Claims Adjusters, Appraisers, Examiners, and Investigators
- Adjusters and examiners investigate insurance claims, negotiate
settlements, and authorize payments; appraisers assess the cost
or value of an insured item; investigators deal with claims
about which there is a question of liability and where fraud
or criminal activity is suspected.
- Licensing and continuing education requirements vary by State.
- College graduates have the best opportunities; competition
will be keen for jobs as investigators, because this occupation
attracts many qualified people.
Individuals and businesses purchase insurance policies to protect
against monetary losses. In the event of a loss, policyholders
submit claims, or requests for payment, seeking compensation for
their loss. Adjusters, appraisers, examiners, and investigators
work primarily for property and casualty insurance companies,
for whom they handle a wide variety of claims alleging property
damage, liability, or bodily injury. Their main role is to investigate
the claims, negotiate settlements, and authorize payments to claimants,
all the while mindful not to violate the claimant’s rights under
Federal and State privacy laws. They must determine whether the
customer’s insurance policy covers the loss and how much of the
loss should be paid to the claimant. Although many adjusters,
appraisers, examiners, and investigators have overlapping functions
and may even perform the same job, the insurance industry generally
assigns specific roles to each of these claims workers.
Adjusters plan and schedule the work required to process
a claim that would follow, for example, an automobile accident
or damage to one’s home caused by a storm. They investigate claims
by interviewing the claimant and witnesses, consulting police
and hospital records, and inspecting property damage to determine
the extent of the company’s liability. Adjusters may consult with
other professionals, such as accountants, architects, construction
workers, engineers, lawyers, and physicians, who can offer a more
expert evaluation of a claim. The information gathered, including
photographs and written or audio-taped or video-taped statements,
is set down in a report that is then used to evaluate the associated
claim. When the policyholder’s claim is legitimate, the claims
adjuster negotiates with the claimant and settles the claim. When
claims are contested, adjusters will work with attorneys and expert
witnesses to defend the insurer’s position.
Many companies centralize claims adjustment in a claims center,
where the cost of repair is determined and a check is issued immediately.
More complex cases, usually involving bodily injury, are referred
to senior adjusters. Some adjusters work with multiple types of
insurance; however, most specialize in homeowner claims, business
losses, automotive damage, or workers’ compensation.
Claimants can opt not to rely on the services of their insurance
company’s adjuster and may instead choose to hire a public adjuster.
These workers assist clients in preparing and presenting claims
to insurance companies and in trying to negotiate a fair settlement.
They perform the same services as adjusters who work directly
for companies; however, they work in the best interests of the
client, rather than the insurance company.
Claims examiners within property and casualty insurance
firms may have duties similar to those of an adjuster, but often
their primary job is to review the claims submitted in order to
ensure that proper guidelines have been followed. They may assist
adjusters with complex and complicated claims or when a disaster
suddenly greatly increases the volume of claims. Most claims examiners
work for life or health insurance companies. In health insurance
companies, examiners review health-related claims to see whether
costs are reasonable on the basis of the diagnosis. The examiners
are provided with guides that supply information on the average
period of disability, the expected treatments, and the average
hospital stay, for patients with the various ailments for which
a claim may be submitted. Examiners check claim applications for
completeness and accuracy, interview medical specialists, and
consult policy files to verify the information reported in a claim.
Examiners will then either authorize the appropriate payment or
refer the claim to an investigator for a more thorough review.
Claims examiners usually specialize in group or individual insurance
plans and in hospital, dental, or prescription drug claims.
In life insurance, claims examiners review the causes of death,
particularly in the case of an accident, because most life insurance
policies pay additional benefits if a death is accidental. Claims
examiners also may review new applications for life insurance
to make sure that the applicants have no serious illnesses that
would make them a high risk to insure and thus disqualify them
from obtaining insurance.
Another occupation that plays an important role in the accurate
settlement of claims is that of the appraiser, whose role
is to assess the cost or value of an insured item. The majority
of appraisers employed by insurance companies and independent
adjusting firms are auto damage appraisers. These appraisers
inspect damaged vehicles after an accident and estimate the cost
of repairs. This information is then relayed to the adjuster,
who incorporates the appraisal into the settlement. Auto damage
appraisers are valued by insurance companies because they can
provide an unbiased judgment of repair costs. Otherwise, the companies
would have to rely on auto mechanics’ estimates, which might be
Many claims adjusters and auto damage appraisers are equipped
with laptop computers from which they can download the necessary
forms and files from insurance company databases. Many adjusters
and appraisers use digital cameras, which allow photographs of
the damage to be sent to the company via the Internet. Many also
input information about the damage directly into their computers,
where software programs produce estimates of damage on standard
forms. These new technologies allow for faster and more efficient
processing of claims.
