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

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

Doing that requires both initiative and imagination. When faced with a new and difficult kind of claim, a good adjuster will be excited to solve it and prepared to delve into the facts of the loss.

I recall my first explosion claim which involved an insured contractor building a dock in the Florida Keys, who had blasted away a mass of coral rock in order to build a side to the jetty. A little over a quarter of a mile away was a condominium, and all the residents were claiming cracks in their foundations and walls from the blasting.

A little booklet in the office on explosions said that real blast damage was supposed to have a “shattered” appearance, with little hairline cracks running in various directions. Settlement cracks were different — they tended to follow the inside framing of the structure. On first inspection, these cracks did not fit the pattern for blast damage, and they did not appear new. Litigation was being threatened, and the hard-headed Yankees who owned the units and ran the association were not about to take “No!” for an answer.

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

Finding an expert

There was no internet then, just phone books. (For readers under 25, those are big, thick yellow books with everyone's address and phone number in it.) Asking around, I finally found a vibration engineer.

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 the ground beneath the soil between the two comprised, (it was coral rock covered with half a foot of sand, with top soil above it) and the velocity of each shot made by the contractor, plus the exact formula of the material used in each blast.

He even wanted to know the weather and exact temperature at the time 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 the statement and examined, photographed and measured the cracks. He showed me some physics formula, which I copied and put in my report to the insurer. In short, the cracks were not “blast damage,” and we would be able to prove it in court. We then met with the condominium association president, presented our evidence and denied his claim. He was unhappy, but no lawsuit was ever filed.

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 what Rudyard Kipling said was the motto of the mongoose: “Go, and find out!”

On serious claims one does more than just get a police or fire department report; investigation requires getting the photos, the autopsies, the full description of the stolen items, plus whatever information is needed. An adjuster must be a sleuth, digging like a character in a Damon Runyon detective story to find the truth of each claim. It can't easily be done from behind a computer screen.

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

Ken Brownlee, CPCU, is a former adjuster and risk manager based in Atlanta, Ga. He now authors and edits claims-adjusting textbooks. Opinions expressed are the author's own.

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A good insurance adjuster must be excited about finding the facts of a claim

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