What does a loss adjuster do?

What’s a loss adjuster?

Loss adjusters are industry experts in the handling of insurance claims.

When you make a claim on your home insurance policy, your provider may send out a loss adjuster to visit your home.

Typically, a loss adjuster will be sent to investigate substantial insurance claims, such as those resulting from a major incident like a fire or flood.

It's their job to evaluate whether your policy provides cover for the damage or loss you've claimed for and if it does, the level of pay-out you should receive.

Who appoints a loss adjuster?

A loss adjuster is appointed and paid for by an insurance company to investigate a claim.

Loss adjusters are required to carry out their duties in an impartial manner and to adhere to rules set by the Financial Conduct Authority (FCA).

Your insurer might give the loss adjuster the complete authority to settle a claim on their behalf. Or they'll limit their role to that of providing recommendations and guidance on the claim.

What are loss adjusters looking for?

When a loss adjuster visits your home, typically, they'll look to establish:

• The cause of the incident from which your claim arises
• That the damage caused is covered by your insurance policy
• That the amount you are claiming for is fair and correct
• That you have adequate insurance in place to cover your losses
• That you have met all terms and conditions of your policy

What's the difference between a loss adjuster and a loss assessor

In general, a loss adjuster works for the insurance company, while a loss assessor works for the policyholder making a claim.

You can appoint a loss assessor if you are making a large insurance claim. They'll work on your behalf, guide you through the claims process and prepare your claim from start to finish.

They're usually paid a percentage of your total claim, so it’s in their best interest to secure you the maximum possible amount from your insurance company as a settlement.

The scope of their job can include:

• Organising emergency clean-up and repairs to your property and arranging emergency alternative accommodation, if necessary
• Assessing damage to your property and its contents and calculating your losses
• Preparing and presenting a report on the damages to your insurers
• Managing and negotiating your claim with your insurer and/or loss adjuster throughout
• Securing interim payments
• Liaising with your insurer to appoint specialist contractors to carry out ongoing repairs

As an alternative to a loss assessor, there’s also the option to appoint a chartered loss adjuster to work on your behalf on an insurance claim. You can find members of the Chartered Institute of Loss Adjusters (CILA) on their website.

Do I have to accept the loss adjuster’s offer?

If your insurance company’s loss adjuster agrees that some/ all of the loss or damage you're claiming for is covered by your policy, they'll accept your claim. They'll then prepare an offer of settlement to repair the damage, cover the cost of repairs, or replace items you’ve lost.

Your insurance policy settlement should aim to help put you back in the position you were in before the damage or loss occurred.

If you're unhappy with what you’re offered to settle your claim or feel that the pay-out is too low, you don’t have to accept it.

Take, as an example, that your loss adjuster has asked you to get quotes for building work to repair fire damage. You present the quotes but the loss adjuster feels the costs are too high. They might offer you a lower amount to cover the building work. In such circumstances, if you feel their offer is unfair and would leave you out of pocket or unable to get your repairs done to a satisfactory standard, you may choose not to accept this offer.

You can employ the services of a loss assessor (or your own loss adjuster) to help you negotiate a better deal. Or you can make a complaint to your insurer yourself.

In such cases, you should first speak with the loss adjuster and/or write to your insurer. If you aren’t happy with their reply, you can make a formal complaint using your insurer's official complaints process (details of how to do this will be on their website).

If you still aren’t satisfied with their reply, you can take your complaint to the Financial Ombudsman Service (FOS). It’s a free, independent service which will assess your circumstances in detail and aim to come up with a fair resolution.

The decision made by the FOS is binding on your insurer.

If you're unhappy with the decision of the FOS, you still have the option of taking the insurer to court. However, this may result in expensive legal fees.

Can a loss adjuster cause my claim to be rejected?

Yes, in some cases, a loss adjuster may decide to reject your claim.

Reasons for this can include:

• You made an error/s when giving information about your claim
• They dispute the cause of the damage
• You failed to comply with some of the policy’s terms and conditions
• You failed to tell your insurer about a change in your circumstances
• You didn’t follow the claims process properly
• Your policy’s exclusion clauses mean you can’t claim for what’s happened
• Lack of due care. For example if your home was burgled because you forgot to lock your front door
• Poor upkeep. Some insurers may refuse to pay out on a claim they feel has been caused because of failure to maintain your home in good condition. For instance, if pipes in your loft space burst in cold weather because they weren't lagged

The loss adjuster must always let you know the reason for rejecting your claim.

You can then check your policy and its wording thoroughly to see if you feel the reason for the failure of your claim holds up.

If you feel the loss adjuster is being unfair or is wrong, you can contest their decision.

Again, you can employ your own loss assessor or loss adjuster to independently assess your claim and help to fight your insurer’s decision.

Otherwise, you can follow the complaints process as detailed above.

How to make sure you get a fair claim settlement

• Call your insurer as soon as possible after the incident. Most companies have 24-hour emergency lines. In cases where claims are for a substantial amount, they may send out a loss adjuster to your home
• Read your insurance policy carefully so you know exactly what you’re entitled to claim for, before you liaise with the loss adjuster
• If you’re claiming for a significant amount, you may feel more confident in using the service of a loss assessor to help present and negotiate your claim 
• Take photographs and videos as evidence of the extent of the damage to your home and its contents
• Gather receipts for items that have been stolen or damaged in the incident
• Don’t get rid of damaged items until your insurance company or the loss adjuster tells you it’s okay to do so. They’ll probably want to see the items themselves to properly assess the damage