualified members. In the loss adjuster was an employee of a loss adjusting company or firm, the Employer would have ultimate responsibility for discipline.
A loss adjuster is skilled at understanding your trading history, comparing that to the current situation and presenting the findings in a way that the insurers will find hard to refute.
A large loss is usually regarded as an incident that exceeds £150,000, although the exact figure can vary.
This is usually a Chartered Loss Adjuster who routinely handles claims of a value more than £150,000.
Adjustment expenses arise for the cost of professional services in measuring and negotiating the settlement figure. These may be calculated on a percentage or hourly rate basis, dependent upon the size of the claim.
An adjuster representing the insurance company may wish to inspect the buildings and any equipment and stock at the affected premises. There will be enquiries into the cause of an incident to ensure that policy cover engages.
Thompson-Roberts is here to obtain professional advice on the full scope of your policy wording and the accurate measurement of any insured losses. We negotiate on your behalf to advance your case to resolution.
Firstly, if they have assigned you a loss adjuster, that is a positive sign. However, like many financial roles the company instructed will be representing their clients’ needs above all else. So whilst they will review your claim, it is not their role to represent your best interests. For peace of mind, you may wish to engage your own professional adjuster who should provide you with all the necessary advice on policy coverage and amount claimable that you require.
We only charge you if the claim is successful and your insurer pays out. The fee is clearly defined in out terms and conditions that are agreed before we proceed.
We don’t have any hidden fees for our claim management services. However, sometimes other financial information is required. If you use an external accountant, they may charge you for collating this information. The good news is that in some cases, this fee is refundable via your insurance policy.
We do not give any timeframes because there are a lot of variables. Currently we are working though claims and expect to have all historic claims assessed and responded to by the 14th February, any new claims should be assessed by us within 7 days. Once a claim is assessed, if there is a valid policy claim, we will then instruct your insurer. It is then down to them to respond and ultimately pay-out.
We have created a streamlined process: You fill in the mandate and send us some basic accounting information about your business. We analyse your case and inform you whether we believe your insurer is more likely to pay out your BI claim or not. You will then have to decide if you wish to proceed with the case.
The process is simple however the computations and calculations that drive it are not. We use qualified loss adjusters and forensic accountants to look at your specific business and apply the right model and variables based on what your business is doing. we then present that to your insurer for acceptance in the format that they will understand and respond to.
At this point there is no benefit to engage the legal team, the precedent has been accepted by the supreme court on specific rulings. Lawyers, Barristers and Solicitors are experts in legal terminology, but not necessarily in financial transactions and reporting.
You don’t need legal representation at this juncture. You may do further down the line in case your insurer is either reluctant or refusing to pay a valid claim. At this point you need to lodge your valid claim in a timely fashion and the correct format to reduce the likelihood of needing to engage expensive legal representation.
An insurer can refuse to pay if a policyholder has not honestly answered all questions on a proposal form or confirmed changes affecting their legal/ financial history at the renewal of the policy or an alteration in the risk proposed. Also, following a claim, the policyholder must demonstrate that the policy wording should apply and the eventual claim presentation is not fraudulent.
