What Does a Loss Adjuster Do?

You may have cleaned up what you can, taken photographs, and waited for the insurance company to send someone to inspect the damage. The point people often miss is that the person coming to your home is not there to act as your adviser.

Instead, a loss adjuster is a professional appointed by the insurer to investigate the claim, assess the damage, and report back. That doesn't make them hostile, but it does mean you should prepare properly, answer carefully, and keep your own evidence at hand.

The Role of a Loss Adjuster Explained

A loss adjuster is an insurance professional who investigates and assesses a claim on behalf of the insurance company. In plain English, they are sent to work out what happened, whether the policy may cover it, how much the damage may cost to put right, and what the insurer should do next.

A loss adjuster can be independent in the sense that they may work for a separate loss-adjusting firm rather than directly for your insurer. With that said, they are still appointed and paid by the insurer.

You may also see the phrase "chartered loss adjuster". In practice, that points to professional status within the loss-adjusting field, often linked to the Chartered Institute of Loss Adjusters.

A loss adjuster may:

• Inspect the damage: They may look at the affected rooms, damaged contents, repairs already carried out, and any remaining physical evidence.
• Ask what happened: They may ask about the cause, timing, previous problems, maintenance, security, or any steps taken after the loss.
• Review the policy position: They may compare the facts with the section you are claiming under, the general exclusions, the general conditions, and the policy schedule.
• Assess value: They may consider repair costs, replacement costs, quotes, invoices, and whether the sum insured in the policy schedule is enough.
• Report to the insurer: Their report usually recommends how the insurer should treat the claim, but the insurer makes the claim decision.

What the Loss Adjuster Looks For During a Visit

A loss adjuster visit is usually about four things: cause, cover, scope, and value.

They are not simply looking at the visible damage. Instead, they are trying to decide what caused it, whether that cause falls within the section you are claiming under, whether any exclusion in the general exclusions may apply, whether any requirement in the general conditions matters, and what the claim may be worth under the policy schedule.

Here are some of the factors they may look into:

• Cause of damage: What event caused the loss, when it happened, and whether there were earlier signs of the problem.
• Scope of damage: Which rooms, contents, structures, or systems were affected.
• Policy cover: Whether the loss appears to fall under the section you are claiming under.
• Exclusions and conditions: Whether the general exclusions or general conditions give the insurer a reason to question the claim.
• Value: Whether repair quotes, replacement costs, invoices, or valuations support the settlement amount being considered.
• Mitigation: Whether reasonable steps were taken after the damage to stop the loss from deepening.

In some claims, the adjuster may also check a specific exclusion in the general exclusions, such as whether an item was said to be "unattended".

How a Loss Adjuster Calculates the Settlement Offer

The loss adjuster may calculate repair costs, replacement costs, alternative accommodation costs where covered, and any excess shown in the policy schedule. They may also compare the claimed amount with the sums insured, single-item limits, and any limits in the section you are claiming under.

While their figure may feed into the settlement offer, it is still a recommendation to the insurer as they remain the organisation responding to the claim.

Valuation disputes often come from three places:

• Scope of works: The insurer may accept that damage occurred, but disagree about how much work is needed to put it right.
• Cause of damage: The insurer may say some damage comes from wear and tear, gradual deterioration, or an excluded cause in the general exclusions.
• Policy limits: The policy schedule may contain a sum insured, single-item limit, excess, or other limit that affects the amount payable.

Note that underinsurance is a separate issue from ordinary valuation. Where the sum insured is understated, most policies let the insurer pay only a rateable proportion. In practice, if contents worth £40,000 are insured for £20,000, the policyholder has insured half the value.

However, that does not mean an underinsurance argument applies just because the insurer says the numbers look low. The relevant issue is whether the policy contains a rateable-proportion clause, usually in the policy wording or policy schedule, and whether the insurer's valuation of the total contents is sound.

If you dispute the valuation, focus on documents. Replacement quotes, invoices, photographs, room-by-room lists, and independent valuations may give the insurer a clearer basis on which to reconsider the settlement amount.

Preparing for the Loss Adjuster's Visit

Instead of rehearsing answers, you should be making sure that the relevant facts, documents, and damaged items are all available when the adjuster arrives. A simple order works best here:

1. Locate the policy wording, policy schedule, policy summary, and statement of facts. The policy wording shows the cover, exclusions, and conditions. The policy schedule shows sums insured, limits, and excesses.

