The role of the insurer’s loss adjuster is often viewed critically, especially regarding their independence. You may wonder whether these experts truly work neutrally or primarily serve the insurer’s interests. In this blog post, we examine the legal frameworks and professional codes of conduct that a loss adjuster affiliated with the insurer must comply with.
In addition, we highlight practical aspects and case law that provide insight into the independence of these experts in claims handling and settlement. It is essential that you know what to expect from an insurer’s loss adjuster and what rights you have as an insured party in the event of a claim. This allows you to take an informed position in what is often a complex situation.
What is the role of an insurer’s loss adjuster?
A loss adjuster acting on behalf of the insurer plays a crucial role in determining the extent and cause of the damage. This expert carefully assesses the submitted claims and determines the extent to which the insurance agreement provides coverage. The goal is an objective and accurate assessment, so that both the insured and the insurer receive a fair judgment.
During the claims process, the expert investigates the damage on-site, collects evidence, and analyzes the relevant documents. Based on this, they prepare a report with the total damage value. This report forms an important starting point for the settlement of the claim. If you have doubts about the correctness of the judgment, it is advisable to seek legal advice from an insurance law attorney.
The role of the loss adjuster is essential to prevent misunderstandings and unjustified claims. Although the expert works on behalf of the insurer, they must perform their task objectively and expertly. In this way, they contribute to a transparent and fair handling of insurance matters.
Is the insurer’s expert truly independent?
Are you submitting a claim? The insurer may then engage an expert to assess the damage. The question is often whether this expert is truly independent, because the insurer pays them. Although the expert is formally supposed to be independent, the relationship with the insurer can sometimes play a role in practice. This can affect the insured’s trust.
Regulations and professional codes guarantee independence. Experts must adhere to objective standards and report carefully. Nevertheless, reports can turn out in the insurer’s favor, for example, through strict valuations of damage items. You have the right to appoint a counter-expert when you doubt the findings, so that your interests are also well represented.
Do you have doubts? Then seek legal advice. This prevents you from unjustly settling for too low a compensation. An independent expert can help obtain a fairer assessment and restore trust in the process.
How does an investigation by the loss adjuster proceed?
Are you reporting damage to your insurer? The insurer typically engages a loss adjuster to determine the nature and extent. The expert first contacts you for an appointment. During the inspection, they visit the site to carefully assess the situation. They map out possible causes and consequences and examine the condition of the object prior to the loss event.
Next, the loss adjuster takes photos and measurements and collects other relevant documentation. Based on that, they prepare a report with their findings and an estimate of the repair costs. This report forms the basis for the handling of your claim and is shared with the insurer and, if applicable, with you as the insured.
Finally, the loss adjuster discusses their conclusions with you and provides advice on next steps. If necessary, they conduct additional investigations or consult specialists. The goal is always an objective and reliable assessment that can be used to determine a fair compensation.
What if you disagree with the expert report?
Do you disagree with the expert report? Study the report carefully and note which points you dispute. A well-substantiated response increases the chance of reconsideration. In many cases, you can file an objection within a certain period. Clearly state why you do not accept the report.
If possible, add additional evidence or independent expert reports to your objection. This shows that your position is well-founded and allows you to better conduct the discussion with the insurer or other involved parties. In complex matters, legal assistance is advisable.
For filing a formal objection against the insurer, you can find more information at objection against insurer. This helps you protect your rights and effectively represent your interests when you disagree with the expert report.
The right to a counter-expertise explained
Do you disagree with an expert report, for example, in a claim or insurance matter? Then you often have the right to a counter-expertise. This is an independent second assessment to verify the accuracy of the original report. The goal is an objective and fair outcome in which all parties can have confidence.
Please note: this right does not always apply automatically. Sometimes it must be explicitly stated in the insurance agreement or general terms and conditions. The costs of the counter-expertise can usually be divided between the insured and the insurer, depending on the outcome. Do you feel you are not being treated well? Then turn to the Kifid, the Financial Services Complaints Institute, for mediation and dispute resolution.
A counter-expertise can limit discussions about damage or value. Ensure that you are well informed in advance about your rights and obligations. This prevents unnecessary costs and delays. Always consult the conditions of your policy and, if necessary, consult a legal advisor to safeguard your position.
Who pays the costs of a counter-expert?
Do you have a dispute where an expert report is important? Then a counter-expert may be needed to critically assess the initial findings. The costs can be significant, so it is important to know who ultimately bears them.
In the case of indemnity insurance, the reasonable costs necessary to determine the damage can be borne by the insurer under Article 7:959 of the Dutch Civil Code (Burgerlijk Wetboek, BW). Depending on the circumstances, this can include the costs of a counter-expert. Sometimes the insured pays the expert first; this does not change the fact that reimbursement can subsequently be raised directly with the insurer. Inform the insurer in advance and properly document the assignment and cost estimate.
If you lose the proceedings? Then there is a chance that you will have to bear the costs of the counter-expert yourself. Therefore, seek advice in advance about the feasibility and financial consequences. This prevents unexpected costs and leaves you better prepared.
Legal steps after a rejected claim
A rejected claim is understandably disappointing. First, thoroughly investigate on what grounds the rejection is based. Additional documentation or further explanation can strengthen your case. Contact your insurer for clarification and possible reconsideration.
Does the insurer stick to the rejection and do you consider it unjustified? Then consider legal steps. You can submit the dispute to the disputes committee of the trade association or, if necessary, start proceedings in court. Legal advice increases your chance of a favorable outcome.
For more information about possible procedures and your rights as a consumer, we refer you to rechtspraak.nl. Here you will find extensive information about the handling of legal disputes in the Netherlands and the steps to get your claim recognized after all.
Frequently Asked Questions
Can I refuse my insurer’s loss adjuster?
No, you are generally obliged to cooperate with the insurer’s investigation. However, you can subsequently engage your own counter-expert if you disagree with the insurer’s findings.
Is a counter-expertise always reimbursed by the insurer?
In most cases, yes. The law stipulates that the reasonable costs for determining the damage are borne by the insurer. Always consult your policy conditions for the exact regulations and any exceptions.
What is the role of the Kifid in a dispute about damage assessment?
If you cannot reach an agreement with the insurer and the experts, you can file a complaint with the Kifid. They independently assess whether the insurer has adhered to the rules and conditions when settling your damage.
Read also
- Rejection of damage by insurer – what can you do?
- Claim rejected after damage investigation – what now?
- Filing a complaint with the Kifid – your rights, step-by-step plan and tips
Need help?
Do you have a dispute with your insurer about the assessment of the damage or do you doubt the independence of the engaged expert? The specialists at Arslan & Arslan Advocaten are ready to assist you. We have extensive experience in insurance law and are happy to help you further. Contact us for a free initial consultation and discover what we can do for you in your specific situation.