What a claims adjuster does when you file a claim

A claims adjuster is the person your insurance company assigns to investigate your claim, determine what happened, and decide how much the insurer will pay. When you file a claim after an accident, the adjuster becomes the main point of contact between you and the insurance company. They are employees of the insurer, not neutral third parties—their job is to protect the company's interests while following the terms of your policy.

The adjuster's core responsibilities are to verify the facts of the accident, inspect vehicle damage, review police reports, interview witnesses, and calculate the cost of repairs or replacement. They also check whether the claim falls within your coverage limits and whether any exclusions explore. In some cases, they may hire independent engineers or medical professionals to assess the damage or injury claims.

Understanding what adjusters do and how they work helps you prepare for their investigation and know what to expect at each stage. It also helps you recognize when an adjuster's decision seems wrong and when you have grounds to dispute it.

Key Takeaways

  • Claims adjusters are insurance company employees who investigate accidents, inspect damage, and determine the payout amount based on your policy terms.
  • An adjuster will request documents from you, inspect your vehicle, and may contact witnesses or obtain police reports without needing your permission.
  • Adjusters work for the insurance company, not for you, so their goal is to settle claims fairly but also to minimize payouts when the policy allows it.
  • You have the right to hire your own independent adjuster or appraiser if you disagree with the insurer's damage estimate.
  • The adjuster's written report and damage estimate become the basis for the settlement offer, so accuracy matters to your final payout.

How adjusters are assigned and what happens first

After you report a claim to your insurance company, a claims handler (sometimes called a claims representative) opens a file and assigns an adjuster. The assignment usually happens within one to three business days, depending on the insurer's workload and the claim's complexity. For minor claims, some insurers use a streamlined process where the handler may settle the claim without sending an adjuster to inspect the vehicle.

The adjuster will contact you to schedule an inspection. They may call, email, or send a letter with a date and time. You are not required to meet them at a specific time—you can ask to reschedule if the proposed time does not work. However, delaying the inspection can slow down your claim. The adjuster may also ask you to provide documents before the inspection: your policy, the police report (if one exists), photos you took at the scene, repair estimates, and receipts for any temporary repairs you made.

Some adjusters work for the insurance company directly; others work for a third-party adjusting firm that the insurer contracts with. Either way, they represent the insurer's interests. If you hire a contractor or body shop to assess the damage before the adjuster arrives, that estimate becomes part of the record and may influence the adjuster's own assessment.

What happens during the damage inspection

The adjuster will examine your vehicle in person, take photographs, measure damage, and document the condition of the car before and after the accident. They use this inspection to estimate the cost of repairs and to determine whether the vehicle is a total loss (meaning the cost to repair it exceeds a certain percentage of its pre-accident value, usually 70 to 80 percent depending on your state).

During the inspection, the adjuster may ask you detailed questions about how the accident occurred, the weather conditions, road conditions, and whether you sought medical treatment. They may also ask about the vehicle's maintenance history and any pre-existing damage. You should answer honestly but do not volunteer information beyond what they ask. Anything you say can be used in the adjuster's report.

The adjuster will also check whether the damage is consistent with the accident description you provided. If the damage pattern does not match your account, the adjuster may flag this in their report, which can affect the claim's outcome. If you believe the adjuster's inspection was incomplete or inaccurate, you can request a second inspection or hire an independent appraiser to perform your own assessment.

How adjusters calculate repair costs and total loss

After the inspection, the adjuster uses specialized software (such as Xactimate, CCC, or Mitchell) to estimate repair costs. These programs contain databases of labor rates, parts prices, and repair procedures for different vehicle makes and models. The adjuster enters the damage details, and the software generates a repair estimate. This estimate becomes the basis for the settlement offer.

For a total loss, the adjuster determines the vehicle's actual cash value (ACV)—what the car was worth when ready before the accident. They use resources like NADA Guides, Kelley Blue Book, or Manheim to look up comparable vehicles in your area. The ACV is not the price you paid for the car or what you owe on a loan; it is the market value at the time of loss. If you owe more on the car than the ACV, you may have a gap, and your gap insurance (if you carry it) would cover the difference.

Adjusters may also deduct a salvage value if the vehicle is a total loss. Salvage value is what the insurer can recover by selling the damaged vehicle to a salvage yard or parts recycler. The insurer subtracts this amount from the ACV before paying you. In some states, you have the right to keep the salvage and reduce the payout accordingly.

Disputes over damage estimates and repair costs

If you disagree with the adjuster's repair estimate, you have several options. First, obtain your own repair estimate from a body shop or independent appraiser. Many body shops will provide a written estimate at no cost. Compare the two estimates line by line—differences often come down to labor rates, parts choices (original manufacturer parts versus aftermarket), or whether certain repairs are necessary.

