The figure of the loss adjuster is key in the world of insurance, especially in home insurance policies. In our day-to-day work, we have observed that their function generates many doubts among insurance users and consumers, 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 loss adjuster as follows:
“who rule on the causes of the incident, the valuation of damage and the other circumstances influencing the determination of compensation deriving from an insurance contract and make the proposal for the net amount of the indemnity”.”
When an expert is called in, the first thing he or she 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 taken out, etc. For example: if a home insurance is declared as a flat 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 reduces, logically, the compensation). For this reason, at the brokerage firm we always advise on the importance of a correct valuation of assets in our home.
The vast majority of the experts are not on the company's payroll. It is precisely for this reason that we talk about their objectivity. In the past, it was more common for insurers 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 will be called for these two reasons:
- Doubts about the coverage of the claim: when the company's claims adjuster is not sure whether 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 surveyor.
Although we see the importance of the loss adjuster, his or her “expert report” will be reviewed by the insurance company who ultimately decides whether or not to cover the claim and assess the damage.
If the insured does not agree, what do you do?
The law provides for several options in such cases: the parties appoint an expert and, if still no agreement is reached, a third expert is assigned the possibility to settle the matter.
In practice, however, this is rare. It is our duty as Insurance Brokerage to defend our policyholders. For this reason, pressure is put on the company to achieve its objective:
- Increase compensation: for example, it is common in damage to refrigerated goods, in the event of a blackout
- Refuting the company's refusal, when the insured is right: when faced with electrical damage, we usually ask for a report from a technician to support our insured's version.
In short, the loss adjuster plays an essential role in the resolution of claims in which he or she is involved. Thanks to our Claims Department and our great experience and volume of clients, we have a good relationship with them, which translates into better treatment in the face of resolutions. It has nothing to do with a private client putting pressure on the company, as opposed to a brokerage with more than 4,000 clients behind it.
If you want to enjoy these advantages, don't hesitate, and take out your home insurance with us. Not only will you get the best after-sales service, but we will also help you choose the policy that best suits your needs in terms of price and cover.
