When a car accident happens, the moments that follow are often chaotic. Between damage, possible injuries, and emotional stress, most people give little thought to what actually happens after they call their insurance company.
In a recent episode of Insurance Hour, host Karl Susman was joined by former claims adjuster Rachel Goldman to unpack one of the most misunderstood parts of insurance: the auto claims process. Their discussion revealed how adjusters investigate accidents, how fault is determined, why delays occur, and what policyholders can expect once a claim is filed.
What emerged was a clear, human look inside a system shaped by deadlines, judgment calls, documentation, and emotion.
What a Claims Adjuster Actually Does
A claims adjuster’s core job is to investigate what happened, examine the facts, determine who is at fault, and apply the insurance coverage correctly.
“We get information about what happened in an accident or damage to a car, and we figure out who’s at fault,” Goldman explained. “Then we resolve the claim and pay the right parties based on the coverage.”
In practice, adjusters handle far more than just fault decisions. They collect statements, review police reports, coordinate inspections, communicate with repair shops, work with medical providers, and, when necessary, interact with attorneys. Goldman spent a decade handling auto claims, often managing between 40 and 100 open cases at a time.
The Pressure and Workload Behind Every Claim
Many policyholders don’t realize the volume of work carried by a single adjuster.
“There were times where I would have anywhere from 50 to 100 pending claims,” Goldman recalled. “It’s very challenging when you’re waiting on statements, inspections, and people to call you back.”
Each claim includes multiple moving parts and deadlines, creating pressure from both customers who want fast resolutions and employers who track performance metrics. Even with today’s automation tools, the claims process still depends heavily on human organization, follow-up, and decision-making.
The Myth of the “Evil Adjuster”
A common belief is that insurance adjusters exist to deny claims or increase premiums. Goldman pushed back strongly against this idea.
“People think we’re trying to show they’re at fault so the carrier can charge them more,” she said. “But that’s not how it works. We don’t assign surcharges. We just determine what happened and apply the policy.”
Many drivers also view insurance like a personal savings account—believing that years of premium payments guarantee reimbursement.
“You’re paying for risk transfer, not guaranteed payouts,” Goldman explained. Insurance is a shared pool designed to protect against unpredictable loss, not a refund system.
How Fault Is Really Determined
Few phrases frustrate adjusters more than, “It wasn’t my fault.” Determining fault is often the hardest and most emotionally charged part of a claim.
Some cases are clear-cut, like many rear-end collisions. Others involve conflicting stories, unclear evidence, or driver admissions that change over time.
“People will say they saw the other car coming fast, but turned anyway,” Goldman said. “That admission alone can shift fault.”
Honesty is critical. Every statement given becomes part of the official claim record, and inconsistent accounts often weaken credibility. Early documentation helps adjusters assess facts before memories fade or stories evolve.
When Attorneys Enter the Picture
Once an attorney becomes involved, the adjuster can no longer communicate directly with the policyholder. All correspondence goes through legal channels, which slows the process and increases administrative costs.
“You may not end up with more money,” Goldman cautioned. “You could even end up with less because of attorney fees.”
Legal representation is valuable in complex or severe cases, particularly those involving serious injuries or underinsured drivers. The mistake many people make is hiring an attorney purely out of frustration rather than necessity.
The Emotional Reality of Handling Claims
Adjusters interact with people during some of the worst moments of their lives. Almost no one calls an adjuster in a good mood.
“You answer the phone knowing someone is upset, scared, or angry,” Goldman said.
While emotions are understandable, she emphasized that kindness can make the experience smoother.
“It won’t change the outcome of your claim,” she explained, “but it can change how the process feels. Adjusters are human.”
Insurance Fraud and Its Impact on Everyone
Fraud is a persistent issue in auto claims and one of the biggest drivers of rising premiums.
Goldman described staged accidents known as “swoop and squat” schemes, where organized groups intentionally cause rear-end collisions and file exaggerated injury claims. These operations often involve coordinated legal and medical participants.
Red flags such as identical accident stories, too many passengers, or immediate attorney involvement can trigger referral to a special investigations unit. Even when detected, fraud increases investigation costs and administrative expense—costs ultimately passed along to consumers.
Why Documentation Is Critical
Thorough documentation is the backbone of the claims process.
“Every conversation, every promise, every date had to be documented,” Goldman said. “If another adjuster took over, they needed to know exactly what happened.”
For policyholders, this same principle applies. Photos taken immediately after an accident—showing vehicle positions, damage, road conditions, and surroundings—can be decisive. Written notes and witness information also help preserve facts before memories shift.
Who the Adjuster Really Represents
Susman posed a question many drivers quietly wonder: whose side is the adjuster on?
“We represent the insured, but we also represent the law and the policy,” Goldman explained. “We’re not on anyone’s side. We look at the facts and apply the contract.”
Insurance policies are legal agreements. Adjusters function more like referees than advocates, enforcing coverage based on contract language rather than emotion or sympathy.
How to Protect Yourself During a Claim
Goldman offered several practical tips for navigating the claims process successfully:
- Take photos immediately after the accident
- Write down what happened while details are fresh
- Collect names and contact information of witnesses
- Be honest and consistent in your statements
- Remain calm and professional in all communications
Preparation and clarity at the start of a claim often prevent disputes later.
Key Lessons Every Policyholder Should Know
Claims adjusters are not adversaries—they are bound by law and policy language.
Documentation protects both you and the outcome of your claim.
Courtesy doesn’t change fault but does improve the experience.
Fraud increases premiums for honest drivers.
Attorneys are helpful in complex cases but unnecessary in many routine claims.
Insurance is risk protection, not a guaranteed reimbursement fund.
Final Thoughts on the Human Side of Claims
Every time a claim is filed, a real person steps in to manage dozens of cases, interpret policy language, gather facts, and guide the process to resolution.
Auto insurance is not just about vehicles and repairs—it’s about communication, trust, accountability, and shared responsibility. Understanding how the claims process truly works helps transform a stressful event into a more informed experience.
As Insurance Hour reminds listeners each week, the more you understand about insurance, the more empowered you are to protect what matters most.
