Investigating the claim

When people make claims on their insurance policies, the insurance claims adjuster checks the coverage, finds out what happened, determines the amount of the loss or damage covered under the policy and negotiates a settlement. Claims adjusters work in insurance companies or independent insurance adjusting firms.

Your first task as a claims adjuster is to find out if the insurance coverage is still valid and whether or not it covers the loss being claims. You ensure that premiums have been paid, that the policy has not lapsed, and that the claimant did not do anything to prejudice the case.

You then investigate the circumstances surrounding the loss and, if necessary, determine who was at fault. You take statements, check records and reports, consult with claimants, witnesses, doctors, police and others directly involved. You may also inspect cars, homes, businesses or damaged property. You assess the extent and the nature of the damage and determine the amount of compensation. You then negotiate settlement of the claim and prepare a report.

Do you have what it takes?

In this profession, you start working as a company claims adjuster or s a junior clerk in an independent office and focus on smaller claims. With education and experience, you are given more complex cases and you can eventually become a senior independent adjuster, contracting out your services to different insurance companies. At this level you work on more complex and difficult claims.

Company claims adjusters are paid salaries. Licensed independent adjusters are paid fees.

You will enjoy this job if you are decisive and motivated. You should also enjoy asking questions and digging for answers on a variety of subjects from medicine to contract law. Since you handle a lot of information, you need to be well organized and able to compile and assess all of the data relating to a claim.

You need good communication, interviewing and negotiating skills. you must be fair in approaching any claim since it is your task to negotiate a settlement. You also need strong writing ability in order to produce clear and detailed reports of your findings.

What you need

• a high school diploma
• experience as a clerical worker in the claims department of an insurance company, independent adjusting firm or insurance company is an asset
• a community college diploma, a university undergraduate degree, or some post- secondary education in the liberal arts, sciences or business is recommended
• a provincial licence issued by the Superintendent of Insurance in the province or territory where you work is required if you are an independent adjuster
• several years of on-the-job training and completion of a formal training program offered through The Insurance Institute of Canada will give you certification as an Associated of The Insurance Institute of Canada

To find out more, contact

• your high school guidance counsellor
• your local public library
• a local insurance company
• The Insurance Institute of Canada

18 King street East

6th Floor

Toronto, Ontario M5C 1C4

Tel.(416)362-8586

* The Canadian Independent Adjusters' Association

55 Queen Street East

Suite 1305

Toronto, Ontario M5C 1R6

Tel.(416)362-7466

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