What the Adjuster is Expected to do When a Claim is Reported

Since the invention of the adjuster more than a century ago the first person from the insurer that the insured meets when he or she suffers a first party commercial property loss is the adjuster.

The claim adjuster was invented to smooth the claims process and avoid the unfair results of a case like White v. Home Mutual, supra. The adjuster was created by the insurance industry to be certain that the insured receives the indemnity promised by the policy. To do so the adjuster is expected to perform a complete and thorough investigation to ascertain:

1)??????the cause of loss,

2)??????the extent of loss,

3)??????the indemnity required by the policy conditions,

4)??????that the loss was caused by a peril insured against, and

5)??????to avoid fraudulent claims.

Every modern claim adjuster should know that it is his or her duty to aid the insurer in the insured’s obligation to fulfill the promises made when the policy of insurance was acquired and assist the insured in presenting his or her claim to the insurer.

An insurance adjuster, regardless of duty, is a person engaged in the business of insurance. The first party property insurance adjuster limits his or her activities to the investigation and adjustment of first party property claims like fire, lightning, windstorm, hail, theft, etc.

Statutes define an adjuster as one who investigates losses on behalf of an insurer as an independent contractor or an employee of an independent contractor. An insurance adjuster is an agent of the insurer and his or her powers and authority are prima facie coextensive with the business entrusted to his or her care.?

The duty of the adjuster is to ascertain and determine the amount of any claim, loss or damage payable under an insurance contract, and/or effecting settlement of such claim, loss or damage.

Under Louisiana law, there is generally no cause of action against an insurance adjuster for processing and handing an insurance claim. [Hoffman v. Ellender, No. CIV.A. 15-309-JWD, 2015 WL 4873342, at *4 (M.D. La. July 23, 2015) (quoting Munsterman v. State Farm Fire & Cas. Co., No. 06-8722, 2007 WL 29183, at *2 (E.D. La. Jan. 3, 2007)), report and recommendation adopted, No. CIV.A. 15-309-JWD, 2015 WL 4873350 (M.D. La. Aug. 13, 2015); see also Edwards v. Allstate Prop. & Cas. Co., No. 04-2434, 2005 WL 221560, at *3 (E.D. La. Jan. 27, 2005) (collecting cases); and Bellina v. Liberty Mut. Ins. Co. (E.D. La. 2020)]

The acts of an adjuster within the apparent scope of his authority are binding on the company without notice to the insured of limitations on his powers. [Old Republic Ins. Co. v. Von Onweller Const. Co., 239 So.2d 503 (Fla. App. 2 Dist., 1970)]