What Does an Insurance Adjuster Do?

In a city as busy and densely populated as New York, accidents can occur without warning. From taxi collisions to slip-and-fall incidents on crowded sidewalks, personal injury cases are a common reality. Dealing with the aftermath goes beyond addressing physical recovery. It involves facing insurance claims and legal requirements that are distinct to New York’s personal injury laws. Insurance adjusters play a key role in this process, as they are responsible for investigating claims, assessing damages, and negotiating settlements in line with state regulations.

Having the support of a Brooklyn personal injury attorney can significantly impact your case. At Kucher Law Group, our dedicated team of attorneys provides strong representation and skilled guidance throughout the claims process, including negotiations with insurance adjusters. Contact us at (929) 563-6780 to discuss your case and protect your right to fair compensation.

What Is an Insurance Adjuster?

An insurance adjuster is a professional responsible for investigating and managing insurance claims. Insurance adjusters play a critical role in handling claims and determining the compensation owed after accidents. 

For personal injury cases in New York, these individuals act as the decision-makers for insurance companies, evaluating claims and negotiating settlements. Their primary focus is to protect the interests of the insurer while resolving claims efficiently.

Their duties include assessing the details of an accident, gathering evidence, and determining the value of the claim.

• They review documentation, such as medical records and police reports, to verify the extent of damages and injuries.
• They may visit the accident scene, inspect property damage, or interview witnesses to gain a full picture of the incident.
• Adjusters calculate settlement amounts based on the available evidence and the terms of the insurance policy.

In New York personal injury cases, insurance adjusters are key figures in the claims process, as they are responsible for negotiating with injured parties or their attorneys.

Why Are Insurance Adjusters Involved in Personal Injury Claims?

Insurance adjusters are involved in personal injury claims to evaluate the validity of the claim and determine the amount of compensation the insurance company should pay. Their role is essential in ensuring that the insurer fulfills its contractual obligations while avoiding overpayment.

For personal injury cases in New York, adjusters analyze multiple aspects of the incident:

• Fault and Liability: Adjusters examine the evidence to determine who was at fault for the accident. New York follows a comparative negligence rule, meaning your compensation could be reduced if you share partial responsibility for the accident.
• Extent of Injuries: They scrutinize medical records and treatment history to confirm the severity of injuries and the related costs.
• Applicable Coverage: Adjusters verify the policy limits and conditions to establish how much the insurer is obligated to pay.

Their involvement is a standard part of the claims process, as they act on behalf of the insurer to resolve cases efficiently while minimizing financial losses.

In New York, adjusters must:

• Acknowledge receipt of a claim within 15 business days.
• Commence an investigation promptly to determine liability and damages.
• Provide a fair and equitable settlement offer based on the findings.

Their role is crucial in maintaining the integrity of the insurance system and protecting the interests of all parties involved.

Types of Insurance Adjusters 

In New York personal injury law, managing insurance claims involves a range of professionals, each with distinct responsibilities and roles. These adjusters work within the framework of state laws and regulations to handle claims effectively.

Staff Adjusters

Staff adjusters are full-time employees of insurance companies, representing the insurer’s interests throughout the claims process. They investigate claims, determine policy coverage, and negotiate settlements in accordance with company policies and New York’s legal requirements. Familiarity with the state’s personal injury laws, such as statutes of limitations and the no-fault insurance system, is essential for these adjusters as they aim to minimize the insurer’s liability while complying with legal standards.

Independent Adjusters

Independent adjusters operate as contractors rather than employees of a specific insurance company. Often hired to manage overflow claims or work in areas without local staff, they may handle claims for multiple insurers. In New York, independent adjusters are frequently involved after large-scale events, such as natural disasters or major accidents, where claims volume is high. Like staff adjusters, they must adhere to New York’s personal injury laws and regulations throughout the claims handling process.

Public Adjusters

Public adjusters differ from other types because they are hired directly by policyholders rather than insurance companies. Their role is to advocate for claimants, helping them navigate the claims process and secure fair settlements. This is particularly valuable in New York, where insurance laws and processes can be complex for individuals unfamiliar with legal or insurance terminology. Working on a contingency fee basis, public adjusters align their interests with those of the policyholder, striving to maximize settlement amounts within the boundaries of state law.

