The figure of the loss adjuster is key in the insurance world, especially in home insurance policies. In our day-to-day work we have been observing that his function generates many doubts to the users and consumers of insurance, who are all of us. We are going to clarify their functions and competences.
Main functions and “objectivity” of experts
Law 20/2015, which regulates insurers, describes the functions of the appraiser as:
“those who give an opinion on the causes of the loss, the valuation of the damage and the other circumstances that influence the determination of the indemnity deriving from an insurance contract and formulate the proposal of the liquid amount of the indemnity”.
When an expert is called in, the first thing he does is to compare what you see at the scene of the claim with what is stated in the policyThe following are some examples: risk characteristics, sums insured contracted, etc. For example: if a home insurance is declared as an apartment in the policy and, however, it is a detached house, it will greatly influence the proposed valuation of compensation (a rule will be applied that decreases, logically, the compensation). Therefore, from the brokerage we always advise on the importance of a correct valuation of the property in our home.
Most of the experts are not on the company’s payroll. Precisely for this reason we talk about their objectivity. In the past, it was more common for insurance companies to have a staff of loss adjusters who were always used.
When does a loss adjuster intervene in a claim?
In practice, in the main, an expert witness will be called for these two reasons:
- Doubts about the coverage of the claim: when the company’s claims adjuster is not sure if the claim is covered by the policy, an expert is called in to prepare a report.
- A claim exceeding a certain amount: from 300-3,000 €, depending on the company. The insurers give a maximum value of autonomy in which the trades can repair without the “OK” of the expert.
Although we see the importance of the loss adjuster, his “expert report” will be reviewed by the insurance company who is the one who ultimately decides whether or not to cover the claim and assess the damages.
If the insured does not agree, what is done?
The Law establishes several options in such cases: that the parties appoint an expert and, if still no agreement is reached, a third expert is assigned the possibility of resolving the matter.
However, in practice this is infrequent. It is our duty as an insurance broker to defend our policyholders. For this reason, pressure is put on the company to achieve the objective set:
- Increasing compensation: for example, it is frequent in the case of damage to refrigerated goods in the event of a power outage.
- To refute the company’s refusal, when the insured is right: in the event of electrical damage, we usually ask for a report from a technician to support our insured’s version.
In short, the loss adjuster has an essential role in the resolution of claims in which they intervene. Thanks to our Claims Department and our great experience and volume of clients, we have a good relationship with them, which translates into a better treatment before the resolutions. It has nothing to do that an individual client pressures the company, than a brokerage with more than 4,000 clients behind.
If you want to enjoy these advantages, do not hesitate and contract your home insurance with us. Not only will you have a better after-sales service, but we will also help you choose the policy that best suits your needs, in terms of price and coverage.
