There is clearly a significant difference between an insurance agent and a loss claims adjuster when dealing with your insurance provider. Their duties within the scope of operation for the insurance company are completely different, and clients rarely see the claims adjuster until something goes wrong and filing a claim is necessary. Of course, potential clients never see the adjuster at the beginning, which is done by design from inside the company operation. Agents are contracted associates, and they tend to be cordial and personal because they are trained in public response and perception. While most potential customers realize this structure when purchasing insurance protection, others think the agent makes the decision on payment of claims. This absolutely is not the case, and many times even when the agent is a personal friend they cannot influence the claims adjuster in any manner. Understanding the difference in their job responsibilities is vital when submitting a claim for benefits. [5 Reasons Your Car Accident Claim Might Be Denied]

Agency Responsibilities

The primary difference between an insurance agent and an insurance claims loss adjuster is the public perception and business procurement responsibilities regarding policy sales and client intake into the company system. Agents assess the customer for coverage availability, such as purchasing auto insurance for a rate assignment based on the applicant’s driving record and then produce a premium rate that the company would require to join the insured group. Agents are largely the face of the company in their communities and are trained in good public relations policy. Insurance agents are also responsible for compiling all of the documentation needed to handle any case and then submitting a report to the actual claims loss adjuster. Your accident attorney will typically not discuss the case with an insurance sales agent unless it is regarding an initial contact or request some detailed information. 

Claims Loss Adjuster Responsibilities

The duties of the claims loss adjuster are much different than a sales agent. They evaluate the details of the case and generate any requests for more documentation in support of a claim. There are actually two types of claims loss car accident insurance claims attorneysadjusters, with one working the office making decisions from the desk and another out in the field physically inspecting claim facts and looking for any reason available to deny or make a low offer on a claim. Their first responsibility to the company is determining if the company has grounds for a case denial. North Carolina uses the contributory negligence law that restricts financial recovery for anyone causing their own accident-based injuries, and the insurance companies use contributory negligence regularly as a claim denial defense. In actually valid cases, they will typically send claimants to a so-called “independent” doctor for verification purposes when the claim is an injury case. Examples of additional evidence in physical property claims could be multiple estimates for repair. The claims loss agent is always focused on claim value reduction, and an aggressive auto accident attorney in North Carolina will understand how to negotiate claims with them to hopefully avoid going to trial.

How They are Similar

The duties of an insurance sales agent and a claims loss agent can also be very similar in some instances. Some cases are actually settled quickly in obvious situations and a claims loss agent usually defers to the primary agent to perform all communication on the case. They can also work together to convince a claimant to accept a low offer when cases are more valuable than the claimant realizes in hopes they will not retain an auto accident attorney to further negotiate general damages. All payouts in claims come off of the income debit of the primary sales agent, and they are often ready to convince a client to not retain counsel to represent the case. This especially applies when an auto accident attorney will be needed. General damages are the claim for pain and suffering, which is different from “special” or specific damages for losses that can be submitted in exact dollar amounts. 

Contact Our Law Firm

It is never a good decision to accept an offer from a North Carolina insurer without discussing the case with an experienced auto accident attorney. The contributory negligence laws in the state often give both insurance agents and claims loss adjusters significant incentive to offer a low settlement to end a claim or take the case to court in hopes of a case dismissal. While the insurance agent is supposed to be a representative of the client when claims are filed based on their agency contract with the company, the fact is that they often work together to reduce claim payouts. Let us use our legal expertise to help you when dealing with either company representative.