Insurance Claims

• Application. The application is the written information, which contains the questions the insurance company wants to know from you regarding its potential risks.
• The Declaration Page. The declarations page is a written document which tells you the policyholder's name, a description and location of either the person or property which is insured, the amount of insurance policy limits, the deductibles and any potential endorsements that may limit or expand the insurance coverage.
• The Policy. The policy is a written booklet that contains the insurance agreement, including the definitions of the words used within the agreement, any conditions that may apply, exclusions and written endorsements that may limit or expand available insurance coverage, and typically the policy will set forth the duties and responsibilities of you and your insurance company.

Typically, the claims adjuster will make early contact with you in an attempt to gain that trust and control. The insurance company would rather deal with a layperson than an attorney. The insurance company knows that an experienced plaintiff’s attorney may substantially increase the value of the claim.

The claims adjuster normally will receive a first loss report form from an agent or an insured. This allows the adjuster to gather the names and numbers of the individuals involved so that contact can be made prior to the involvement of an attorney.

The claims adjuster will attempt to determine facts that are favorable to the insurance companies case and facts that may limit coverage or damages.

The insurance adjuster may request statements regarding the incident, including written statements and recorded statements. They may also request information regarding employment, school records, and medical records. Take caution in providing this information without contacting an experienced Plaintiff’s attorney.

The insurance adjuster will be expected by the insurance company to maintain a claims file. This file typically will contain the information related to the investigation of the claims adjuster. The adjuster may also be put on notice of certain liens, including those filed by hospitals, doctors, and other insurance companies.

The insurance adjuster will typically have a claim’s manual, which educates him or her regarding what it must do to resolve cases. Sometimes, insurance companies fail to accurately train an adjuster with regard to these manuals.