How Insurance Adjusters Investigate Claims

In New York personal injury claims, insurance adjusters conduct thorough investigations to assess the validity and value of each claim. Their evaluation process involves collecting and analyzing various forms of evidence to determine liability and appropriate compensation.

Gathering Evidence: What Insurance Adjusters Look For

Insurance adjusters meticulously collect evidence to build a comprehensive understanding of the incident. Their focus includes:

• Photographs and Videos: Visual documentation of the accident scene, property damage, and injuries helps establish the circumstances and severity of the incident.
• Accident Scene Details: Information such as skid marks, debris, traffic signals, and road conditions provides context to the event.
• Surveillance Footage: Video recordings from nearby cameras can offer objective perspectives on the accident.
• Repair Estimates: Assessments of property damage costs contribute to determining the financial impact.

In New York, the credibility and relevance of the gathered evidence are crucial, as they directly influence the outcome of the claim.

Interviewing Witnesses and Reviewing Police Reports

Speaking with witnesses and reviewing police reports are important aspects of the investigation process. Witness accounts and official records often provide unbiased information that helps adjusters make informed decisions.

• Interviewing Witnesses: Adjusters may contact individuals who saw the accident to gain additional perspectives. Witnesses can clarify details such as the sequence of events, the actions of each party, and environmental factors.
• Police Reports: These reports are critical in personal injury cases in New York. They often include key details such as:
  • The names and contact information of the parties involved.
  • The officer’s observations regarding fault or traffic violations.
  • A summary of statements from drivers or witnesses at the scene.

Police reports carry significant weight in personal injury claims because they are regarded as an objective account of the incident. Adjusters analyze these documents carefully to support their findings.

Evaluating Medical Records and Injury Documentation

Medical documentation is critical in substantiating injury claims and calculating appropriate compensation.

• Medical Records: Detailed reports from healthcare providers outline the nature and extent of injuries, treatments administered, and prognosis.
• Treatment Plans: Documentation of prescribed therapies and rehabilitation efforts demonstrates the claimant’s commitment to recovery.
• Medical Bills: Financial records of medical expenses incurred provide a basis for economic damage calculations.

In New York, consistent and thorough medical documentation strengthens the credibility of the claim and supports the pursuit of fair compensation.

By systematically gathering and analyzing these elements, insurance adjusters aim to reach an informed conclusion regarding the claim’s validity and value within the framework of New York personal injury law.

Common Tactics Insurance Adjusters Use to Minimize Payouts

In New York personal injury claims, insurance adjusters may employ various tactics to reduce settlement payouts. Recognizing these strategies is crucial for claimants to protect their rights and pursue fair compensation.

Delaying Claims to Pressure Victims

Insurance adjusters might intentionally slow down the claims process to create financial strain on the claimant. This tactic can lead victims to accept lower settlements out of necessity. Such delays may include:

• Requesting unnecessary documentation repeatedly
• Failing to respond to communications in a timely manner
• Changing adjusters mid-process, causing further delays

While there are regulations requiring insurers to handle claims promptly, enforcement can be inconsistent. Claimants should document all interactions and consider seeking legal assistance if unreasonable delays occur.

Misinterpreting or Downplaying Medical Records

Adjusters may scrutinize medical records to find inconsistencies or pre-existing conditions that can be used to minimize the claim’s value. Common approaches include:

• Highlighting gaps in treatment to suggest that injuries are not severe
• Attributing injuries to pre-existing conditions rather than the incident
• Questioning the necessity of certain medical treatments

Such tactics can undermine the legitimacy of a claim. It’s important for claimants to maintain thorough medical documentation and consult with healthcare providers to clarify the extent of injuries related to the incident.

Offering Lowball Settlements Early in the Process

Soon after an incident, adjusters might present settlement offers that are significantly lower than the claim’s actual value. These offers are often made before the full extent of injuries and damages is known. Indicators of such tactics include:

• Pressure to accept the offer quickly
• Lack of a detailed explanation for the settlement amount
• Discouragement from seeking legal counsel

Accepting early lowball offers can result in inadequate compensation for ongoing medical expenses and other damages. Claimants should carefully evaluate any settlement proposal and consider consulting with a personal injury attorney to assess the offer’s fairness. Awareness of these common tactics empowers claimants to make informed decisions and seek appropriate compensation for their injuries and losses.

