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What Are Insurance Adjusters Looking For?

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Adjuster

An insurance adjuster is considered: “the person appointed by the Insurance Institution, to whom it entrusts the evaluation in which the causes of the loss and other circumstances that may influence the determination of the compensation derived from an insurance contract are established. , with the purpose that the Insurance Institution has the necessary elements to determine the origin of the claim and the compensation proposal.

Based on the foregoing, once the adjuster is appointed by Seguros Azteca Daños, he will be responsible for determining the cause of the loss and estimating the lossin accordance with the provisions of the contract, while Seguros Azteca Daños will be the one who issues the decision on the origin of compensation.

Adjuster Activities

During the evaluation and/or attention to claims, the adjuster must carry out the following, but not limited to, activities:

– Appear at the scene of the incident and identify himself through the card issued by the CNSF that certifies him as an adjuster. 

– Carry out the inspection at the scene of the events or the affected location to verify the causes and circumstances of the incident. 

– Prepare a report corresponding to the claim, which can only be delivered to Seguros Azteca Daños. 

– Collect the information and documentation of the insured and/or affected as well as the evidence corresponding to the claim. 

– Issue a report based on the conditions of the insured property. 

– Inform the insured and/or affected party of the procedure to be followed for compensation or repair of the damage if appropriate at the discretion of Seguros Azteca Daños. 

– Inform the insured and/or affected party of the content and scope of each format and necessary document that must be signed and/or required during the claim. 

– Review the documentation provided by the insured and/or affected. 

– Act in accordance with the principles contained in the Code of Ethics of the Adjuster and Internal Staff of Seguros Azteca Daños, avoiding unfair competition during the advice and management of claims. 

– Advise the insured in a truthful, sufficient, detailed and clear manner on the procedures derived from the claim, as well as the alternatives in case of going to the competent authorities. 

– Review all the facts and circumstances of the claim, as well as the causes that gave rise to it in a complete and exhaustive manner in order to determine the origin or not of the claim, determining the amount to be compensated. 

– Safeguard and maintain the correct management of the documents that have been entrusted to it. 

– Show impartial behavior in conflicts that arise between the insured and third parties. 

General responsibilities of the adjuster

– Be registered and have a valid ID issued by the National Insurance and Surety Commission. 

– Comply with the current applicable legal regulations of the Single Circular, as well as with the guidelines issued by the National Insurance and Bonding Commission, in accordance with what is described in the policies and procedures indicated by Seguros Azteca Daños. 

– Act in accordance with the principles contained in the Code of Ethics of the Adjuster and Internal Staff of Seguros Azteca Daños, avoiding unfair competition during the advice and management of claims. 

– Advise the insured in a truthful, sufficient, detailed and clear manner on the procedures derived from the claim, as well as the alternatives in case of going to the competent authorities. 

– The adjuster must review all the facts and circumstances of the claim, as well as the causes that gave rise to it in a complete and exhaustive manner in order to provide the information, documentation and opinion to Seguros Azteca Daños so that the company can determine the origin or not of the claim and authorize the amount to be compensated. 

– Safeguard and maintain the correct management of the documents that have been entrusted to it. 

– Show impartial behavior in conflicts that arise between the insured and third parties. 

A. Code of ethics of the adjuster and internal claims personnel

– The adjuster must have a profile of skills and abilities as well as a work philosophy and good practices, focused on improving the quality of the service provided to clients.

Basic principles:

-The trust. Internal claims personnel as well as external insurance adjusters must be entitled to it, demonstrating at all times a history of honesty, respect, integrity and service attitude with all parties involved. 

-As far as possible, avoid revealing the identity of the insured, their broker or sensitive information that could be used by third parties.

-Deliver to your work with commitment, performing all tasks in the most transparent way towards our insured. 

-When defining responsibilities, personal factors should not intervene and you should explain the reasons for your decision to our insured. 

-You must not influence the statement of the insured or that of the third party to try to affect or benefit any of the parties involved. 

-Respect the opinion of the insured in case of not agreeing with the disclaimer, giving all the support that corresponds to each case. 

-If this is the case, the adjuster must carry out his work in the presence of our insured and not hold talks in private with the adjuster of another company or third party involved. 

-You must not receive from our insured or from any of the parties involved, any type of remuneration and/or gratuity derived from the performance of their duties.

B. Adjuster Prohibitions

-Exercise activities other than those indicated in the insurance regulations and in the policies and procedures of insurance adjusters that are in force.

– Communicate to the insured any indication about the origin or not of the claim without first obtaining the authorization of Seguros Azteca Daños.

-The adjuster at no time should receive any gift, benefit, trip offered by the insured and/or third parties involved in the claim. If any of these occur, he must report it immediately to the supervisor of Seguros Azteca Daños.

-Practice claims adjustments in which there is any type of relationship and/or kinship with the interested persons or any interest in the property of the damaged goods.

-Receive, directly or indirectly, economic benefits of the insured or third parties and retain for themselves or award to the persons referred to in the preceding paragraph, the goods or products of adjustments that have been made.

-Treat the insured and third parties involved in a derogatory, harassing or threatening manner.

-Consume, sell, possess or work under the influence of drugs, alcohol during working hours.

-Acquire or retain for himself the rescues that result as part of the adjustment made.

-Reveal information of the insured and/or third parties to personnel outside of Seguros Azteca Daños.

-Alter any authorized document or data that affects Seguros Azteca Daños for the determination of compensation.

-Provide information derived from claims to any person outside of Seguros Azteca Daños.

-Under no circumstances may it cover expenses for legal assistance or payment of fines or bonds, since it is not empowered to release the insured from the deposit of sureties and bonds set by the authorities.

-Offer different or special services to those indicated and regulated for adjusters.

Sanctions to the adjuster

-The sanctions will be applied in accordance with what is stated in the LISF in accordance with article 485 Section II Subsections J and L. 

-Furthermore, it is established that in case of not complying with the guidelines mentioned in this document, Seguros Azteca Daños reserves the right to terminate the service contract as it suits your interests.

Suspension of the adjuster

It will be cause for suspension of the adjuster, when:

-Falsely declares any of the information consigned in the application submitted to obtain registration with the CNSF or presents false or altered information or documentation. 

-Require the insured or beneficiary, any benefit that is not legally justified, even when it is not received. 

-Hide information or provide false data or documentation about the causes of the claim, and other circumstances that influence the determination of the compensation derived from an insurance contract. 

-When for any reason your ID and/or registration is not valid. 

In these cases, Seguros Azteca Daños will immediately terminate the legal relationship with the adjuster without liability of any kind.

Adjuster Cancellation

It will be cause for cancellation of the adjuster, when:

-Acts within the national territory as adjuster in insurance operations prohibited in the applicable law and regulation. 

-No longer meets the requirements for granting registration as an insurance adjuster related to adhesion contracts.

-Act as insurance adjuster with the respective registration suspended. 

-Incurs in any of the grounds for suspension, after having been sanctioned with suspension of registration on two occasions. 

-In these cases, Seguros Azteca Daños will immediately terminate the legal relationship with the adjuster without liability of any kind. 

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