Guide to working effectively with insurance claims adjusters. Understand their role, how to communicate, and what to expect during the process.
A claims adjuster is an insurance professional who investigates, evaluates, and determines the settlement amount for insurance claims. They act as the insurance company's representative to assess the validity and value of your claim.
Claims adjusters are typically assigned to your case when you file a claim that meets certain criteria. Understanding when they get involved helps you prepare accordingly.
There are three main types of adjusters, each with different roles and loyalties. Knowing the difference helps you understand whose interests they represent.
Employed directly by insurance companies like Jubilee, CIC, or Britam. They handle claims exclusively for their employer and work to protect company interests while ensuring fair settlements.
Self-employed or work for adjustment firms contracted by insurers. Common in Kenya include firms like Crawford & Company and McLarens. They're paid per claim by insurance companies.
Work exclusively for policyholders (you). They charge a fee (typically 10-20% of settlement) but advocate for your interests. Less common in Kenya but growing in availability.
Understanding the typical adjustment process helps you know what to expect and when. Most adjustments follow this timeline:
The adjuster contacts you to schedule an inspection. They'll request basic information about the incident and gather initial documentation.
Site visit, damage assessment, evidence collection, witness interviews, and police report review. For motor claims, they inspect the vehicle at a garage or assessment center.
Review policy coverage, determine liability percentage, calculate repair/replacement costs, and prepare preliminary settlement offer.
Present findings, discuss settlement amount, address disputes, and finalize agreement. This phase can extend if there's disagreement.
Process paperwork, obtain approvals, and issue payment. Total process typically takes 3-8 weeks depending on complexity.
Your relationship with the claims adjuster significantly impacts your settlement outcome. Follow these best practices for productive interactions:
Proper documentation strengthens your claim and helps adjusters assess damages accurately. Comprehensive evidence leads to faster, fairer settlements.
Important: Never dispose of damaged items until the adjuster completes their assessment. Store damaged property safely for inspection.
Initial settlement offers are often negotiable. Don't feel obligated to accept the first offer - adjusters expect some negotiation.
Negotiation Example: If your garage quotes KES 250,000 for repairs but the adjuster offers KES 180,000, present your quotes and ask them to justify the difference. They may agree to KES 215,000 as a compromise.
The Insurance Regulatory Authority (IRA) of Kenya sets standards for claims handling. Understanding your regulatory rights protects you during the adjustment process.
Under IRA guidelines, insurers must:
IRA Complaints: If your claim is mishandled, contact IRA on 0780 100 600 or email complaints@ira.go.ke. Keep all documentation to support your complaint.
Understanding costs associated with the adjustment process helps you budget appropriately and know what's normal versus excessive.
Tip: Only hire a public adjuster or independent assessor if the potential settlement increase exceeds their fees. For claims under KES 200,000, it's often not cost-effective.
Learn from real-life examples of how claims adjusters handle different situations in Kenya.
Claim Value: KES 450,000 | Duration: 5 weeks
Situation: Two-car collision at roundabout. Both drivers claimed right of way. Comprehensive insurance on both vehicles.
Adjuster Actions:
Outcome: First driver received KES 315,000 (70% of KES 450,000). Second driver's claim reduced proportionally. Both parties satisfied with evidence-based decision.
Claim Value: KES 2,800,000 | Duration: 12 weeks
Situation: Kitchen fire destroyed part of home. Homeowner claimed entire house needed rebuilding. Insurer suspected over-claiming.
Adjuster Actions:
Outcome: Determined KES 1,900,000 was appropriate for repairs. Homeowner initially disputed but accepted after seeing structural report. Claim paid in stages as repairs progressed.
Claim Value: KES 680,000 | Duration: 8 weeks
Situation: Business owner claimed 15 computers and office equipment stolen during break-in. Limited documentation provided.
Adjuster Actions:
Outcome: Could only verify 10 computers with documentation. Settlement reduced to KES 480,000. Business learned importance of maintaining inventory records and receipts.
No. Refusing to cooperate with the adjuster can result in claim denial. Your insurance policy requires you to assist in the claims investigation. However, you can reschedule meetings for reasonable times and request a different adjuster if there's a legitimate conflict.
You have several options: 1) Obtain independent repair estimates and present them to the adjuster, 2) Request a re-assessment or second opinion, 3) File a formal complaint with the insurance company, 4) Hire a public adjuster to advocate for you, or 5) Contact the IRA if you believe the assessment is unreasonable.
Not necessarily. First offers are often negotiable. Take time to review the offer, compare it with your own research, and don't feel pressured to accept immediately. However, if the offer is fair and well-documented, prolonging negotiations may not yield better results.
In Kenya, you can record conversations you're part of without the other party's consent (one-party consent). However, it's professional courtesy to inform the adjuster. Taking detailed written notes is often more practical and equally effective for documentation purposes.
IRA guidelines require insurers to settle approved claims within 15 days of reaching agreement. Complex claims may take longer for investigation (up to 60 days with valid reasons). If your claim exceeds these timelines without explanation, file a complaint with IRA.
Request detailed written explanation of how they determined liability. Present any additional evidence (witnesses, photos, expert opinions). If still unresolved, you can escalate to the insurer's claims manager, seek mediation, or consider legal action for disputed liability cases.
No. The adjuster must schedule property inspections with your consent. However, unreasonably refusing access can delay or jeopardize your claim. It's in your interest to cooperate and schedule inspections promptly while ensuring you or a representative is present.
Follow these professional tips to maximize your chances of a fair settlement and smooth claims process.
Remember: The adjuster works for the insurance company, not for you. While most are fair and professional, your job is to protect your interests by being informed, organized, and assertive when necessary. Don't be afraid to question assessments or seek second opinions on significant claims.
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