If the estimates differ significantly, you can request an appraisal. An appraisal is a formal process where you and the insurer each hire an independent appraiser, and if those two disagree, they hire a third appraiser (called an umpire). The three appraisers review the damage and reach a binding decision on the repair cost. Most insurance policies include an appraisal clause that allows either party to request this process. Appraisals typically cost $300 to $800 per appraiser, and costs are usually split between you and the insurer.

You can also hire a public adjuster—a licensed professional who works on your behalf to negotiate with the insurance company. Public adjusters charge a percentage of the settlement (usually 5 to 10 percent) and are most common in property claims, but some handle auto claims as well. Before hiring one, confirm they are licensed in your state and understand their fee structure.

What adjusters look for to deny or reduce claims

Adjusters are trained to identify reasons a claim might be denied or the payout reduced. Common reasons include coverage exclusions (such as damage from flood or earthquake if you did not purchase that coverage), policy lapses (your coverage was not active at the time of loss), or misrepresentation on your process (you told the insurer you were the primary driver but you were not).

Adjusters also investigate whether the accident was caused by something excluded from your policy. For example, if you were using your car for commercial delivery and your policy excludes commercial use, the claim may be denied. If the adjuster suspects fraud—such as intentional damage or a staged accident—they may deny the claim and refer the matter to law enforcement.

Adjusters may also reduce a payout if they determine you were partially at fault for the accident. In states that follow comparative negligence rules, your payout is reduced by your percentage of fault. For example, if you were found 20 percent at fault, you receive 80 percent of the claim value. The adjuster's information of fault is based on the police report, witness statements, and the damage pattern.

Your rights during the claims process

You have the right to be present during the damage inspection and to ask questions about the adjuster's findings. You also have the right to provide additional documentation or evidence that supports your claim. If the adjuster's estimate seems low, you can submit your own repair estimates or informed opinions for the adjuster to consider.

You have the right to request a written explanation of any denial or significant reduction in the payout. This explanation should cite the specific policy language or state law that supports the decision. If you disagree with the adjuster's decision, you can file a complaint with your state's insurance commissioner or pursue an appraisal. You also have the right to hire an attorney if you believe the insurer acted in bad faith—meaning they unreasonably refused to pay a valid claim.

Keep records of all communications with the adjuster, including dates, times, names, and what was discussed. Request written confirmation of any agreements or next steps. If the adjuster makes a verbal promise about the settlement, ask them to put it in writing. These records protect you if a dispute arises later.

How long the adjuster's investigation takes

The timeline for an adjuster's investigation varies based on the claim's complexity and the insurer's workload. A straightforward claim with minor damage may be settled within one to two weeks. A complex claim involving multiple vehicles, injuries, or disputes over fault can take four to eight weeks or longer.

During the investigation, the adjuster may request additional information from you, such as medical records (if you filed an injury claim), repair receipts, or clarification on how the accident occurred. Respond to these requests promptly—delays on your part can extend the timeline. Once the adjuster completes their investigation and issues a damage estimate, the insurer typically sends you a settlement offer within a few business days.

If you do not hear from the adjuster within the timeframe they promised, follow up by phone or email. Insurance regulations in most states require insurers to acknowledge claims within a specific number of days (often 10 to 30 days) and to make a decision within a set period (often 30 to 60 days). If the insurer misses these important date without good cause, you may have grounds for a complaint.

Frequently Asked Questions

Can I choose my own repair shop, or does the adjuster pick one?

You have the right to choose your own repair shop. The adjuster cannot force you to use a specific shop. However, if you use a shop the insurer does not have a relationship with, the adjuster may request detailed invoices and may dispute certain charges if they seem high compared to market rates in your area.

What if the adjuster says my car is a total loss but I think it can be repaired?

You can dispute a total loss information by obtaining your own repair estimate and requesting an appraisal. If your estimate shows the repair cost is below the threshold your state uses for total loss, you have grounds to challenge the adjuster's decision. An appraisal will resolve the disagreement through a binding process.

Do I have to talk to the adjuster, or can I have my attorney do it?

You can have an attorney, public adjuster, or representative communicate with the adjuster on your behalf. However, the insurer may still require you to provide certain documents or sign forms directly. Let the adjuster know upfront if someone else will be handling communications, and provide written authorization.

What happens if the adjuster finds I was at fault for the accident?

If you carry collision coverage, your claim will be paid regardless of fault, minus your deductible. The adjuster's information of fault affects your rates and future insurability, but it does not prevent payment under collision coverage. If you carry only liability coverage, fault information is critical because liability only covers damage you cause to others, not to your own vehicle.

Can the adjuster contact my doctor or employer without my permission?

The adjuster can contact third parties like medical providers or employers if you filed an injury claim or if the claim involves questions about your income or activities. However, they cannot access your medical records without your written authorization. If the adjuster requests medical records, you can limit what you provide to records related only to the accident injury.