Who’s Who in an Insurance Claim?

On the insurance side

• Claims adjuster — investigates and evaluates a claim. Depending on the claim and their authority, an adjuster may interview you and witnesses, review police reports, inspect damage, decide whether the policy covers the loss, negotiate, and authorize payment.
• Liability, bodily injury (BI), PIP and total-loss adjusters — job labels for the part of a claim an adjuster handles: who is responsible for the accident (liability), injuries to other people under liability coverage (BI), benefits under your own policy’s personal injury protection (PIP), or settling a car that isn’t worth repairing (total loss). These labels vary by company. They are not licensing categories.
• Auto-damage appraiser — inspects the damaged car and estimates the cost of repairs. An appraiser estimates damage; they don’t decide who caused the accident.
• Subrogation adjuster — works on getting money back from another party or insurer after a loss has been paid or recovery rights otherwise exist. Recovery is not guaranteed.
• SIU investigator — part of an insurer’s Special Investigative Unit, which takes a closer look at claims where fraud is suspected. A referral is not proof of fraud.
• Claims examiner — reviews claims to check that guidelines were followed, and may authorize payment, deny the claim or refer it to an investigator.
• Independent adjuster — usually a contractor hired to handle claims for an insurer, not one of its regular employees. “Independent” does not mean they represent you. (A public adjuster is different: one is hired by the policyholder.)
• Third-party administrator (TPA) — a person or company hired to investigate and process claims. A TPA is not the policyholder or the insurer, so the company handling your claim is not necessarily the insurer. For example, a business that pays its own auto claims (self-insured) may hire a TPA to process them.
• Rideshare claims administrator — an Uber or Lyft claim may be handled by an insurer, claims administrator or insurance representative whose name differs from the app’s. How to verify who has your claim.

Around the car

• Body-shop estimator — works for or with the repair shop and estimates the repair from the shop’s side. A shop’s estimate is not a coverage or fault decision.
• Rental company — provides the rental car. Whether insurance pays for it is a separate question. When the at-fault insurer has to pay.
• Tow or storage facility — moves and stores the car and charges for it. The facility’s bill and an insurer’s agreement to pay it are different questions. Who pays towing and storage.

On the legal side

• Your lawyer (claimant’s attorney) — represents you in your claim. What happens after you hire one.
• Defense attorney — defends the person being sued. If you are the one sued, your insurer may provide this lawyer. What that means.
• Paralegal — trained to support legal work under a lawyer’s supervision. A paralegal is not a substitute for the lawyer.

Three jobs that are easy to mix up

• Appraiser: estimates the damage to the car.
• Liability adjuster: works on who is responsible for the accident.
• Body-shop estimator: estimates the repair for the shop.

They are three different jobs. A damage estimate, from either side, is not a decision about fault.

Do I need a lawyer for my car accident claim? →Why are PIP and bodily injury claims open at the same time? →