QUEENS, NY – After a car accident in New York, the insurance adjuster’s review can significantly affect settlement offers, investigation timelines, and how disputed issues are resolved. Queens personal injury attorney Keetick L. Sanchez of K L Sanchez Law Office, P.C. (https://accidentlawyer-queens.com/what-does-an-insurance-adjuster-do/) outlines what adjusters do, what their legal duties are under New York law, and what injured claimants should understand before answering questions or accepting a settlement offer.
According to Queens personal injury attorney Keetick L. Sanchez, an insurance adjuster investigates and evaluates an insurance claim. In a car accident case, the work may include reviewing the police report, inspecting vehicle damage, examining medical records, assessing liability, and communicating with the claimant or the claimant’s attorney. “In an insurer-side claim, the adjuster reviews the claim for the insurance company, not as the claimant’s advocate,” Sanchez notes.
Queens personal injury attorney Keetick L. Sanchez explains that claimants in New York may deal with three different types of adjusters. Staff adjusters are regular employees of insurance companies who handle claims for their employer. Independent adjusters handle claims on behalf of insurers but are not regular staff employees of one insurance company and generally must be licensed unless a statutory exception applies. Public adjusters work for insured policyholders, not insurance companies, and may assist with certain property-loss claims.
Attorney Sanchez points out that for a Queens car accident involving injuries, disputed fault, or settlement negotiations, a personal injury attorney is usually the more appropriate advocate than a public adjuster. Insurance Law § 2601 prohibits insurers from engaging in unfair claim settlement practices, including misrepresenting important facts, failing to acknowledge claim communications with reasonable promptness, failing to adopt reasonable standards for prompt investigations, and failing to attempt prompt, fair, and equitable settlement when liability is reasonably clear.
The firm notes that Regulation 64 sets claim-handling standards for insurers, including rules for claim communications, investigations, and settlement practices. Insurers must acknowledge the claim within 15 business days, must have procedures to begin investigating within 15 business days after notice, and must accept, reject, or send written notice explaining the need for more time within 15 business days after receiving a properly executed proof of loss and all requested information.
“Statements made to an adjuster can affect how the insurer evaluates liability, damages, medical history, and settlement value,” Sanchez emphasizes. The firm advises claimants to answer carefully, stay consistent with the record, and avoid guessing, minimizing injuries, admitting fault, or giving incomplete accident details without legal guidance.
Sanchez observes that an insurer-side adjuster may evaluate whether the claimant shares fault for the accident. Under New York’s pure comparative negligence rule under CPLR § 1411, compensation can be reduced in proportion to the claimant’s share of fault. New York’s no-fault rules may also affect the adjuster’s review. For covered people, first-party benefits can reimburse basic economic loss up to $50,000 per person, subject to statutory limits and offsets.
The Jackson Heights firm explains that adjusters may need additional time when a claim involves serious injuries, multiple parties, disputed liability, high claimed losses, missing records, inconsistent statements, or unresolved medical questions. “A delay becomes more concerning when the insurer misses required claim-handling steps, stops communicating, fails to request needed information within the required timeframe, or does not provide required written explanations,” Sanchez adds.
When an adjuster undervalues a claim, attorney Sanchez recommends documenting everything, declining to give a recorded statement without legal guidance, strengthening the medical record where needed, rejecting an inadequate offer in writing with a counteroffer, and considering a complaint to the Department of Financial Services. The firm notes that repeated unfair claim handling, when done without just cause and often enough to show a general business practice, may violate Insurance Law § 2601.
New York licenses adjusters as independent adjusters or public adjusters, the firm explains. A person may not act on behalf of an insurer unless licensed as an independent adjuster, and may not act on behalf of an insured unless licensed as a public adjuster, unless a statutory exception applies. Claimants who suspect they are dealing with an unlicensed adjuster can verify credentials through the DFS Producer/Licensee Search tool.
For those involved in a car accident claim in Queens, Jackson Heights, or across New York City, consulting a personal injury attorney can help evaluate the offer, handle negotiations with the adjuster, and pursue litigation if a fair settlement cannot be reached.
About K L Sanchez Law Office, P.C.:
K L Sanchez Law Office, P.C. is a Jackson Heights, Queens-based personal injury law firm representing accident victims throughout the five boroughs of New York City. Led by attorney Keetick L. Sanchez, the firm guides car accident victims through documenting losses, handling insurance communications, and pursuing fair compensation when claims are delayed, undervalued, or disputed. For consultations, call (646) 701-7990.
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