Motor Insurance has given rise to a new breed of professionals, who are known as motor claims loss adjusters or also known as surveyors. The loss adjusters can be an independent individual or an organization doing the job of motor loss adjusting. Many accident management companies also do the job of motor loss adjusting or assessing.
Rodney D Young insurance company and many other reputable insurers have an in-house loss adjusting team, which is involved in the processing of the claims with certain limitations. These teams are usually involved in small claims. Whereas in case of large claims or complex claims or claims related to the commercial vehicles are handled by the independent motor loss adjusters.
If the individuals are handling the loss adjusting function then they are supposed to have the minimum mandatory qualification and a license to work as loss adjusters. The organizations should also have a license to operate as a loss adjuster for motor claims. The regulators prescribe the minimum requirements like qualification, fees, and mandatory requirements to get the license to act as a motor loss adjuster.
Some of the major functions of the loss adjusters are as follows:
A pre-risk survey is also known as a pre-acceptance risk survey. For most types of auto insurance pre-risk, inspection is one of the requirements of the underwriters. Before accepting the risk, the underwriter wants to be aware of the risk he is accepting. Hence pre-risk surveys help him in assessing the risk. Most of the pre-risk surveys related to motor insurance are usually done by the in-house staff.
However, in case of specialist risk the survey will be done by the third-party surveyors and a professional report is provided by the surveyor. The surveyors usually provide photographs of the risk to be insured and they will also provide the engine number and chassis number of the vehicle. The surveyor also will provide a copy of the registration certificate. They will also comment on the overall condition of the auto along with their recommendation of the valuation.
The purpose of the spot survey is to help in fraud control. Spot surveys are required when there is a major accident, an accident to commercial vehicles, and accidents involving deaths to the third parties. Some insurance companies have made it a mandatory requirement to have a spot survey for certain types of claims like commercial vehicle accidents.
The spot survey is done at the spot of the accident and the surveyor usually takes pictures of the accident and advises the insured on the process of claim. He also provides a tentative estimate of the loss due to the accident; he may also comment on expected hidden damages of the vehicle. The surveyor also gets an opportunity to talk to the witnesses and other parties involved in the accident.
The loss adjusting is one of the important functions of the claims department. Whether it is done in-house or outsourced the following are the important responsibilities of the loss adjuster.
- The primary investigation of the auto insurance claims filed.
- Confirming the coverage by going through the policy coverage thoroughly.
- Building contact with the insured or the claimant. Also interviewing the other parties related to the claim including the witnesses, mechanics, police and medical personnel etc.
- Inspection of the damaged properties and bodily injuries and or death of the persons.
- Evaluation of the damages or losses relevant to the event.
- Evaluating the various documents related to the claim and meeting the concerned parties where necessary.
- Preparation of the preliminary and final reports of the claim assessment for the insurance companies.
Usually, valuation of the auto is required at the time of pre risk survey and also at the time of the accident. However, in certain cases, the vehicle valuation is done in isolation and is not related to the pre-risk survey or adjusting. In this case, the surveyor sees the vehicle and gives his best estimate of the vehicle before insuring the vehicle so that it will aid the insured and the insurer in arriving at the right value of the auto. The surveyor is also involved in assessing the salvage value of the vehicle post-accident so that a correct settlement of the claim is done.
It is estimated that there are between 5% – 20% fraudulent claims in motor insurance. In order to avoid these types of claims, the insurance companies will engage the services of detectives or investigators. Sometimes this role is also performed by the loss adjusting firms or individuals. The investigator’s role is very comprehensive. He has to visit the scene of the accident and find the facts related to the accident. He has to find out the liability in case of liability claims.
Thorough research has to be done as to the type of coverage and its relationship to the accident. He has to find whether the vehicle was used as per the terms of the policy and whether the driver was qualified to drive the vehicle. Sometimes the date of the accident is before the inception of the cover. In all such cases, the job of the investigator is crucial and he has to get the necessary evidence supported by documents and photographs.
Once the investigation is done then the investigator will submit his report. Based on the report of the investigator the insurance company will decide the status of the claim. In case of repudiation of the claim the report and contest by the insured the report may become a part of scrutiny by the judicial authority.
Loss adjusters are the major component of the claims handling process. Hence, they not only investigate the claims in case of dispute but also involved in the various dispute resolution methodologies. They may be asked to attend the court proceedings or other mediation methods. Hence the loss adjusters should be familiar with the legal guidelines and processes.