Dealing with the loss adjuster your insurer appoints

Who the adjuster really works for

Whether employed directly by the insurer (a staff adjuster) or engaged from an independent firm, the adjuster is instructed and paid by the insurer. Their task is to investigate the claim, establish cause, verify that the loss falls within the policy and recommend a settlement figure. Professional standards in the UK, Ireland, Canada, Australia and the US expect adjusters to act fairly and treat customers reasonably, but their client is the insurer.

That distinction matters most when cause or value is contested. A friendly and helpful adjuster can still conclude that damage is excluded or that repairs should cost less than your builder suggests.

A typical inspection, step by step

Smaller claims may be handled remotely by photograph, video call or desk review. Larger or complex claims usually involve a site visit, during which the adjuster will ask how and when the loss was discovered, inspect affected areas, take photographs and measurements, and may request access to neighbouring or concealed areas.

They may appoint specialists such as drying contractors, forensic engineers, fire investigators or forensic accountants. Afterwards, they prepare a report for the insurer covering cause, policy liability, reserve and recommended settlement, and often request further documents from you.

Questions you should expect

Being ready for these points avoids delays and misunderstandings:

• when the damage first appeared and what you did to limit it
• the age and condition of the affected structure or items
• proof of ownership and value for contents and equipment
• previous claims, repairs or known defects
• whether anyone else, such as a contractor or neighbour, may be responsible

Documents the adjuster leans on

Adjusters weigh contemporaneous records heavily. Photographs taken immediately after the event, emergency repair invoices, receipts, bank statements and maintenance records all help establish the facts. For commercial claims, trading accounts, stock records and payroll information are central to any business interruption calculation.

Keep your own copies of everything you hand over and keep notes of each conversation, including dates and the names of those present. If the adjuster gives an oral indication of what will be paid, ask for it in writing.

Recurrent sticking points

Most disputes between policyholders and insurer-appointed adjusters relate to cause, scope or price. On cause, adjusters may attribute damage to wear and tear, gradual seepage, inadequate maintenance or pre-existing movement rather than to the insured event. On scope, they may propose localised repairs where you believe whole areas need replacing for a consistent finish.

On price, the adjuster may rely on network contractor rates or estimating software that differ from local market quotes. Depreciation on contents, cash settlement instead of reinstatement, and the application of underinsurance or average are other frequent sources of friction.

Your rights during the process

You can ask for an explanation of any decision, request copies of reports relied on, take your own photographs during the inspection and obtain your own quotes. Regulators and ombudsmen in each of these markets expect insurers to handle claims promptly and fairly, and unreasonable delays or unclear refusals are legitimate grounds for complaint.

Reading the adjuster's findings and the offer

The adjuster's conclusions usually reach you indirectly, through a decision letter or settlement offer from the insurer. Read it against the policy wording: does it explain which section of cover applies, why any item is excluded, how depreciation or betterment was calculated and whether the figure is for reinstatement or cash settlement? Vague references to 'policy terms' without a clause number deserve a written follow-up question.

Compare the offered scope with the damage you can see and with your own quotes. Missing rooms, omitted trades such as electrical or decorating work, or no allowance for drying and strip-out are common gaps. If anything is unclear, ask for the breakdown behind the figure before accepting, and avoid signing a full and final release while questions remain open.

When to call in your own expert

For straightforward claims, many policyholders deal with the insurer's adjuster without difficulty. Independent representation by a loss assessor or public adjuster becomes more relevant when the loss is large, technically complex, involves business interruption, or when the adjuster's preliminary view on cause or value is far from your own evidence.

Appointing a representative early allows them to attend the adjuster's inspection, record the damage independently and manage the documentation. Check licensing or authorisation in your jurisdiction, such as state licences for US public adjusters, and be wary of unsolicited approaches immediately after a storm or fire.

The insurer's adjuster is a key figure in your claim, but not the final word. Prepare your evidence, ask for decisions in writing and consider independent support when the stakes or the gap justify it.