What Happens When You Disagree With an Insurance Adjuster?

Disagreements with insurance adjusters are not uncommon in New York personal injury cases. When a settlement offer does not align with the damages incurred, claimants have several avenues to pursue a more equitable resolution.

Steps to Take if You Think the Settlement Offer Is Unfair

When presented with a settlement offer that seems inadequate, consider the following actions:

• Request a Detailed Breakdown: Politely ask the adjuster for a comprehensive explanation of how they arrived at the settlement figure. This can reveal any omissions or miscalculations.
• Gather Supporting Evidence: Compile all relevant documentation, including medical records, receipts, and any correspondence that supports the extent of your injuries and associated costs.
• Submit a Formal Counteroffer: Present a well-documented counteroffer that reflects the actual damages and losses suffered. Include all supporting evidence to substantiate your claim.
• File a Complaint with the New York State Department of Financial Services: If you believe the adjuster’s conduct violates state regulations, you can file an official complaint. This step can prompt a review of the adjuster’s practices.

Taking these steps demonstrates a proactive approach to securing a fair settlement and can often lead to more favorable outcomes.

Step	Description	Purpose/Outcome
Request a Detailed Breakdown	Ask the adjuster for an explanation of how the settlement amount was calculated	Identifies errors, omissions, or low valuations
Gather Supporting Evidence	Collect medical records, receipts, and related documentation	Strengthens your position with factual proof of your losses
Submit a Formal Counteroffer	Provide a revised settlement amount with documentation	Advocates for a fairer compensation offer
File a Complaint with NY DFS	Report the adjuster to the New York State Department of Financial Services if misconduct is suspected	May lead to a review or corrective action by regulatory authorities

The Role of Your Personal Injury Attorney in Negotiations

Engaging a personal injury attorney can significantly impact the negotiation process. An attorney can:

• Evaluate the Strength of Your Case: Assess the merits of your claim and determine the appropriate compensation based on New York laws.
• Develop a Strategic Negotiation Plan: Formulate a plan that considers all aspects of your case to effectively negotiate with the insurance company.
• Handle Communications: Manage all interactions with the insurance adjuster, reducing the risk of misstatements or admissions that could harm your claim.
• Advocate on Your Behalf: Represent your interests vigorously to achieve a settlement that accurately reflects your damages and losses.

An attorney’s involvement often leads to more substantial settlement offers and can alleviate the stress associated with the claims process.

When to Consider Filing a Lawsuit

If negotiations fail to yield a satisfactory settlement, filing a lawsuit may be the next appropriate step. Consider this option when:

• The Statute of Limitations Is Approaching: In New York, personal injury claims must generally be filed within three years of the incident. Delaying legal action could forfeit your right to compensation.
• Settlement Offers Remain Inadequate: If the insurance company persistently offers settlements that do not cover your documented damages, litigation may be necessary.
• Liability Is Disputed: When the insurance company contests fault, a court may need to determine liability based on the evidence presented.

Filing a lawsuit can compel the insurance company to reassess its position and may lead to a more favorable settlement or a court-awarded judgment.

Disagreeing with an insurance adjuster’s settlement offer in New York requires a methodical approach. Taking deliberate steps, engaging legal representation, and considering litigation when necessary can help claimants pursue the compensation they rightfully deserve.

What Happens When You Disagree With an Insurance Adjuster?

When an insurance adjuster offers a settlement that seems unfair or unreasonable, you are not obligated to accept it. Disagreements with adjusters often arise when the compensation offered does not fully cover the financial and emotional impact of an accident. 

Steps to Take if You Think the Settlement Offer Is Unfair

If you believe the settlement offer does not reflect the true value of your claim, there are steps you can take to protect your rights and seek proper compensation.

