Claims Adjusting Practices and Procedures
The claim lifecycle
Acknowledge the loss, investigate (recorded statements, scene photos, police and fire reports, medical records, wage documentation, expert opinions), determine coverage, evaluate damages, negotiate, settle, pay, and pursue recovery through subrogation or salvage. Document every contact, decision, and basis for payment in the claim file - the file is your defense in a bad-faith dispute.
Coverage tools
When coverage is uncertain, issue a reservation of rights letter or a non-waiver agreement so the investigation continues without waiving the insurer's position. A proof of loss is a sworn statement; an examination under oath is enforceable only where the policy grants it. Appraisal resolves disputes about the amount of loss, never coverage. Stay within granted settlement authority.
California timing rules
Under the Fair Claims Settlement Practices Regulations (10 CCR §2695): respond to claim communications within 15 calendar days; accept or deny a first-party claim within 40 calendar days of receiving proof of claim; pay within 30 calendar days after settlement is agreed. Refer suspected fraud to SIU and the CDI Fraud Division.
Traps
Adjusters get burned by admitting coverage before the investigation is complete, treating a reservation of rights as a denial, confusing appraisal with arbitration, contacting a represented claimant directly, and ignoring liens from health plans, workers compensation, or Medicare.
Worked example
Loss on March 1; reported March 3. Acknowledge by March 18. Proof of loss received April 10 → decision due by May 20. Settlement agreed June 2 → payment due July 2. Count calendar days, not court days.