Understanding The Insurance Company Bureaucracy

If you are trying to negotiate your claim with the insurance company, then you may be wondering:

Why does the settlement process have to be so difficult?
Why is the insurance company being so blatantly unreasonable?
Why is the adjuster dragging his feet?

The simplest (and, no doubt, most frustrating) answer to all of these questions is: “That’s the way insurance companies do business.” Most large, national insurance carriers are giant bureaucracies, in which every decision must be documented and approved up the chain of command. While the specific terminology may vary from one company to another, here is an overview of the insurance company hierarchy, starting at the top:

The Home Office:

The insurance company’s “ivory tower.”

The Regional Office:

1. Regional managers are responsible for supervising the local claims offices in a particular region.
2. Regional managers deal with coverage issues, claims that exceed the reserves or policy limits, and other complex issues.

The Local Claims Office:
Claims Manager

1. Runs the local office.
2. Ensures that Claims Supervisors and Claims Adjusters follow the carrier’s established settlement practices.
3. Monitors all claims handled in the office.
4. Monitors all lawsuits.
5. Protects the bottom-line, especially with regard to the multitude of small-to-medium-sized cases being handled by the office.

Claims Supervisors

1. Local office “middle management.” They report directly to the Claims Manager and supervise the Claims Adjusters.
2. Assign claims to Adjusters for investigation and day-to-day handling.
3. Set “reserves.” The “reserve” is the estimated cost of the claim to the insurance company. It is the amount the company sets aside (or “reserves”) to pay the claim.

Claims Adjusters

1. Report to Claims Supervisors.
2. Responsible for day-to-day handling of claims, including interviewing the insured and the injured claimant; reviewing medical records; and negotiating a settlement.
3. Is rewarded, with promotions and employment perks, for settling cases in an amount that costs the insurance company as little as possible.
4. Typical caseload: 150-200 claims!

Intentionally or not, overworked claims adjusters tend to ignore and/or take advantage of claimants who are not represented by counsel. If you are frustrated by your dealings with the adjuster, please call us. We would be happy to talk with you about the claims process and, if you would like, to schedule a time for you to come to our office for a more in-depth, consultation – at no cost and no obligation to you.