What Is An Insurance Adjuster? Texas Law

In Texas, an insurance adjuster is a person who acts on behalf of the insured to pay benefits under an insurance policy. These individuals, also known as claims adjusters, investigate an insurance claim to determine if a claim falls under the policy coverage, and if so, how much should be paid to a claimant.

As an example, if you're struck by a speeding vehicle and file an insurance claim against the at-fault motorist, his or her insurance company will assign a claims adjuster to verify coverage and the extent of your damages. 

What Is the Role of an Insurance Adjuster?

Insurance adjusters are responsible for conducting accident investigations, calculating damages, and negotiating settlements for insurers and insurance companies.

These adjusters inspect all of the pieces of evidence in an accident such as property damage, bodily injuries, police reports, and witness accounts to determine the monetary amount that the claimant should receive. If the claimant was at fault for causing the accident, the adjuster will decide whether the insurance company will pay for the claim or not.

The adjuster reviews the damages and compares them to the claimant’s policy coverage to determine what is covered and what is not. After the adjuster calculates an estimated sum, they present it to the claimant for it to be reviewed and possibly negotiated. The adjuster will then file a report with the claimant’s insurance company about their investigation and the settlement amount they calculated. Insurance adjusters handle many types of claims including:

• Auto accidents

• Catastrophe claims

• Medical malpractice

• Slip and fall accidents

• Construction injuries

• Animal attacks

• Property damage

• Defective products claims

Insurance adjusters do not always calculate damages correctly, even in cases involving significant medical bills, so it’s important to consult with an attorney to ensure you get the proper compensation amount for your damages. Call (866) 434-0014 to speak with an experienced Sneed and Mitchell attorney today.

What Types of Insurance Adjusters Are Involved In The Personal Injury Process?

There are various types of personal injury insurance adjusters who have different goals and responsibilities. These insurance adjusters consist of:

First-Party Insurance Adjusters

First-party insurance adjusters collaborate directly with policyholders to review and resolve the claims they file with the adjuster’s insurance company. The goal of first-party insurance adjusters is to represent the claimant while also adhering to the insurance policies and standards to determine an appropriate settlement amount for their damages. 

Personal Injury Protection (PIP) Adjuster

A personal injury protection adjuster manages a claimant’s car accident claim so they can receive financial assistance for their medical bills and lost wages after an accident. The adjuster determines the validity and accuracy of the damages to ensure they are correctly filed. 

A personal injury protection (PIP) plan is a no-fault insurance plan, meaning it provides medical coverage to the insured and anyone else in the car with them at the time of the accident, despite who was responsible for causing it. Some states require all drivers to carry PIP, while others offer it as an option. If multiple people get injured in an accident with a PIP policyholder, the insurance adjuster will investigate each person’s damages to determine the proper amount of compensation to give them. 

Property Adjuster

A property adjuster inspects damages that have occurred on a claimant’s property due to a natural disaster or other type of accident to calculate how much the insurance will pay for each item damaged. A person’s property can be damaged by storms, fires, arson, and theft, which are all investigated by the adjuster after a claim is filed. Property adjusters are knowledgeable about repair processes and often use special software to help them examine the degree to which an object on a property is harmed. 

Liability Adjusters

Liability adjusters investigate claims to determine if and how much an insurance company is liable to pay for damages. This process often involves an assessment of the claimant’s role in the accident to discover their percentage of liability. Third parties who were involved in an accident with the claimant are also investigated as well.

Bodily Injury (BI) Adjuster

A bodily injury adjuster examines a claimant’s physical injuries to determine what caused them and how much they affect the claimant’s daily life. Their goal is to discover whether the injuries resulted from the claimant’s accident or if they were pre-existing conditions. Bodily injury adjusters analyze medical records and documents, evaluate police reports, gather witness statements, and study the scene of the accident to determine how much compensation the claimant can receive. They also implement factors such as lost wages and the claimant’s ability to receive future wages when calculating compensation. 

Private Investigators

Private investigators are often employed by insurance companies to perform background checks on claimants to observe their activities after an accident in an attempt to identify inconsistencies with their injury claims. For example, if a claimant stated that they injured their leg but then posted themself running a marathon two days later, then it can be concluded that they exaggerated or lied about their injury. While private investigators do extensive research and digging on claimants, they are still required to obey privacy laws.

Other Adjusters You May Encounter

If you were involved in an accident, you will most likely work with the other party’s insurance adjuster who will examine and investigate your claim on behalf of their insurance company. These adjusters may ask you questions about what you were doing at the time of the accident, exactly how you obtained your injuries, and how the injuries have affected you. The goal of these investigations is to determine your percentage of liability in the accident.