• Review the Offer Carefully: Assess whether the offer accounts for all damages, including medical expenses, lost wages, and pain and suffering. Compare it with the documentation and evidence you’ve provided.
• Gather Additional Evidence: If the adjuster disputes certain aspects of your claim, consider providing more supporting evidence, such as updated medical records, additional witness statements, or expert opinions.
• Respond in Writing: Clearly explain why you believe the offer is insufficient and provide a counteroffer. Include evidence to support your position and highlight the full extent of your losses.
• Be Patient: Avoid rushing to accept a low offer. Negotiations often take time, and persistence can lead to a better outcome.

Taking these steps can help strengthen your position and demonstrate the legitimacy of your claim.

How Your Personal Injury Attorney Can Help in Negotiations

When disputes with an insurance adjuster arise, a personal injury attorney can play a critical role in achieving a fair settlement. Their involvement can level the playing field, as adjusters are trained to protect the interests of the insurer.

• Evaluating the Claim’s True Value: Attorneys can calculate the full extent of your damages, including future medical costs and non-economic losses like pain and suffering.
• Communicating with Adjusters: Attorneys handle negotiations on your behalf, using their knowledge of New York personal injury laws to counter the adjuster’s arguments or tactics.
• Strengthening Your Case: They can gather additional evidence, consult with medical experts, or use case precedents to demonstrate the validity of your claim.
• Protecting Against Pressure Tactics: Adjusters may use strategies to minimize payouts, but an attorney can advocate for your rights and keep the process focused on achieving fair compensation.

In many cases, an attorney’s involvement can lead to a more equitable outcome, as they are well-versed in the claims process and negotiation strategies.

When to Consider Filing a Lawsuit

If negotiations fail to produce a fair settlement, filing a lawsuit may be the next step. This option is often considered when the adjuster refuses to offer reasonable compensation or disputes crucial aspects of the claim.

• Statute of Limitations: In New York, personal injury lawsuits must generally be filed within three years of the accident. Acting within this timeframe is essential to preserve your legal rights.
• Pre-Trial Negotiations: Filing a lawsuit does not always mean the case will go to trial. Many cases settle during pre-trial negotiations or through mediation once legal action is initiated.
• Presenting Your Case in Court: If the insurer remains unwilling to settle, your attorney can present your case before a judge or jury. This process allows for a full review of the evidence and often results in a more favorable outcome for the victim.

While filing a lawsuit may seem daunting, it can serve as an effective tool for holding the insurance company accountable and securing the compensation you deserve.

Why Hiring a Personal Injury Attorney Is Crucial When Dealing With Adjusters

Engaging a personal injury attorney is a critical step when dealing with insurance adjusters, as it helps to protect your legal rights and ensures that your claim is handled appropriately. Insurance adjusters represent the interests of the insurance company and often employ strategies to minimize the value of claims. An attorney acts as your advocate, managing all communication with the adjuster to avoid any misstatements or misinterpretations that could negatively impact your case. They also conduct a thorough evaluation of your damages, including medical expenses, lost wages, and non-economic losses, to present a comprehensive and accurate claim.

Additionally, an attorney brings a professional approach to negotiations, countering low settlement offers and leveraging evidence and applicable laws to pursue fair compensation. If the adjuster engages in tactics such as delays or unwarranted claim denials, an attorney can escalate the matter appropriately, including initiating legal action if necessary. With an attorney handling the claims process, you can focus on your recovery while knowing your case is being managed with precision and diligence.

Taking the Next Step Toward Fair Compensation

Recovering from a personal injury in New York involves more than healing from physical harm—it requires addressing the legal and financial challenges that follow. Successfully handling these matters often means dealing with insurance adjusters, gathering evidence, and negotiating for fair compensation, all while adhering to the state’s personal injury laws. Having knowledgeable legal representation can make a meaningful difference, giving you the confidence to focus on your recovery while your rights are protected.

If you or a loved one has been injured in an accident, taking timely action is crucial. The team at Kucher Law Group is prepared to guide you through the claims process and advocate for the compensation you deserve.

Contact us today at (929) 563-6780 to discuss your case and take the first step toward securing your future.

from Kucher Law https://www.rrklawgroup.com/what-does-an-insurance-adjuster-do/