What Is a Claim Agent?

S. McCumber

A claim agent — or claims adjuster — is an insurance professional who determines the extent of a monetary loss resulting from an accident and the amount the insurance company will pay to indemnify the injured party. The agent investigates such losses to determine which party is at fault and whether the insurance company has a responsibility to make any payments. Negotiating the amount paid is also part of the agent's duties. There are several areas of specialty for claims agents, from commercial lines adjusting to life and health adjusting.

A claim agent reviews insurance claims.
A claim agent reviews insurance claims.

Most claims adjusters deal with property or bodily injury liability claims. Property claims occur when property protected by an insurance policy is damaged as a result of something such as a fire or severe weather. Liability claims occur when someone is injured or something is damaged and an insured person is to blame. A large part of the job of a claim agent is to investigate claims and determine if the loss is the result of something covered by the insurance policy and if the loss is the result of actions taken by the insured party.

Claims agents may settle claims related to workers' compensation injuries.
Claims agents may settle claims related to workers' compensation injuries.

The claim agent will document the facts of an accident by taking pictures, recording statements and making measurements of things such as tire marks. The agent will also examine estimates to repair or replace damaged property and determine whether the estimates are within normal ranges. An adjuster often will need to examine medical bills submitted by an injured party.

Claim agents may deal with personal injuries resulting from a vehicle accident.
Claim agents may deal with personal injuries resulting from a vehicle accident.

There are several types of claims adjusters. Commercial lines adjusters deal with property damage and liability claims of businesses. A personal lines claim agent handles claims against auto and home insurance. Life and health adjusters process death, disability and medical claims.

Commercial lines adjusters settle claims for such things as damage to office buildings, commercial vehicles and equipment or business machines. They also settle claims for damages such as injuries suffered by someone while on an insured property or damage to someone else’s property caused by employees of an insured business. Commercial lines adjusters may also settle claims related to workers' compensation injuries.

A personal lines claim agent deals largely with automobile claims. Many auto claims involve accidents between vehicles; the claim agent settles claims for damage to the insured vehicle and, potentially, for injury to the other party or damage to the other party’s vehicle. Most homeowner claims involve damage to a home or personal property from perils such as lightning or fire. A homeowner policy also covers liability for such events as a pet injuring someone or the homeowner accidentally damaging someone else’s property.

A lesser known claim agent is the life and health adjuster. This type of claim agent deals mostly with claims against life insurance and disability policies. In the case of a life policy, the adjuster issues settlements based on death certificates and medical records. For disability claims, the adjuster determines eligibility for benefits based on doctors’ statements and medical records.

A personal lines claims agent handles claims against home insurance.
A personal lines claims agent handles claims against home insurance.

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