When adjusters or examiners suspect fraud, they refer the claim
to an investigator. Insurance investigators in an insurance
company’s special investigative unit handle claims in which the
company suspects fraudulent or criminal activity, such as arson,
falsified workers’ disability claims, staged accidents, or unnecessary
medical treatments. The severity of insurance fraud cases can
vary greatly, from claimants simply overstating the damage to
a vehicle to complicated fraud rings responsible for many claimants
and supported by dishonest doctors, lawyers, and even insurance
Investigators usually start with a database search to obtain
background information on claimants and witnesses. Investigators
can access certain personal information and identify Social Security
numbers, aliases, driver’s license numbers, addresses, phone numbers,
criminal records, and past claims histories to establish whether
a claimant has ever attempted insurance fraud. Then, investigators
may visit claimants and witnesses to obtain a recorded statement,
take photographs, and inspect facilities, such as doctors’ offices,
to determine whether the doctors have a proper license. Investigators
often consult with legal counsel and can be expert witnesses in
Often, investigators also perform surveillance work. For example,
in a case involving fraudulent workers’ compensation claims, an
investigator may covertly observe the claimant for several days
or even weeks. If the investigator observes the subject performing
an activity that is ruled out by injuries stated in a workers’
compensation claim, the investigator will take video or still
photographs to document the activity and report it to the insurance
Working environments of claims adjusters, appraisers, examiners,
and investigators vary greatly. Most claims examiners employed
by life and health insurance companies work a standard 5-day,
40-hour week in a typical office environment. Many claims adjusters
and auto damage appraisers, however, often work outside the office,
inspecting damaged buildings and automobiles. Adjusters who inspect
damaged buildings must be wary of potential hazards such as collapsed
roofs and floors, as well as weakened structures.
In general, adjusters are able to arrange their work schedules
to accommodate evening and weekend appointments with clients.
This accommodation sometimes results in adjusters working irregular
schedules or more than 40 hours a week, especially when they have
a lot of claims to investigate. Some report to the office every
morning to get their assignments, while others simply call in
from home and spend their days traveling to claim sites. New technology,
such as laptop computers and cellular telephones, is making telecommuting
easier for claims adjusters and auto damage appraisers. Many adjusters
work inside their office only a few hours a week, while others
conduct their business entirely out of their home and automobile.
Occasionally, experienced adjusters must be away from home for
days—for example, when they travel to the scene of a disaster
such as a tornado, hurricane, or flood—to work with local adjusters
and government officials. Adjusters often are called to work in
the event of such emergencies and may have to work 50 or 60 hours
a week until all claims are resolved.
Insurance investigators often work irregular hours because of
the need to conduct surveillance and contact people who are not
available during normal working hours. Early morning, evening,
and weekend work is common. Some days, investigators will spend
all day in the office, searching databases, making telephone calls,
and writing reports. Other times, they may be away, performing
surveillance activities or interviewing witnesses. Some of the
work can involve confrontation with claimants and others involved
in a case, so the job can be stressful and dangerous.
|Training, Other Qualifications, and Advancement
Training and entry requirements vary widely for claims adjusters,
appraisers, examiners, and investigators. Although many in these
occupations do not have a college degree, most companies prefer
to hire college graduates. No specific college major is recommended,
but a variety of backgrounds can be an asset. A claims adjuster
who, for example, has a business or an accounting background might
specialize in claims of financial loss due to strikes, breakdowns
of equipment, or damage to merchandise. College training in architecture
or engineering is helpful in adjusting industrial claims, such
as those involving damage from fires or other accidents. Some
claims adjusters and examiners apply expertise acquired through
specialized professional training to adjust claims. A legal background
can be beneficial to someone handling workers’ compensation and
product liability cases. A medical background is useful for those
examiners working on medical and life insurance claims.
