What are the Roles and Responsibilities for Accredited Claims Adjusters and Claimants When a Claim is Filed?

insurance adjuster reviewing car accident damage with claimant

Auto accidents are something nobody wishes for. The outgoing expense of your deductible to repair your vehicle, unless it’s determined a total loss, is one headache. The time spent at medical offices and physical therapy if required is another nuisance followed by the time it takes in filing your claim from beginning to end. To ensure a smooth and timely claims process from beginning to end there are several responsibilities the claimant and Accredited Claims Adjuster (ACA) must fulfill.

What are the responsibilities of each party to ensure a smooth claims process?

It is the responsibility of the claimant to file their claim in a timely manner. This is step #1. Waiting months or even a year or more to file is not recommended as details are lost and memories fade. Some claims are more involved than others. Serious car accidents, those where fatalities happen or bodily injury is severe, those claims can take longer to process from beginning to end. The rules don’t change with the severity of the accident. All accidents should be filed immediately so the process can get started. Depending on the extent of the claim and if there was more than one vehicle involved in the accident it can take longer from beginning to end for the claim to be completed.
At the start of any claim the claimant must ensure they have every detail of the event that resulted in the claim. Details including all photos, videos, receipts, witness information, police reports, medical receipts, x-rays, body shop where their vehicle was towed to and a summary of what happened are the details needed to start the claim. It will be extremely important for the claimant to be as specific as possible when reporting their claim to their insurance company.

Most insurance agencies offer an online portal for claimants to file their report. The ability to load all documentation into one electronic system reduces the time of the claim process and cuts down on the back-and-forth emails between the Accredited Claims Adjuster and the claimant. Once the claim has been filed, meaning all documentation is reported to the insurance company an adjuster will be assigned. We recommend claimants wait a few days to hear from the adjuster or if filed using an online portal, claimants should check the portal often for alerts and messages.

In the event a claimant does not hear back from their adjuster acknowledging receipt of all claim information, it is the responsibility of the claimant to call their insurance company and follow up. Sometimes this can happen where claimants don’t hear back from their car insurance adjuster in a timely manner. To keep the claim process moving and so the claimant can be “whole” again (put back in the state prior to their accident), they will want to reach out to their insurance agency. It’s fair for the claimant to question their Accredited Claims Adjuster about the long lag time in communication. The claimant should not feel threatened by their insurance company for placing a phone call to report the delay in communication nor should they feel like they will be dropped from their insurance company for filing a claim. It is the claimant’s responsibility to monitor their claim process and ensure it is moving forward in a timely manner. There are thousands of claims reported daily to insurance companies. To ensure a claimant’s claim does not get overlooked, it is recommended they stay in constant communication with their insurance company.

The Accredited Claims Adjuster, what are their responsibilities?


As an Accredited Claims Adjuster their job as an All-Lines Adjuster is to carefully review all information submitted as part of the claim. They are responsible for reaching back out to the claimant to verify their understanding of the claim and that all information (photos, medical documents, videos, police report, etc.) is submitted.
Once the ACA reviews the claim it is their responsibility to contact the body shop/collision center and assess the damage. In the event the All-Lines Adjuster/ACA cannot physically review the damages in person, they will need to rely on all photos and videos submitted by the claimant. This is why submitting footage of the damage is critical in getting a fair claim review. The adjuster may reach back out to the claimant after reviewing the photos, videos and police report to confirm their understanding of what happened. Once the assessment is made it is up to the ACA to assess the value of the vehicles and compare it to the cost for repairs.

Whose responsibility is it to determine if the vehicle is a total loss?


It is the responsibility of the ACA to assess the vehicle value compared to the cost for repairs. Typically, a vehicle will be declared a “total loss” when the cost to repair the vehicle exceeds 80% of the vehicle value. If a claimant’s vehicle is considered a total loss the insurance company will pay the claimant the actual cash value of the vehicle but no more than the policy limit allows.

What happens if the claimant disagrees with the assigned vehicle value?


Is it certainly up to the claimant to ask for a second evaluation for the vehicle value if they feel the vehicle is worth more. Be aware, however, the policy limit will act as a ceiling in that claimants cannot receive reimbursement greater than their policy limit.

Who is responsible for the next steps once the claim has been determined?


The Accredited Claims Adjuster will communicate with the claimant on the status of the claim if it’s a total loss or the vehicle will be repaired. There is usually a different department that handles sending the claimant their reimbursement check for either the repairs or for the vehicle value. The ACA communicates with the accounts payable department for sending the reimbursement to the claimant.

Who is responsible for ensuring how the payment is received?


It is the responsibility of the claimant to double check the work of the ACA. The claimant will want to confirm the ACA has the right information for whom the check should be made payable to, make sure names are spelled right, the mailing address is correct, and the dollar amount is also confirmed. Another point to note is the payout options available. Some of the larger insurance companies offer a direct deposit payment option. If the claimant opts for a direct deposit payment, they should confirm with their insurance company that they have the correct account number, routing number and bank name.

If there are any delays in payment the claimant is responsible for following up with their insurance company. The electronic payment, direct deposit, is usually the fastest option.
This blog concludes our series on car accidents and working with Accredited Claims Adjusters. In our previous blogs we discussed car accidents and filing insurance claims, how an Accredited Claims Adjuster can help with auto accident claims and how to file an auto accident insurance claim.

If the world of insurance interests you or you are considering making a career change or you are looking to create additional revenue streams we invite you to contact us about our Accredited Claims Adjuster designation program. We offer the best ACA designation course. When you pass our designation course you are eligible for your All Lines Adjuster license and no state exam is required. Our affordable 40-hour online course allows people the flexibility to work full-time while earning their designation. We invite you to contact us today at 800-309-2549 for more information.
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