Claims / Adjusters / Investigation

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DEFINITIONS
ADJUSTERS
OMBUDSERVICE
OTHER RESOURCES INCLUDING INVESTIGATORS

Definitions

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Claims adjuster

An individual who acts on behalf of, or is employed by, an insurance company to settle claims.

Adjustment bureau

An organization that provides loss adjustment services to insurers. It is used to supplement staff adjusters and by insurers that do not employ their own staff adjusters.

Adjusters Errors & Omissions

Covers an individual adjuster or adjusting company against claims for breach of duty by reason of any alleged negligent act, error or omission committed by the insured or employees in the capacity of adjusters. Minimum deductible or self-insured retention is usually $1,000. Higher deductibles may be purchased at considerable premium savings. Limit of liability and size of the insured's staff are other important factors. Insurance is written subject to completion of a proposal form.

Claim adjustment

The process used by an insurer to evaluate and settle a claim. This includes determining whether and to what extent the loss is covered by the policy, determining the cause of loss, and valuing the loss.

Claim agent

A claims representative of an ocean marine insurer, located in ports and cities throughout the world, whom a claimant can contact in the event of a loss or damage to an insured shipment.

Field adjuster

A claims adjuster who works outside the office. Field adjusting is principally used for claims for real property damage, automobile physical damage, and auto liability property damage. Most liability, workers' compensation, and casualty claims are handled by inside adjusters, who may use outside adjusting firms if any field investigation is needed.

Independent adjuster

An organization or a person, hired by an insurer, who is paid a fee for settling claims.

Inside adjuster

A claims adjuster who works almost exclusively inside the office and completes the claim adjustment process by telephone and mail. This form of adjusting is commonly used on third-party liability and workers' compensation claims.

Public Adjuster

An individual who acts on behalf of, or is employed by, a claimant to represent its interests in the claims settlement process.

Staff adjuster

An individual employed by an insurance company to settle claims with or for policyholders of the company.

Third-party administrator (TPA)

A claims administrator or insurance company that processes claims on behalf of a self-insured organization or multiple employer welfare arrangement or manages workers' compensation claims for an employer. The administrator is a third party because it is neither the self-insurer nor an insured (claimant or payee). Services may include processing claims (including audits, adjusting, and negotiating settlements), record keeping, self-insurance certification, and notification of excess insurers.

Barry Zalma
Canadian Independent Adjusters Association
Canadian Insurance Claims Managers Association (CICMA)
CatAdjuster.org
CDRG - Canadian Disaster Restoration Group - CDRG offers comprehensive fire, water, oil, textile restoration, duct cleaning and storm damage restoration for insurance carriers, businesses, schools, hospitals, condos, government and private customers.
Chartered Institute of Loss Adjusters - U.K.
CLAIMSPAGES.COM - Excellent Resource.
Corpa Group - International corporate investigation specialists.
Cybersettle.com
Disaster Kleenup International
FirstOnSite Restoration - FirstOnSite is the largest independent disaster restoration company in Canada. We provide remediation, restoration and reconstruction services nationwide.
Holocaust era insurance claims
Institute of Public Loss Assessors - U.K.
ISB - Document Searches - Canada
Intelligent Protection International - Intelligent Protection International Limited provides close protection bodyguards and executive protection services to meet our client’s requirements, whether it is in a hostile environment or a capital city. We operate with an amalgamation of professional standards, great management and highly experienced personnel.
Keyfacts Canada - Investigations.
Mold Update
Kessler International - Offer a full range of Forensic Accounting and Investigation Consulting services to protect companies against the dangers of fraud, counterfeiting, product diversion, trademark and copyright infringement, money laundering and the recent explosion in computer crime.
National Association of Public Adjusters
Origin and Cause Inc. - We work closely with insurance companies, law firms, independent adjusters, and corporate risk managers to accurately determine the origin and cause of a vast array of situations.
Structured Settlements Authority - Historically, personal injury or product liability lawsuits were settled by the exchange of a single lump sum cash payment in return for the release of claim in a lawsuit. Under this arrangement, it was up to the individual and their families to manage the large initial sum and to use it to provide for the victim's medical and income needs over their entire lifetime. Structured settlements laws were created to help reduce the difficulties faced in these types of situations and to help provide the claimant and their families with long-term financial security.
The Claims Network - Our specialty of providing contents valuation has become the Preferred Method for insurers to settle contents claims. Because we are able to assess the value of most items which gives insurers a “One Stop Shop” approach to all contents.
Venue™ Claims Management provides end to end management of the entire claims processing workflow.
Williams & Partners - Forensic & Investigative Accountants.

Claims / Adjusters / Investigation

Definitions

Adjusters

Ombudservice

Other Resources Including Investigators