Who is responsible for verifying coverage, determining the cause of loss, and settling a claim?

The claim adjuster plays a crucial role in the claims process by being responsible for verifying coverage, determining the cause of loss, and settling a claim. This professional conducts thorough investigations of the claims submitted by policyholders to ascertain the validity of the claim and the extent of the insurer's liability.

The process begins with the claim adjuster reviewing the claim details, which includes looking at the insurance policy to confirm coverage applicability. They also gather evidence and assess damages through interviews, inspections, and obtaining necessary documentation. After establishing the cause of loss and evaluating the claim, the adjuster makes decisions on the appropriate settlement amount based on the findings.

This role is distinct from that of an insurance broker, who primarily acts as an intermediary between the client and the insurance company, but does not handle claims directly. Similarly, while a claims manager oversees the claims department and its processes, they do not typically handle individual claims. Lastly, an underwriter is responsible for evaluating the risk of insuring a potential client and determining the terms of coverage, rather than managing claims after a loss has occurred.