In the intricate world of insurance claims, the process doesn’t always follow a straightforward path. Sometimes, claims can escalate into legal disputes, leading to litigation. In such cases, the role of insurance adjusters becomes even more critical. This article delves into what adjusters do when a claim evolves into a legal challenge.

1. Preliminary Analysis and Documentation

Before litigation commences, adjusters conduct a thorough analysis of the claim’s merits. This involves:

  • Reviewing the initial claim assessment and any supporting documentation.
  • Re-interviewing claimants or witnesses, if necessary, to gather additional information.
  • Evaluating policy coverage to determine if the claim, or portions of it, is covered.

2. Legal Liaison

Adjusters serve as the primary bridge between the insurance company and legal teams:

  • They provide lawyers with all the necessary documentation, evidence, and insights related to the claim.
  • They work in tandem with legal counsel, providing expertise about the policy’s terms, conditions, and exclusions.

3. Continuous Evaluation

As the litigation process unfolds, new information can come to light:

  • Adjusters continuously assess the strength of the claim in light of new evidence or testimonies.
  • They may recommend settling outside of court if they believe it’s in the best interest of the insurer, especially if the costs of continuing litigation might exceed potential settlement amounts.

4. Expert Witnessing

In some cases, experienced adjusters might be called upon to serve as expert witnesses during trials:

  • They can provide insights on standard industry practices, policy interpretations, or the claims process.
  • Their testimonies can be vital in influencing the court’s understanding of the claim.

5. Settlement Negotiations

Even when a claim reaches the courtroom, it can still be settled out of court:

  • Adjusters often participate in settlement negotiations, bringing their understanding of the claim’s merits to the table.
  • Their primary goal is to achieve a resolution that’s financially prudent and in line with the insurance policy’s provisions.

6. Post-Litigation Analysis

After litigation concludes, adjusters often play a role in post-mortem evaluations:

  • They review the outcomes of the litigation, assessing what went well and where improvements can be made.
  • Their insights can influence future claim assessments and even policy adjustments.

Conclusion

The role of adjusters in the face of litigation is multifaceted and crucial to the insurance process. They’re not just claim evaluators but also crucial collaborators, liaisons, and, at times, the very face of the insurance company in a legal setting. Through their expertise, adaptability, and rigorous approach, adjusters ensure that even in the complex world of litigation, the interests of the insurance company and the essence of the policy are upheld.