How can loss adjusters affect your home insurance claim?
If you need to make a home insurance claim, you might get a visit from a loss adjuster. Find out exactly what a loss adjuster does and how they can affect the outcome of your claim in this guide.
Key takeaways
A loss adjuster helps insurers decide whether your home insurance claim is accurate
Loss adjusters are professionals with their own codes of conduct and they must remain impartial
In some instances, they might help you claim more by increasing the value of your payout
You can appeal a decision if you believe it's incorrect or unfair
What does a loss adjuster do?
A loss adjuster is a professional who investigates insurance claims to determine:
The cause of the incident: And whether it’s covered by the insurance policy
The extent of the damage or loss: How much has been lost or damaged
The value of the claim: How much compensation the policyholder should receive
If you've been burgled or experienced a fire or flood and need to make a significant home insurance claim, your insurance provider may hire a loss adjuster.
A loss adjuster's main purpose is to ensure you're claiming the correct amount on your home insurance. They investigate your claim by assessing the extent of the damage or loss, and how much it will cost to fix it.
Once they have checked the authenticity of your claim and have negotiated a payout amount, they will report back to the insurers with their recommendations.
Who hires a loss adjuster?
Loss adjusters are hired by insurance companies to handle claims. They work on behalf of the insurer to assess the validity of a claim and determine the appropriate payout.
However, a loss adjuster can also be hired by a policyholder, though this is less common.
Are loss adjusters impartial?
Yes, loss adjusters must remain impartial. While they technically work for insurance companies, their job isn't to reduce your claim intentionally in an effort to save your insurer money.
In some cases, they may suggest that you're actually not claiming enough and increase the value of your final payout.
Loss adjusters are independent professionals with their own codes of conduct, who are governed by these organisations:
They must also adhere to the rules set by the Financial Conduct Authority (FCA).
What is the loss adjustment process?
Here are the common stages of a home insurance claim involving a loss adjuster:
1. Policyholder submits a claim
The policyholder initiates the process by submitting a claim to their insurance company.
2. Loss adjuster is appointed
The insurance company often appoints a loss adjuster (usually for larger or more complex claims) to investigate the claim.
3. Investigation and assessment
The loss adjuster conducts an investigation, which may include visiting the property, gathering documentation, and taking photographs. They assess the extent of the damage, identify the cause of the loss, and determine if it's covered by the insurance policy.
4. Loss adjuster's report is submitted
The loss adjuster compiles a report outlining their findings, including the amount of the claim, whether it's covered by the policy, and whether the conditions of the policy have been met.
5. Claim settlement
The insurance company uses the loss adjuster's report to decide on the settlement offer to the policyholder.
6. Final negotiations
The policyholder may negotiate the settlement offer, and the claim is finalized once an agreement is reached.
What does a loss adjuster look for during their visit?
Loss adjusters are employed to establish how the incident that led to the claim occurred. When they visit your home, they will look for:
The cause of the incident
The value of damage or loss
If the damage is actually covered by your home insurance policy
Whether you've met your policy's terms and conditions or not
If the amount you're claiming for is accurate and reasonable
Loss adjusters often take photographs of any visible damage to include in their report. They may also ask you some potentially uncomfortable questions to rule out fraudulent claims.
After they have identified the cause of your claim and calculated the cost of repairs, a loss adjuster will assess how much you have asked for and see if it matches their amount.
Once they have completed their visit, they will write up a report and send it to your insurer, and you will also get a copy.
Can a loss adjuster refuse a claim?
Yes, in some cases, a loss adjuster has the final decision on your claim, and they may reject this based on their findings. This all depends on the agreement they have with your insurance provider.
Your insurer may immediately accept the loss adjuster's report, whereas others may treat it more as a recommendation, which is considered in addition to their in-house expert's conclusion.
You claim may be refused if:
You don't have the right level of home insurance cover
The damage is a result of wear and tear
You're withholding information
Your claim hasn't met the terms and conditions of your policy
What if I don’t agree with the loss adjuster’s assessment?
If your insurance provider rejects your claim as a result of the loss adjuster's report, you can appeal their decision. To do this, you'll need to prepare and present reasons why you believe the loss adjuster's and insurer's decision is incorrect or unfair.
Make sure you're as accurate as possible and include details such as the timeline from the incident that prompted the claim, up until their decision to reject it.
If your appeal fails and you're still unhappy with this, you can inform the Financial Ombudsman Service within six months of the insurer's decision. The Ombudsman can evaluate both sides as part of an independent investigation and will issue an outcome.
You can also legally hire a loss assessor via their trade body, The Institute of Public Loss Assessors. They will act on your behalf and deal with all the paperwork and proceedings.
If you're recommended a loss assessor, ensure they are authorised by the FCA by searching The Financial Services Register.
What’s the difference between a loss adjuster and a loss assessor?
Loss adjusters are employed by your insurance provider, whereas a loss assessor is someone you can hire to liaise with the loss adjuster on your behalf.
You have the right to appoint a loss assessor at any stage of the process, although most people only tend to do this when they aren't happy with the loss adjuster's report or their insurer's decision.
How can I speed up the claims process?
You can speed up the claims process by assisting your loss adjuster as much as possible. Provide them with any information they require, ideally before their visit. This includes any receipts or paperwork that will support your claim.
Plus, be honest and helpful when answering their questions, and forward any information such as your own photographs of the damage as soon as possible. Try to avoid cleaning up any mess or throwing anything away before the loss adjuster has seen it.
If you need to do any emergency work, such as replacing windows and doors, make sure you visually document this and forward this onto your insurer, and keep any receipts for the work.
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Collette Shackleton
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Collette Shackleton is a highly skilled Content Writer who has over nine years’ experience creating helpful and engaging personal finance content for consumers. Collette shares her experience as a...
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