Who are the people involved in your property insurance claim?
You may hear titles for a lot of people referenced in connection with your homeowners insurance claim in Florida. Who are they?
VIP Adjusting obviously recommends that you hire an experienced public adjuster to assist you in pursuing your claim for damage to your home so that the process can be explained to you all along, but in the event you haven't done that, it's important to know who all of the people associated with your insurance claim are.
As complicated as the insurance claim process can be, it can easily become confusing who is who, and what each person can (and cannot) do for you.
Desk Adjuster
We'll start with perhaps the most important person, the "desk adjuster." The insurance company's desk adjuster is the individual assigned to review your insurance claim in-house, including all the photographs, documents, measurements, estimates (both from the independent adjuster and your public adjuster or general contractor). This person usually has not been to the property and works in an office, exclusively reviewing claims.
The desk adjuster might also be referred to as the "inside adjuster" because they're the person at the insurance company who reviews the claim and makes a recommendation on whether to extend coverage for a claim, and how much to pay.
The desk adjuster often is in charge of editing (read: reducing) the estimate prepared by the independent adjuster according to internal adjusting standards.
The person assigned as the desk adjuster usually also has final authority to settle your claim in-full, subject to internal standards, of course. Sometimes separate authority is needed for claims over certain amounts.
Field Adjuster
The field adjuster is the individual who actually comes to your home and inspects the damages. This person may or may not be a direct employee of the insurance company, and their motives may not always be known.
The field adjuster is in charge of taking photographs, measurements, and preparing an estimate. As previously mentioned, the field adjuster's estimate may not be the amount of the payment, because it is subject to review and modification by the desk adjuster.
Field adjusters may say things at the property that bind the insurance company. Statements that they're accepting coverage or will pay for certain items are binding on the insurance company, as these individuals have what's referred to as "apparent authority" even if the insurance company tries to claim they have no authority. This is another reason having a public adjuster present at these inspections can be in your favor, and this may become a very contentious subject if the claim requires a lawsuit at a later date.
Independent Adjuster
An independent adjuster is a field adjuster, but they usually aren't a direct employee of the insurance company. Independent adjusters have a certain license in Florida that allows them to work for insurance companies adjusting claims. They may work for themselves, or they may work for a third party adjusting company. They may only handle claims for one insurance company, or may work for several insurance companies.
Since the independent adjuster's financial interests aren't always known, it's not always possible to know how happy they want to keep your insurance company if they appreciate their paycheck. Yet another reason to have an experienced public adjuster in your corner looking out for your best interests and protecting the value of your claim.
Claim Examiner
Claim examiner is another name for the desk adjuster.
Ready for us to blow your mind though? Sometimes the people involved in your claim can have multiple roles and these words can be used interchangeably. Sometimes, the desk adjuster/claim examiner can be one in the same as the independent adjuster/field adjuster.
Third Party Administrator (TPA)
A third party administrator as it pertains to a homeowners insurance company in Florida is an outsourced claims handling operation. Some insurance companies don't have their own in-house claims departments. Certain Underwriters at Lloyd's of London is one such insurance company (technically, Lloyd's isn't an insurance company but a collection of underwriters, but that's another story). Since Lloyd's doesn't have their own claims department, you would report your claim to your agent, who would follow some procedure internal to whichever underwriter holds your insurance policy, and that underwriter would outsource the roles of the claim examiner/desk adjuster and independent adjuster/field adjuster to a third party claim company.
Other times, third party administrators are used by insurance companies who do have in-house claims staff, but who either have more claims than they can handle (like in the aftermath of a hurricane or other natural disaster), or may use a TPA when reviewing a dispute to try to reasonably resolve the claim.
Claim Representative
This is a catch-all term and can refer to any one of the terms so far above. This term is often used by insurance companies who like to send out unsigned letters, usually insignificant, like acknowledging a claim, or acknowledging receipt of a communication related to a claim. Other insurance companies use this term as a cowardly way to send out boilerplate document requests, or to make a letter impossible to respond to.
