The adjuster's role in the claims process is to investigate the loss, determine whether coverage applies, assess the amount of the damage, and recommend a settlement to the insurer. The adjuster is not the policyholder's advocate. The adjuster is a professional who works for the insurer, or who has been retained by the insurer, and whose responsibility is to protect the insurer's interests while complying with the insurer's obligation to handle claims fairly and in good faith.
Understanding this relationship is important because it affects how the policyholder should approach the claims process. The adjuster is not an adversary. Most adjusters are fair, thorough, and genuinely interested in reaching an accurate assessment. They take no pleasure in reducing claims, and they do not receive bonuses for denying coverage. But the adjuster's job is to measure the loss accurately, not to maximize the payout, and the measurement is based on the evidence available, not on the policyholder's expectations.
The adjuster follows a structured process on every claim. The first step is the coverage analysis. Before the adjuster evaluates the amount of the loss, the insurer needs to confirm that the loss is covered under the policy. This means checking the insuring agreement, the exclusions, and the conditions, the same process described in the previous course. For the restaurant water loss, the coverage analysis was straightforward. Water damage from a burst plumbing coupling was a covered peril under the all-risk form. No exclusion applied. The operator had provided prompt notice and had taken steps to mitigate further damage. Coverage was confirmed within a few days of the adjuster's visit.