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Claims Adjusters, Appraisers, Examiners, and Investigators

Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims. They decide whether an insurance company must pay a claim, and if so, how much. Show Details

Duties

Claims adjusters, appraisers, examiners, and investigators typically do the following:

  • Investigate, evaluate, and settle insurance claims
  • Determine whether the insurance policy covers the loss claimed
  • Decide the appropriate amount the insurance company should pay
  • Ensure that claims are not fraudulent
  • Contact claimants’ doctors or employers to get additional information on questionable claims
  • Confer with legal counsel on claims when needed
  • Keep claims files, such as records of settled claims and an inventory of claims requiring detailed analysis
  • Negotiate settlements
  • Authorize payments

What insurance adjusters, examiners, and investigators do varies by the type of insurance company they work for. They must know a lot about what their company insures. For example, workers in property and casualty insurance must know housing and construction costs to properly evaluate damage from floods or fires. Workers in health insurance must be able to determine which types of treatments are medically necessary and which are questionable. 

Some claims adjusters work as self-employed public adjusters.

Often, they are hired by claimants who prefer not to rely on the insurance company’s adjuster. The goal of adjusters working for insurance companies is to save as much money for the company as possible. The goal of a public adjuster working for a claimant is to get the highest possible amount paid to the claimant.

Sometimes, self-employed adjusters are hired by insurance companies in place of hiring adjusters as regular employees. In this case, the self-employed adjusters work in the interest of the insurance company.

Adjusters inspect property damage to determine how much the insurance company should pay for the loss. The property they inspect could be a home, a business, or an automobile.

They interview the claimant and witnesses, inspect the property, and do additional research, such as look at police reports. Adjusters may consult with other workers, such as accountants, architects, construction workers, engineers, lawyers, and physicians, who can offer a more expert evaluation of a claim.

They gather information—including photographs and statements, either written or recorded audio or video—and put it in a report that claims examiners use to evaluate the claim. When the examiner approves policyholder's claim, the claims adjuster negotiates with the claimant and settles the claim.

If the claimant contests the outcome of the claim or the settlement, adjusters work with attorneys and expert witnesses to defend the insurer's position.

Appraisers estimate the cost or value of an insured item. Most appraisers who work for insurance companies and independent adjusting firms are auto damage appraisers. They inspect damaged vehicles after an accident and estimate the cost of repairs. This information then goes to the adjuster, who puts the estimated cost of repairs into the settlement.

Claims examiners review claims after they are submitted to ensure that proper guidelines have been followed by claimants and adjusters. They may assist adjusters with complicated claims or when, for example, a natural disaster occurs and the volume of claims increases.

Most claims examiners work for life or health insurance companies. Examiners who work for health insurance companies review health-related claims to see whether the costs are reasonable, given the diagnosis. After they review the claim, they authorize appropriate payment, deny the claim, or refer the claim to an investigator.

Examiners who work for life insurance companies review the causes of death and pay particular attention to accidents, because most life insurance companies pay additional benefits if a death is accidental. Examiners also may review new applications for life insurance policies to make sure the applicants have no serious illnesses that would make them a high risk to insure.

Insurance investigators handle claims in which the company suspects fraudulent or criminal activity such as arson, staged accidents, or unnecessary medical treatments. The severity of insurance fraud cases varies, from claimants overstating vehicle damage to complicated fraud rings. Investigators often do surveillance work. For example, in the case of a fraudulent workers’ compensation claim, an investigator may covertly watch the claimant to see if he or she does activities that would be ruled out by injuries stated in the claim.

Occupational Health and Safety Specialists

Occupational health and safety specialists analyze many types of work environments and work procedures. Specialists inspect workplaces for adherence to regulations on safety, health, and the environment. They also design programs to prevent disease or injury to workers and damage to the environment. Show Details

Duties

Occupational health and safety specialists typically do the following:

  • Identify chemical, physical, radiological, and biological hazards in the workplace
  • Collect samples of potentially toxic materials for analysis
  • Inspect and evaluate workplace environments, equipment, and practices to ensure that safety standards and government regulations are being followed
  • Recommend measures to help protect workers from potentially hazardous work conditions
  • Investigate accidents to identify their causes and to determine how they might be prevented in the future

Occupational health and safety specialists, also known as occupational safety and health inspectors, examine lighting, equipment, ventilation, and other conditions that could affect employee health, safety, comfort, and performance. Workers usually are more alert and productive in environments that have specific levels of lighting or temperature.

Specialists seek to increase worker productivity by reducing absenteeism and equipment downtime. They also seek to save money by lowering insurance premiums and workers’ compensation payments and by preventing government fines. Some specialists develop and conduct employee safety and training programs. These programs cover a range of topics, such as how to use safety equipment correctly and how to respond in an emergency.

Specialists work to prevent harm not only to workers but also to property, the environment, and the public by inspecting workplaces for chemical, radiological, and biological hazards. Specialists who work for governments conduct safety inspections and can impose fines.

Occupational health and safety specialists work with engineers and physicians to control or fix potentially hazardous conditions or equipment. They also work closely with occupational health and safety technicians to collect and analyze data in the workplace. For more information, see the profile on occupational health and safety technicians.

The tasks of occupational health and safety specialists vary by industry, workplace, and types of hazards affecting employees.

Environmental protection officers evaluate and coordinate storing and handling hazardous waste, cleaning up contaminated soil or water, and other activities that affect the environment.

Ergonomists consider the design of industrial, office, and other equipment to maximize workers' comfort, safety, and productivity.

Health physicists work in locations that use radiation and radioactive material, helping to protect people and the environment from hazardous radiation exposure.

Industrial hygienists identify workplace health hazards, such as lead, asbestos, noise, pesticides, and communicable diseases.

Loss prevention specialists work for insurance companies. They inspect the facilities that are insured and suggest improvements to prevent losses.

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