Because they often work closely with claimants, witnesses, and
other insurance professionals, claims adjusters and examiners
must be able to communicate effectively with others. Knowledge
of computer applications also is extremely helpful. In addition,
a valid driver’s license and a good driving record are required
for workers for whom travel is an important aspect of their job.
Some companies require applicants to pass a series of written
aptitude tests designed to measure their communication, analytical,
and general mathematical skills.
Licensing requirements for these workers vary by State. Some
States have very few requirements, while others require either
the completion of prelicensing education or a satisfactory score
on a licensing exam. Fulfilling the requirements for earning a
voluntary professional designation may, in some cases, be substituted
for completing the exam. In some States, claims adjusters employed
by insurance companies can work under the company license and
need not become licensed themselves. Separate or additional requirements
may apply for public adjusters. For example, some States require
public adjusters to file a surety bond.
Continuing education in claims is very important for claims adjusters,
appraisers, examiners, and investigators, because Federal and
State laws and court decisions affect how claims are handled or
who is covered by insurance policies. Also, examiners working
on life and health claims must be familiar with new medical procedures
and prescription drugs. Some States that require licensing also
require a certain number of continuing education credits per year
in order to renew the license. These credits can be obtained from
a number of sources. Many companies offer training sessions to
inform their employees of industry changes. A number of schools
and associations give courses and seminars on various topics having
to with claims. Correspondence courses via the Internet are making
long-distance learning possible. Workers also can earn continuing
education credits by writing articles for claims publications
or by giving lectures and presentations. In addition, numerous
adjusters and examiners choose to earn professional certifications
and designations for independent recognition of their professional
expertise. Although requirements for these designations vary,
many entail at least 5 to 10 years of experience in the claims
field and the successful completion of an examination; in addition,
a certain number of continuing education credits must be earned
each year to retain the designation.
For auto damage appraiser jobs, insurance companies and independent
adjusting firms typically prefer to hire persons with experience
as an estimator for, or manager of, an auto body repair shop.
An appraiser must know how to repair vehicles in order to identify
and estimate damage, and technical skills are essential. While
auto damage appraisers do not require a college education, most
companies prefer to hire persons with formal training. Many vocational
colleges offer 2-year programs in auto body repair on how to estimate
and repair damaged vehicles. Some States require auto damage appraisers
to be licensed, and certification also may be required or preferred.
Basic computer skills are an important qualification for many
auto damage appraiser positions. As with adjusters and examiners,
continuing education is important because of the continual introduction
of new car models and repair techniques.
Most insurance companies prefer to hire former law enforcement
officers or private investigators as insurance investigators.
Many experienced claims adjusters or examiners also become investigators.
Licensing requirements vary among States. Most employers look
for individuals with ingenuity who are persistent and assertive.
Investigators should not be afraid of confrontation, should communicate
well, and should be able to think on their feet. Good interviewing
and interrogation skills also are important and usually are acquired
in earlier careers in law enforcement.
Beginning claims adjusters, appraisers, examiners, and investigators
work on small claims under the supervision of an experienced worker.
As they learn more about claims investigation and settlement,
they are assigned larger, more complex claims. Trainees are promoted
as they demonstrate competence in handling assignments and progress
in their coursework. Employees who demonstrate competence in claims
work or administrative skills may be promoted to more responsible
managerial or administrative jobs. Similarly, claims investigators
may rise to supervisor or manager of the investigations department.
Once they achieve a certain level of expertise, many choose to
start their own independent adjusting or auto damage appraising
Adjusters, appraisers, examiners, and investigators held about
263,000 jobs in 2004. Only 5 percent of these jobs were held by
auto damage insurance appraisers. Insurance carriers, agencies,
brokerages, and related industries, such as private claims adjusting
companies, employed more than 8 out of 10 claims adjusters, appraisers,
examiners, and investigators. Relatively few adjusters, appraisers,
examiners, and investigators were self-employed.
Employment of claims adjusters, appraisers, examiners, and investigators
is expected to grow about as fast as average for all occupations
over the 2004–14 period. College graduates have the best opportunities.
Numerous job openings also will result from the need to replace
workers who transfer to other occupations or leave the labor force.
