Claims Adjusting Practices and Ethics
The claim file is the case
Adjusters follow a repeatable sequence: acknowledge the claim promptly, investigate (statements, photographs, scene inspection, experts), determine coverage before evaluating damages, reserve, document every decision, then negotiate, pay, subrogate, and close. Every conclusion should rest on evidence and a written rationale a stranger could follow - that file is your defense in a market conduct examination or a bad-faith suit.
Coverage before dollars
Read the insuring agreement, then exclusions, then exceptions to exclusions, then conditions. The duty to defend is broader than the duty to indemnify and generally ends when limits are exhausted. When coverage is uncertain, issue a reservation of rights letter rather than denying or paying outright. Proof of loss, examination under oath, and appraisal are contractual tools; appraisal decides the amount of loss, never whether coverage exists.
Ethics
Adjusters owe good faith and fair dealing to the insured and honest reporting to the insurer. Conflicts of interest (such as referring work to a vendor you own), giving unauthorized legal advice, padded estimates, and undocumented depreciation are discipline-worthy. Claim information is confidential, and settlement authority must never be exceeded.
Traps
Paying before coverage is confirmed; missing claim acknowledgment or payment deadlines; doing it that way for years as a justification; and treating a public adjuster's demand as an admission of value.
Rule of thumb
If you cannot state the coverage determination in one sentence citing form and provision - for example, covered under Coverage C for accidental discharge of water - you are not ready to pay. Reserve rights and keep investigating.