Claims Adjuster here, may have unintentionally misled third party

[CenTexAdjuster]

Hey guys, this is my first post here.

I work solely in auto claims and have only been in this profession for about 6 months. Our insured is at fault, so I’m dealing with third party on getting their vehicle fixed. They are concerned about damages not being fully covered, I told her that damages would be covered and that she shouldn’t have to pay out of pocket. I confirm the shop she wants to use and check our list of shops that are “problematic” and they’re not on it, so I think to myself that’s it’s good to go. Except I’ve come to find that after repairs have begun and we’re one supplement in that the shop is charging higher rates than what we cover for. Now there may be a possibility that our appraiser doesn’t bail me out and the third party may have to pay out of pocket. What can or should I do in this situation? I feel horrible because I’ve told this person that they would be fully covered and that may turn out to be untrue. Thanks!

 

[fed up]

If you okayed the repair based on the estimate and the shop is keeping to the estimate, pay the bill and add them to your list or meet with the shop and negotiate rates letting them know that the future if additional work rests with their agreement

 

[adjusterjack]

Retired claim rep here.

No, you haven't misled the claimant.

1 - You pay what your insured is "legally liable" to pay. That's the cost of repairs.

2 - Texas law allows the claimant to use the shop of his choice.

3 - If the claimant sued your insured for that shop's cost of repair, the claimant would win.

You were correct in telling the claimant that the repairs were covered.

Does your company employ, or have access to, a field collision estimator? If you had one, you could get a first look at the damage, give your estimate to a claimant and say "Take this to the shop of your choice and have them call me if there any hidden damage is found." That gives you the opportunity to negotiate costs with the shop owner if he's overpriced.

Or does your company have a preferred repair shop. You can offer that option, indicating that the cost would be of no concern to the claimant since the shop will bill your company direct. You can also sweeten the offer by arranging for a rental to be direct billed to your company.

 

[briannosch]

Did you manage to solve this issue? There is a lot to consider when you are a claims adjuster.
I think you are essentially right and didn’t mislead the 3rd party. Your company will have to pay everything they are legally liable to pay and not more. And the estimation of the damages it’s not exactly what does an insurance adjuster do. There is another specialist called a field collision estimator who can better assess the situation.
These people are better with the technical part, and their assessment and estimation are more reliable. You can pass this case to one of them and see what they have to say.

 

[fed up]

Did you manage to solve this issue? There is a lot to consider when you are a claims adjuster.

What, no Spam in your latest post?

 

[adjusterjack]

There is a lot to consider when you are a claims adjuster.

No sh-t, Sherlock.