For an insurance company and its representatives to be ethical, they must believe in and practiceintegrity and the principle of indemnification.

That's what insurance is about: restoring to wholeness thefirst- or third-party person(s) who have suffered loss that iscovered within the policy contract, or owed under the law.

Doing that requires both initiative and imagination. When facedwith a new and difficult kind of claim, a good adjuster will beexcited to solve it and prepared to delve intothe facts of the loss.

I recall my first explosion claim which involved an insuredcontractor building a dock in the Florida Keys, who had blastedaway a mass of coral rock in order to build a side to the jetty. Alittle over a quarter of a mile away was a condominium, and all theresidents were claiming cracks in their foundations and walls fromthe blasting.

A little booklet in the office on explosions said that realblast damage was supposed to have a “shattered” appearance, withlittle hairline cracks running in various directions. Settlementcracks were different — they tended to follow the inside framing ofthe structure. On first inspection, these cracks did not fit thepattern for blast damage, and they did not appear new. Litigationwas being threatened, and the hard-headed Yankees who owned theunits and ran the association were not about to take “No!” for ananswer.

The right expert can provide critical information to verifyor invalidate a claim. (Photo: Shutterstock)

Finding an expert

There was no internet then, just phone books. (For readers under25, those are big, thick yellow books with everyone's address andphone number in it.) Asking around, I finally found a vibrationengineer.

We met, and he gave me a long list of information he would need:the exact distance from the blast site to the condominium, what theground beneath the soil between the two comprised, (it was coralrock covered with half a foot of sand, with top soil above it) andthe velocity of each shot made by the contractor, plus the exactformula of the material used in each blast.

He even wanted to know the weather and exact temperature at thetime of the blasts. I called the insured, met with him at the dock,and took the longest recorded statement I'd ever taken.Transcribed, it was at least 15 pages.

A few days later I met with the engineer and we went over thestatement and examined, photographed and measured the cracks. Heshowed me some physics formula, which I copied and put in my reportto the insurer. In short, the cracks were not “blast damage,” andwe would be able to prove it in court. We then met with thecondominium association president, presented our evidence anddenied his claim. He was unhappy, but no lawsuit was everfiled.

The value of investigation

Not every claim is a “fender bender” or “stolen bicycle,”although there are enough of those. An adjuster has to follow whatRudyard Kipling said was the motto of the mongoose: “Go, and findout!”

On serious claims one does more than just get a police or firedepartment report; investigation requires getting the photos, theautopsies, the full description of the stolen items, plus whateverinformation is needed. An adjuster must be a sleuth, digging like acharacter in a Damon Runyon detective story to find the truth ofeach claim. It can't easily be done from behind a computerscreen.

Adjusting claims is one of the most exciting and enjoyableprofessional vocations anyone can find. But it requires acommitment of ingenuity and the use of imagination to do the jobcorrectly and reach the right solution. Curiosity may, as thesaying goes, “kill the cat,” but a lack of it will certainly killthe professional adjuster's job.

Ken Brownlee, CPCU, is a former adjuster and risk managerbased in Atlanta, Ga. He now authors and edits claims-adjustingtextbooks. Opinions expressed are theauthor's own.