Insurance Adjusters Do Not Work for Injury Victims

Insurance adjusters do not represent or protect injury victims but rather work for the best interest of the insurance company that employs them. Most insurance companies share a common goal which is to save the most money possible on claims. To fulfill this goal, insurance companies hire adjusters to use their investigation methods to find ways to reduce a claimant’s compensation. They often use pressure tactics to persuade injury victims into settling on an amount that is much lower than what they deserve.

If you were involved in an accident and need protection against an insurance adjuster, you can call an experienced attorney at (866) 434-0014. At Sneed and Mitchell, we use our knowledge of the legal system to ensure that insurance companies and adjusters abide by the law and provide you with the correct and fair amount of compensation

What Unethical Tactics Do Insurance Adjusters Use to Refute Claims? 

Although the Texas Department of Insurance has a Code of Ethics that adjusters are required to follow , Insurance adjusters tend to use devious tricks to manipulate claimants’ situations by making their claims seem lower in value than they really are. They may even persuade claimants into believing their claim is not worth pursuing at all. The tactics that many insurance adjusters use include:

Blaming You for the Accident

Insurance adjusters like to use the comparative negligence law to shift the blame onto the opposing party to deduct a certain percentage of their compensation. If a jury has enough proof to believe that a party is partially responsible for an accident, they will reduce their compensation by their percentage of fault. This method uses “proportionate responsibility” values which are meant to ensure that compensation is distributed fairly. However, insurance adjusters use it to their advantage to attempt to frame the opposite party in a negative light so the insurance company does not have to pay as much money toward the settlement.

The Fishing Expedition

When insurance adjusters ask a party broad questions, it typically indicates that the adjuster is fishing for an answer that can be used against them. It is important to not go into detail or overly explain things when answering their questions because it can lead to an accidental admission. Adjusters may also attempt to get a party to sign documents without fully reading the context so they consent to certain things. Insurance adjusters may attempt to provoke a party’s emotions, misinterpret their statements, or fish for specific answers to get them to act or speak in a certain way to exploit them.

Checking Your Social Media Accounts

Social media accounts are often checked by insurance adjusters because they provide insight into the personal lives of claimants. This insight can show what kind of extracurricular activities they participate in and how they are acting and feeling after the accident. For example, if a claimant posts on social media that they swam at a pool a few days after they claimed they could barely move, it might be inferred that they overemphasized or completely fabricated their injury story. If you were involved in an accident, be cautious about the things you post on social media to prevent accusations from occurring.

Requesting a Recorded Statement

It is never a good idea to agree to provide a recorded statement to an insurance adjuster without the attendance of a lawyer. The adjuster may pretend like the questions are innocent, but they are often laced with bad intentions. If they record your statement, they have the power to edit it, taking out certain words and inserting others in convenient places to completely change your statement’s meaning.

Using Your Own Words Against You

Insurance adjusters often ask carefully worded questions that are crafted to get a specific answer out of a claimant which can be used against them later. These questions are called “leading questions,” because they lead the person to either admit or deny an accusation. Open-ended questions are also used by insurance adjusters in hopes that the person will give them enough elaborate details that can be picked apart and reexamined at a later time. The goal of both of these questions is to get the person to contradict themselves, admit to a fault, or provide information that can easily be misinterpreted.

Sending You a Premature Settlement Check

Insurance adjusters are known to offer settlement checks to claimants immediately following an accident, attempting to settle the issue before the claimants have a chance to understand the full value of their claim. This settlement check is typically very low in comparison to the actual amount that the claimant can receive. Recovering from an injury requires medical treatment and procedures that accumulate costs over time. These expenses can contribute to the settlement amount by increasing the claim’s value, which is why adjusters try to settle quickly to avoid additional damages being accrued. Once a settlement check is accepted, the claimant can no longer pursue further compensation, regardless of the discovery of more injuries. 

Hiring A Private Investigator

Insurance adjusters may hire a private investigator to observe your daily activities to try to catch you performing in a way that contradicts your injury claims. They often conduct surveillance watches, background checks, and evidence investigations to determine how truthful and accurate a claim is. Although they must abide by the law’s privacy standards, they can still watch you from a distance, so be aware of the actions you take outside your home.

The Delay Game

Insurance adjusters often play the delay game with claimants by intentionally prolonging the settlement process in hopes that the claimants will grow impatient and accept the first offer given to them before their statute of limitations time is up. The first offer is typically very low compared to the actual amount they can get, and the adjuster knows this. They may take several days to respond to an important matter, make excuses to gain extra time, be unresponsive about claim updates, and say they need additional information from claimants to delay the claim’s success. 

Telling You “You Don’t Need an Attorney”

Insurance adjusters often discourage claimants from hiring an attorney, fully aware that legal representation would benefit them. They do this to avoid paying the full amount of economic and non-economic compensation on your claim. In general, it is always a good idea to hire an attorney to help you with your claim to ensure you get a fair and accurate amount of compensation.

