A changing role

In the FAnews June 2014 edition, a disgruntled broker wrote an article titled Loss adjusters and assessors: a changing role, which highlighted the concern that the more claims loss adjusters or assessors repudiate, the more likely the insurer is to reappoint that particular loss adjuster or assessor to a new case, says Alan Blem of the Associated Loss Adjusters.

The role of a professional loss adjuster and certainly a Member of the Institute of Loss Adjusters of Southern Africa, is to act as an independent adjudicator in the settlement of claims, by providing his or her principals with sufficient information to determine matters of indemnity, liability, values at risk and technical detail, in order for a financial settlement to be reached.

A loss adjuster is a responsible and often highly qualified individual, who is governed by a Code of Conduct which requires that he or she must, at all times, preserve independence and integrity and promote public confidence in the profession by showing the highest standards of professional skills and ethics.

Settling the claim

Ideally, the various parties engaged in the arrangement and implementation of the contract should be regarded as a team consisting of the broker, who secures the business on behalf of the insurer or underwriter, the insurer or underwriter who underwrites the business and the loss adjuster or claims negotiator, who is tasked with settling the claim and interpreting the policy.

It has often been stated that since the loss adjuster is paid by the insurer or underwriter, there can be no question of his or her impartial dealing with the claim as the primary duty of the loss adjuster or assessor is to protect the interests of his principal. This however, overlooks the fundamental principal of good faith on which the policy of insurance is based and ignores any professional ability.

Loss adjusters and assessors do not repudiate claims; insurers and/or underwriters repudiate claims based on the merits and cover elected, and to infer that an adjuster’s appointment to a new claim is exponential to the number of favorable recommendations made on behalf of insurers and/or underwriters is incorrect and there is no doubt in my mind that insurers and/or underwriters have, and will continue to appoint an adjuster on a specific matter based on their technical expertise.