A SHORT VISIT TO THE ADJUSTMENT OF CLAIMS.

          Adjusting insurance claims sometimes seems like the opposite of what Mark Twain said about the weather:  'Everybody is doing something about it, but nobody talks about it.'  This article will focus on that issue.

          Claims are adjusted by an adjuster who is someone in the employ of the insurance company, or specially retained by it for a given claim or set of claims.  An adjuster who is an employee on the payroll of the insurance company is called just that, an "adjuster" (or "claims representative," or whatever terminology the company uses to identify its adjusters).  A person who is specially retained for a given claim or set of claims is ordinarily referred to as an “independent adjuster" or IA.  See, e.g., Bray & Gillespie Management LLC v. Lexington Ins. Co., 527 F. Supp. 2d 1355, 1360 (M.D. Fla. 2007); Odom v. Armed Forces Ins., 2006 WL 2541599 *2 (S.D. Miss. Aug. 31, 2006);  Underwriters Subscribing to Lloyd's Ins. Cert. No. 80520 v. Magi, Inc., 790 F. Supp. 1043, 1046 (E.D. Wash. 1991).

        It is worth nothing here that adjusters and independent adjusters may or may not be on the same deference footing with the insurance company that retained their services; the deference given to independent adjusters may depend on the case and on the adjusters, managers or supervisors employed at the insurance company.  In the Magi case, the independent adjuster hired by the insurance company recommended that the claim be paid, which the insurance company in that case refused to do. The case ended in a judgment of coverage for the policyholder, together with prejudgment interest on the award.  Underwriters Subscribing to Lloyd's Ins. Cert. No. 80520 v. Magi, Inc., 790 F. Supp. 1043, 1046 (E.D. Wash. 1991).

        When certain requirements are met following a catastrophe in particular, the insurance company can perhaps rely on the hired services of adjusters who are not licensed to adjust claims in the given state or jurisdiction.  See, e.g., Cal. Ins. Code § 14022.5 (2005 Main Volume), entitled “Emergency situation; claims adjusted by nonlicensed adjuster; requirements; registration.”

 

To be continued ....

 

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