Many insurance carriers are downsizing their claims staff in
an effort to contain costs. Larger companies are relying more
on customer service representatives in call centers to handle
the recording of the necessary details of the claim, allowing
adjusters to spend more of their time investigating claims. New
technology is reducing the amount of time it takes for an adjuster
to complete a claim, thereby increasing the number of claims that
one adjuster can handle. However, as long as more insurance policies
are being sold to accommodate a growing population, there will
be a need for adjusters, appraisers, examiners, and investigators.
Further, as the elderly population increases, there will be a
greater need for health care, resulting in more health insurance
Despite recent gains in productivity resulting from technological
advances, these jobs are not easily automated. Adjusters still
are needed to contact policyholders, inspect damaged property,
and consult with experts. Although the number of claims in litigation
and the number and complexity of insurance fraud cases are expected
to increase over the next decade, demand for insurance investigators
is not expected to grow significantly, because technology such
as the Internet, which reduces the amount of time it takes to
perform background checks, will allow investigators to handle
more cases. Competition for investigator jobs will remain keen
because the occupation attracts many qualified people, including
retirees from law enforcement and military careers, as well as
experienced claims adjusters and examiners who choose to get their
As with claims adjusters, examiners, and investigators, employment
of auto damage appraisers should grow about as fast as the average
for all occupations. Insurance companies and agents continue to
sell growing numbers of auto insurance policies, leading to more
claims being filed that require the attention of an auto damage
appraiser. The work of this occupation is not easily automated,
because most appraisals require an onsite inspection. However,
employment growth will be limited by downsizing in the insurance
industry and by the implementation of new technology that is making
auto damage appraisers more efficient. In addition, some insurance
companies are opening their own repair facilities, which may reduce
the need for auto damage appraisers.
Earnings of claims adjusters, appraisers, examiners, and investigators
vary significantly. Median annual earnings were $44,220 in May
2004. The middle 50 percent earned between $33,900 and $57,410.
The lowest 10 percent earned less than $27,220, and the highest
10 percent earned more than $72,620.
Many claims adjusters, especially those who work for insurance
companies, receive additional bonuses or benefits as part of their
job. Adjusters often are furnished a laptop computer, a cellular
telephone, and a company car or are reimbursed for the use of
their own vehicle for business purposes.
Median annual earnings of auto damage insurance appraisers were
$45,330 in May 2004. The middle 50 percent earned between $37,210
and $54,280. The lowest 10 percent earned less than $29,550, and
the highest 10 percent earned more than $63,220.
Property-casualty insurance adjusters and life and health insurance
examiners must determine the validity of a claim and negotiate
a settlement. They also are responsible for determining how much
to reimburse the client. Occupations similar to those of claims
adjusters, appraisers, examiners, and investigators include cost
estimators; bill and account collectors; medical records and health
information technicians; billing and posting clerks; credit authorizers,
checkers, and clerks; and bookkeeping, accounting, and auditing
In determining the validity of a claim, insurance adjusters must
inspect the damage in order to assess the magnitude of the loss.
Workers who perform similar duties include fire inspectors and
investigators and construction and building inspectors.
To ensure that company practices and procedures are followed,
property and casualty examiners review insurance claims to which
a claims adjuster has already proposed a settlement. Others in
occupations that review documents for accuracy and compliance
with a given set of rules and regulations are tax examiners, collectors,
and revenue agents, as well as accountants and auditors.
Insurance investigators detect and investigate fraudulent claims
and criminal activity. Their work is similar to that of private
detectives and investigators.
Like automotive body and related repairers and automotive service
technicians and mechanics, auto damage appraisers must be familiar
with the structure and functions of various automobiles and their
|Sources of Additional Information
General information about a career as a claims adjuster, appraiser,
examiner, or investigator is available from the home offices of
many insurance companies.
Information about licensing requirements for claims adjusters
may be obtained from the department of insurance in each State.
For information about professional designation and training programs,
contact any of the following organizations:
- American Institute for Chartered Property Casualty Underwriters
and the Insurance Institute of America, 720 Providence Rd.,
P.O. Box 3016, Malvern, PA 19355–0716. Internet: http://www.aicpcu.org/
- American College, 270 South Bryn Mawr Ave., Bryn Mawr, PA
19010–2196. Internet: http://www.theamericancollege.edu/
- International Claim Association, 1255 23rd St. N.W., Washington,
DC 20037. Internet: http://www.claim.org/
Source: Bureau of Labor Statistics,
U.S. Department of Labor, Occupational Outlook Handbook,