Customer Service Representative
This is another catch-all term and could be used like Claim Representative above, but is more often just a call center employee who can give you basic information about your claim but has no authority to discuss the merits of your claim.
These people are sometimes used to placate homeowners who call a lot to prevent them from wasting the time of people who actually move the claims forward, and other times these people are used to frustrate claimants and prevent them from speaking to the people who are handling the claim.
"Manager"
Sometimes insurance companies will use the term "manager" to make it seem like they are set up like other customer service industries. 99% of the time that is not the case.
You aren't calling AT&T or Comcast when you call your insurance company. You can't ask to speak to "the manager" when you don't like your payment or don't approve of the decisions, behavior, or professionalism of the desk adjuster/claims examiner, but this person usually doesn't have any authority to overrule the desk adjuster or claims examiner because that's the person in charge of your claim. If you speak to a "manager" you're just being strung along.
We put "manager" in quotation marks because there actually are managers but they're usually behind-the-curtain type folks whose approval is required for claims over certain values. You'll never speak to this person.
Litigation Manager
A litigation manager for an insurance company is the person assigned by the insurance company to represent them as their face if you have to sue to overturn a denied homeowners insurance claim or to challenge a dispute in scope or pricing for a claim. This person is usually very experienced in litigation and often knows what they're doing. Sometimes this person is even an attorney.
You might meet this person if you attend the deposition of the insurance company's corporate representative in connection with litigation, or if you attend a mediation or trial.
Appraiser
An appraiser is an individual, usually required to have some sort of competency, to represent an insured or insurer in the appraisal process to resolve a dispute over the amount of a homeowners insurance claim. An appraiser advocates for the party who assigned them, either homeowner or insurance company, but also works to try to reach an agreeable resolution for the claim.
Umpire
An umpire is a third-party neutral in the appraisal process. This person is unbiased and if the insurance company and homeowner's appraisers can't reach a resolution on their own, he or she would be available to break the tie by either deciding in one of the two appraisers favor, or somewhere in between. An umpire is a bit like an arbitrator.
If you’ve found yourself handling your own claim with a rotating cast of characters and feel like you’ve been given the run around, call VIP Adjusting today to speak to one of our public adjusters for a free claim review and consultation.
Public Adjuster vs. Independent Adjuster: What’s the difference?
How does a Public Adjuster compare to an Independent Adjuster?
These terms are definitely confusing, and we want to shed a little bit more light on what the differences between these types of insurance adjusters are, each type of insurance adjusters’ duties, and who they work for. Knowing the difference can make a huge impact on the final result of your insurance claim.
Aaron Fessia, Public Adjuster Inspecting Roof
Public Adjuster vs. Independent Adjuster
Public adjusters are licensed insurance adjusters that represent the general public, homeowners, business owners, and insureds when they’ve had property damage or other direct physical loss to their home or business. Independent adjusters are also licensed insurance adjusters, and have similar qualifications to public adjusters, but they work for and on behalf of the insurance company.
VIP Adjusting is a public adjusting company operating in the Treasure Coast, representing the homeowners and business owners of St Lucie County, Martin County, Indian River County and the surrounding areas. We fight for you and act as advocates for your claim against the insurance company.
Public Adjuster defined
Public adjusters are sometimes also referred to as private adjusters, public insurance adjusters, or private insurance adjusters. They might also be called a “PA.” Public adjusters are licensed and regulated by the state of Florida through the Department of Financial Services and overseen by Florida’s Chief Financial Officer.
The term public adjuster is defined by Florida Statute 626.854 as any person, except a duly licensed attorney at law who, for money, commission, or any other thing of value, prepares, completes, or files an insurance claim form for an insured, or acts on behalf of or aids an insured in negotiating or effecting the settlement of a claim for loss or damage.