Insurance Adjusters and the Settlement Process

Insurance adjusters are typically pressured by the insurance companies they work for to settle large quantities of claims at the lowest amounts possible to increase the companies’ earnings. They are often given 50 to 100 claims each month that are expected to be resolved rapidly without supervision. This pressure often leads adjusters to hastily process claims, resulting in unfair settlement offers.

Rather than thoroughly analyzing each claim, they settle for a generic understanding of them without the full scope of the facts. This lack of insight can significantly impact the compensation a claimant receives, as adjusters may fail to recognize the claim’s full value.

Frequently Asked Questions

Can an insurance adjuster in Texas deny a claim? If so, on what grounds?

Yes, insurance adjusters here Texas can deny a claim and for numerous reasons, some of which are not always valid. The most common reasons adjusters deny claims are a lack of coverage, the liable party failed to pay their premiums, or a finding of insufficient evidence to support the claim. Adjusters might also deny claims if believe that someone won't push back and find an attorney to litigate the case. A denial for any reason could be found unjust under Texas law.

How long does it typically take for an insurance adjuster to settle a claim in Texas?

The time it takes for an insurance adjuster to settle a claim in Texas largely depends on the complexity of the case, whether medical treatment has ended, the type of insurance, and a number of other factors. In more straightforward cases, such as minor car accidents or property damage, settlements can often be reached within the first two weeks. However, more complex claims, such as those involving significant injuries, death, disputed liability, or extensive property damage, a resolution could take several months or longer.

Is there a time period in which insurance adjuster must resolve claims?

The standard time period established under Chapter 542 of the Texas Insurance Code only applies to first party claims. This act, known as the Texas Prompt Payment of Claims Act (TPPCA), requires insurance companies to acknowledge receipt of a new claim within 15 days and to accept or deny it within 15 business days if they have received all necessary documentation. If more time is needed for a further investigation, the insurance adjuster must notify the policyholder and provide updates every 45 days. Delays result in additional penalties.

For third party claims, adjusters are only tied to the deadlines that attorneys set through use of a demand letter. Use to a Stower's Demand, or standard demand letter, force insurance companies to either appropriately resolve the matter, or be subjected to the litigation process.

What should I do if I disagree with the settlement offer from an insurance adjuster in Texas?

If you disagree with the settlement amount offered by a claim adjuster, you should have the claim reviewed by a legal professional. Attorneys have extensive experiencing calculating fair settlements for property and bodily claims and can structure a counter offer with solid evidence and valid justification for additional compensation. Attorneys also have expert witnesses that can draft reports to support your entitlement to higher suns. These experts often include economists, surgeons, therapists, nurses, and more.

What happens if I reject a settlement offer from the insurance adjuster?

When a settlement offer from an insurance adjuster is rejected, negotiations continue, allowing you to present a counteroffer with evidence like medical bills or repair estimates, or risk the offer being withdrawn. However, you should have an attorney handle the negotiations moving forward. Attorneys use demand letters that help a claims settle or mediate, and also carry the threat of a civil lawsuit against the at-fault party. Oftentimes, being a plaintiff in a civil lawsuit is the best way to force an insurance company into compliance. Any accepted offer should covers your medical expenses, property damage, pain and suffering and more.

The insurance adjuster is asking for recorded call, what should I do?

If an insurance adjuster requests a recorded statement, don’t agree without legal advice. Their goal is to minimize your compensation by creating inconsistencies, downplaying injuries, or uncovering information to use against you. You are not required to provide a statement to the other driver’s insurer, and even your own insurance company isn’t fully on your side. Always consult an attorney first. A lawyer can prepare a clear, factual response or handle the insurer directly. Instead of a recorded statement, consider a written one after legal review. Once recorded, your words are permanent, protect your rights before speaking.

Why is the insurance adjuster asking me for a recorded statement?

Insurance adjusters ask for recorded statements to secure details about an accident and determine liability, but their goal is often to minimize payouts. Insurers often use your words to identify inconsistencies, downplay injuries, or dispute a claim. If you file a claim with another party’s insurer, you are not required to provide a recorded statement. Your own policy may require cooperation, but consulting a personal injury lawyer first is essential. Adjusters may ask misleading questions to reduce your settlement, so legal guidance ensures your statement remains factual and protects your rights.

Consult With An Experienced Personal Injury Attorney If You’re Dealing With an Insurance Adjuster

If you are dealing with an insurance adjuster, you should contact a personal injury attorney to ensure that the adjuster treats you fairly. Insurance adjusters may attempt to use manipulative tactics to extract information that can later be used against you or mislead you with false claims.

A personal injury attorney will be able to identify these tactics and put pressure on the adjuster to act legally and responsibly. If you need legal representation to protect you against an insurance adjuster, call (866) 434-0014 or fill out our online form to receive a free consultation of your case.