2. Keep dated photographs or video of the damage before any clean-up, where possible. Include close-up images and wider shots that show the affected area.

3. Gather receipts, card statements, invoices, valuations, guarantees, and repair estimates. A bank or credit card statement can help where the original receipt has been lost.

4. Keep servicing records, repair notes, inspection reports, and correspondence with tradespeople, especially where the insurer may raise wear and tear or poor maintenance.

5. Avoid disposing of damaged items until the loss adjuster has seen them, or the insurer has agreed you can remove them. If an item has to be removed for safety, photograph it first and keep any contractor's note.

6. Consider an independent surveyor's or engineer's report if the cause of damage is likely to be disputed, such as where storm damage may be argued as gradual deterioration.

Tip: If emergency work is needed to prevent further damage, keep the invoices and photographs before starting the repairs. The point is to preserve evidence while still ensuring your property is safe to be in.

Communicating With the Loss Adjuster

The loss adjuster may ask about what happened, when you first noticed the damage, what steps you took afterwards, probe about any previous problems or claims, and what you told the insurer when you bought or renewed the policy.

The safest approach is also the simplest: answer the question asked, stick to what you know, and avoid filling gaps with guesses.

Some good phrases to use include:

• If you are unsure: "I don't know the cause yet. I can provide the contractor's report when I have it."
• If you are estimating: "That is my best estimate from memory. I will check the documents and confirm."
• If the question is unclear: "Can you explain what you mean by that?"
• If you need time: "I would like to check the policy documents before answering that fully."

Avoid saying more than the question needs. The loss adjuster is gathering facts for the insurer, so a casual comment can become part of the report. If you do not know the cause, say so. Do not turn uncertainty into a firm explanation just to be helpful. If you later realise an answer was incomplete or wrong, correct it in writing as soon as you can and keep a copy.

Provided you take reasonable care not to share inaccurate information when you buy or renew your policy, then your insurer cannot cancel your policy or refuse a claim. Even if your mistake was careless, your insurer must still adopt a proportionate response.

Challenging the Loss Adjuster's Report

If the insurer uses the report to refuse the claim or reduce the settlement offer, ask for their reasoning in writing. You can also ask for a copy of the report or the relevant extracts, especially where the insurer is relying on it.

A strong challenge separates evidence, policy wording, and argument:

• Evidence: Photographs, invoices, receipts, valuations, maintenance records, expert reports, and correspondence.
• Policy wording: The section you are claiming under, the general exclusions, the general conditions, and the policy schedule.
• Argument: Why the adjuster's conclusion does not match the facts, why an exclusion may not apply, or why the valuation is not supported.

For example, if the report says a roof leak was caused by poor maintenance rather than a storm, the challenge should not just say you disagree, but point to the buildings section, the relevant general exclusions, the weather or repair evidence available, and any independent surveyor's or engineer's report on the cause.

How SmarterClaims Can Help

If the insurer uses the loss adjuster's report to refuse your claim or reduce the settlement offer, SmarterClaims can help you work through the documents and prepare a structured challenge.

SmarterClaims can assess your refusal letter or relevant correspondence, review the policy documents, identify arguments relevant to the dispute, explain relevant laws and rules, and draft a letter that you can then review, sign, and send yourself.

About SmarterClaims

SmarterClaims is built on the 40-year playbook of Steve Smart, former UK General Counsel at AIG and current Chairman of Lancashire Insurance UK, with a background as a solicitor and Lloyd's broker.

More than £25M has been recovered in refused claims using this playbook. That figure does not promise any outcome in an individual claim.

Final Thoughts

A loss adjuster is a professional doing a job for the insurer. Treat them professionally, but don't mistake their role for that of an adviser acting for you.

The best protection is preparation. Keep the damaged items where possible, gather the evidence, understand the policy wording and policy schedule, and answer questions carefully.

If the report leads to a decision you believe is wrong, focus on the facts, the policy wording, and the evidence. That is how a challenge becomes something the insurer can properly reconsider.

Frequently Asked Questions

Can a loss adjuster refuse a claim?

Do I have to use the loss adjuster's recommended repairer?