TL;DR:

  • Start with policy language first: know the declarations, definitions, endorsements, and exclusions.
  • Build a factual narrative from credible evidence: receipts, photos, witness statements, timelines.
  • Document methodically and preserve the chain of custody for exhibits.
  • Determine coverage using policy terms; escalate ambiguities when needed.
  • Valuation relies on sound method, reasonable depreciation, and noted assumptions.
  • Uphold ethics: impartiality, privacy, and professional boundaries.
  • Communicate clearly and promptly; set expectations with the insured and the team.
  • Prepare for a career in claims: exam-ready knowledge, disciplined habits, and ongoing learning.
  • State-specific requirements vary; verify the current official sources for licensing and procedures.

Policy interpretation: reading the contract before acting

  • The policy is the framework. Start with the declarations page to confirm who is insured, what risks are covered, and the limits. Then study definitions and endorsements that expand or limit coverage.
  • Distinguish coverage grants from exclusions. If a term is ambiguous, document how you resolved it and when you escalated to a supervisor.
  • Avoid assumptions about state law or regulatory expectations. If you encounter a gray area, flag it and refer to the official source or supervisor. Note: state-specific requirements vary; verify current official sources for licensing and procedures.

Investigation: gather facts with discipline

  • Initiate promptly after intake. Notify the supervisor and align on the scope of investigation.
  • Secure and preserve the scene and evidence when applicable. Time-stamped photos, damaged items, and scene notes matter.
  • Gather information from credible sources: insured, witnesses, service providers, and records. Use open-ended questions to elicit details; avoid leading questions when possible.
  • Create a chronological timeline: who did what, when, and how. This helps identify inconsistencies early.
  • Maintain professional boundaries and privacy. Limit inquiries to information relevant to coverage, liability, and damages.

Documentation: tell the story with evidence

  • Produce a clear, objective narrative. The story should reflect facts, not conclusions or conclusions dressed as facts.
  • Attach exhibits: photographs, repair estimates, invoices, medical bills, police or incident reports, appraisals. Label each item and reference it in the narrative.
  • Use a consistent format: dates in YYYY-MM-DD, names spelled exactly, and unit measurements standardized.
  • Preserve chain of custody for every document or item you plan to use in settlement decisions.
  • Keep your notes timely and legible; future readers may be your future self.

Coverage determination: connect facts to policy language

  • Map the facts to policy language: does the loss fall within a covered perils clause, a named endorsement, or a deductible?
  • Consider per-occurrence versus aggregate limits, sublimits, and any limits applying to endorsements like “other insurance” or “unoccupancy.”
  • Identify gaps or conflicts early. If the policy doesn’t clearly cover a particular element, escalate rather than guess.
  • Document uncertainties and the reasoning path you used to resolve or escalate them. If you need a formal determination, request guidance from a supervisor or the appropriate claims-lead.

Valuation: estimate damages with transparent methods

  • Choose a reasonable method for loss calculation: repair estimates, replacement cost, or actual cash value, depending on policy and purpose.
  • Distinguish depreciation from damage. Note whether the policy provides replacement cost or ACV, and whether any salvage value is involved.
  • Document assumptions: age of property, condition prior to loss, contractor quotes, markup allowances, and any discounts.
  • When a total loss is possible, present both a proposed repair estimate and a total-loss scenario with supporting data.

Ethics: every step should feel right under pressure

  • Maintain objectivity. Your role is to assess facts, not to advocate for a political position or a preferred outcome.
  • Handle personal and protected information with care. Limit disclosures to authorized parties and documented purposes.
  • Disclose potential conflicts of interest and recuse yourself if necessary.
  • Avoid biased language, sensationalism, or misrepresentation in writing or communications.

Communication: clarity that sets the right expectations

  • Be transparent about what you know, what you don’t know, and what you’re doing to find out.
  • Communicate next steps, expected timelines, and any required documents to the insured and involved parties.
  • Use plain language. Replace jargon with understandable terms, and explain any technical concepts briefly.
  • Record all communications in the file with dates, participants, and a summary of the conversation.

Career readiness: preparing for exams and a first file

  • Build a reliable study routine: targeted topics, practice questions, and scenario-based drills.
  • Practice writing clear, concise file notes that could stand on their own if reviewed later.
  • Seek feedback from mentors, peers, or supervisors. Use real-world scenarios to test your understanding.
  • Develop professional habits: version-controlled documents, standardized checklists, and a consistent filing structure.
  • Understand the workflow: intake, investigation, coverage decision, valuation, negotiation, and closure.

Practical checklists

New-claim intake checklist

  • Confirm policy number, insured name, and contact information.
  • Note the incident date, time, and location; initial facts and scope of loss.
  • Identify potential coverages and obvious exclusions.
  • Schedule initial inspection or appraisal if needed.
  • Gather available documents: declarations page, endorsements, and known invoices or receipts.

Investigation checklist

  • Secure incident scene and preserve evidence; photograph when appropriate.
  • Interview insured and witnesses with open-ended questions.
  • Collect names, dates, and relationships of all sources.
  • Compile a tentative timeline and flag inconsistencies.
  • Log all communications and preserve copies of documents.

Documentation checklist

  • Write a chronological narrative (plain language, objective tone).
  • Attach exhibits with clear labels and references in the narrative.
  • Ensure chain of custody for all physical or digital evidence.
  • Save drafts, approve notes, and maintain an auditable file history.

Coverage and valuation checklist

  • Cross-check facts against policy language and endorsements.
  • Decide on replacement cost vs. ACV; document depreciation and salvage if applicable.
  • Note any conditions, limitations, or endorsements that affect coverage.
  • Prepare a clear rationale for coverage decisions and valuations; escalate ambiguities.

Ethics and communications checklist

  • Confirm no conflicts of interest; disclose as required.
  • Protect privacy and data; share information only with authorized parties.
  • Communicate clearly with timelines and expectations; avoid making promises you cannot keep.
  • Document every material decision and the rationale behind it.

Final note This article is intended as general training for new adjusters. It does not substitute for legal advice, claim-specific guidance, or any state-specific requirements. Always verify the current official sources from your licensing authority or employer for procedures that apply to your jurisdiction. If you encounter a situation that isn’t clearly covered by policy language or your organization’s standards, seek supervision and document your course of action. A disciplined, fact-driven approach will serve you well on exams and in your first claim file.