A public adjuster is also any person who, for money, commission, or any other thing of value solicits, investigates, or adjusts such claims on behalf of a public adjuster. Other individuals may assist a public adjuster in their duties, and other professions, such as general contractors may perform duties that are typically associated with their license (like preparing estimates). General contractors cannot, however, negotiate with the insurance company on an insured’s behalf.
Attorneys may act as public adjusters but are exempt from licensure
Attorneys are exempt from the licensing requirement because they are already qualified to evaluate Insurance contracts and negotiate settlements by nature of their bar license. An attorney who would like to obtain a public adjuster license must also go through the requirements and testing from the state of Florida. VIP Adjusting’s founder is both an attorney who is a member of the Florida bar, as well as a licensed public adjuster.
Public Adjusting engages the Public Trust
Because public adjusters work for homeowners and other citizens of the general public, public adjusting engages the public trust. That means a duty must be exercised where the interest of the claimant is fairly and honestly put above the public adjusters own interests.
Public adjusters in Florida are held to very high standards, including multiple different required codes of ethics. One code of ethics is for all adjusters in Florida under Florida Administrative Code 69B-220.201. Public adjusters are also governed by Florida Administrative Code 69B-220.201(4)(5).
The public adjusters at VIP Adjusting are also members of the Windstorm Insurance Network and have been certified as appraisers and umpires, adding additional codes of ethics to which they have agreed to be bound above and beyond the ordinary codes of ethics.
Public Adjusters work on behalf of the homeowner. Always!
Public adjusters fight for you! Their duty is to advocate for you and your claim. The purpose of insurance is to put you whole after a loss, subject to a deductible. Your insurance company is supposed to be restoring you to pre-loss condition, and your public adjuster’s job is to make sure that an insured gets paid fairly for their claim and that the insurance company is not causing unreasonable delays or taking advantage of the insured.
Most public adjusters charge a percentage of recovery as a fee. Studies conducted by the state of Florida have shown that the average difference in payment between a homeowner making a claim on their own and a homeowner who has retained a public adjuster, more than makes up for the cost of paying a public adjuster. That figure is based only on the average dollar value of the claim without accounting for delays, denials, or other missteps related to a homeowners inexperience.
Independent Adjusters work for insurance companies
What a misnomer, right? You read that right, though. Independent adjusters are licensed and governed by the state of Florida, similar to public adjusters, but their license does not allow them to represent homeowners or insureds. They work FOR the insurance company.
Independent adjusters either represent insurance companies directly, or work for third party adjusting companies that are retained by insurance companies on a job-by-job basis.
Despite the fact that an independent adjuster’s salary is paid by the insurance company, many homeowners are lulled into a false sense of security because this adjuster interacts with them and may even seem very friendly. Independent adjusters may also make certain promises while walking through the insured’s home even though he doesn’t have the final say as to what gets paid. Homeowners may be confused thinking that because the adjuster is called “independent,” then his evaluation should be independent. This is not correct.
When VIP Adjusting handles a supplemental claim for a homeowner, we often hear that homeowner refer to the prior evaluation by an independent adjuster as the report prepared by “my adjuster.” Remember, an independent adjuster works for the insurance company, NOT for the homeowner.
Even when an independent adjuster is following all ethical guidelines, the continuation of his employment still hinges on the insurance company paying as little as possible for your claim, and even when an independent adjuster is well meaning, there’s a representative inside the insurance company that often reviews and modifies that estimate before it’s approved for payment.
What to do if you have damage
If you’ve suffered loss or damage at your home, it’s best to get in touch with a public adjuster like VIP Adjusting as early on in the process as possible. In addition to having experienced professionals working for you to make sure you’re paid fairly for your claim, a public adjuster also works to prevent delays in the claim, and protect you from the potential landmines of doing it yourself.
VIP Adjusting always fights for you!
You might also be interested in:
Learning more about VIP Adjusting’s background
Why you should hire a public adjuster
Learn more about different types of damages that can result in insurance claims