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Insurance Claim Adjustment

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# Insurance Claim Adjustment
This playbook outlines the sequential steps an insurance claims adjuster takes to evaluate an insurance claim. It explains the roles and responsibilities involved in assessing and resolving claims for policyholders.

### Step 1: Assignment
Receive the insurance claim assignment from the insurance company and review the details of the policyholder&#x27;s filed claim.

### Step 2: Initial Contact
Initiate contact with the policyholder to acknowledge receipt of the claim and discuss the claim process.

### Step 3: Claim Investigation
Investigate the claim by collecting evidence, such as photos from the scene, police reports, and witness statements. This step may also involve interviewing the policyholder and any involved parties.

### Step 4: Damage Evaluation
Assess the damage to policyholder&#x27;s property or possessions. This may include consulting with professionals or specialists for evaluations or quotes.

### Step 5: Coverage Review
Review the insurance policy details to determine the coverage applicable to the claim and identify any exclusions or limits.

### Step 6: Report Preparation
Prepare a detailed claim report which includes the assessment of the damage, investigation findings, coverage determination, and a recommendation for settlement.

### Step 7: Settlement Determination
Based on the assessment and policy details, determine the claim settlement amount and communicate the decision to the policyholder.

### Step 8: Resolution
Address any concerns or negotiations from the policyholder, and finalize the resolution of the claim either through payment, repair, replacement, or denial as per policy terms.

### Step 9: Documentation
Ensure all steps of the claim process are thoroughly documented, including the rationale for settlement decisions, and file these documents appropriately as per company policy.

### Step 10: Follow-up
Conduct a follow-up with the policyholder to ensure that the resolution is satisfactory and to answer any additional questions.

## General Notes

### Continuing Education
Claims adjusters should regularly update their knowledge of policy changes, new laws, and industry best practices through continuing education.

### Ethical Considerations
Adjusters must handle all claims ethically, ensuring fairness to the policyholder while also protecting the interests of the insurance company.