When you buy an insurance policy, your agent is the person who guides you through the process, explaining your coverage, helping you choose the right limits and answering your questions along the way. A sense of trust can form between a policyholder and their agent, especially if they’ve been with their agent for a long time.
So, it can be surprising when, after an accident or loss, you suddenly find yourself working with someone entirely new, the insurance adjuster. To help policyholders better understand the two sides of the insurance business coin, we’re discussing the lifecycle of an insurance policy with an agent, Shannon Martin, and an adjuster, Chantal Roberts.
Chantal: When I first connected with Shannon, it was because she interviewed me for an article about insurance. Somewhere in the hour-long conversation, we both realized that even people inside the industry don’t always understand what another department is doing. So we teamed up to offer insight into the adjuster and the agent roles, explaining how our roles connect — and how they differ.
I want to buy an insurance policy
Shannon: This task falls within the agent’s scope of work. Depending on your insurer, you may have one agent or broker who handles your policy from end to end, or you could be with a carrier like Geico or Progressive, where you purchase your policy online or with a sales agent.
As an agent, my goal is to help potential and current policyholders purchase and maintain a policy that meets their needs. I ask questions, walk them through coverage options, assist with paperwork, process payments and answer almost any other question they may have.
Agents advocate for their policyholders, but we also represent the insurer, which is a balancing act that may not always feel fair to the policyholder. During the sales process, we serve as the insurance company’s first line of underwriting. A big part of my initial conversation with potential policyholders focuses on determining whether someone meets the carrier’s standard of insurability. For example, if you live in a state where we don’t offer coverage, or you have high-risk incidents on your driving record, I would advise you to contact another auto insurance carrier.
Once I know it’s likely I can offer you a policy, the conversation shifts to coverage counseling. I help you understand what financial protection makes the most sense for your needs and make adjustments so the policy works with your budget.
I want to change my coverage types or limits
Shannon: This is also an agent’s job. When you call in to change your coverage or limits, I help guide you through those adjustments based on your current needs and goals. Whether you’re changing your address or adding a new driver or vehicle, I review how those updates can affect both your level of financial protection and your premium.
Depending on your carrier and agent, these conversions can go very differently — this is where quality customer service can matter more than your insurance rate.
For example, let’s say you trade in your car and pay cash for a new one. Your old car was an older model vehicle with liability-only coverage. Your new car is also used, but only a year old. You tell your agent: “Just keep all the coverage the same. No changes.” If your agent simply mirrors the old limits without asking questions, they’ve technically done what you requested. The transaction was fast, and your rate is pleasantly low. But did they serve your best interests?
A good agent doesn’t just process requests. We take the time to review your coverage and ask the right questions, so your policy fits your current needs.
— Shannon Martin, Bankrate insurance expert
If you just paid $20K in cash for your car, the odds are you want collision coverage. It’s always your right to decline the coverage, but I want you to be aware of what that means and where potential coverage gaps may leave you exposed. Unfortunately, not all agents are guaranteed to be this thorough. That’s why it’s always a good idea to ask questions and clarify what’s covered when purchasing or modifying your insurance policy.
I want to file a claim
Shannon: If you’re in a fender bender or a storm damages your roof, it’s completely natural to reach out to your agent to file a claim. But now that the situation is about an actual claim instead of a conversation about hypothetical loss, there’s only so much I can do. I can:
- Let you know if your policy is active
- Provide you with a copy of your policy contract
- Provided you with a copy of your ID cards
- Accept an on-time payment
- Get you in contact with a claims adjuster
Depending on company guidelines, I may even be able to confirm what coverage types and limits you are paying for, but that does not guarantee coverage for the accident or loss that just occurred.
Chantal: Once the claim is reported, it’s assigned to an adjuster. That’s where I come in.
As an adjuster, my job is to investigate the loss, confirm the details, review your policy and determine whether coverage applies. I gather documentation, ask questions and may even consult underwriting or other departments if clarification is needed — including whether the intent of the policy supports coverage in a gray area.
Even though claims generally fall under the responsibilities of an adjuster, a good agent can be an invaluable partner. In one property claim I handled, the declarations page listed one address, but the field appraiser reported the damage occurred at a different location. Based on the documents, it looked like the loss occurred at a property that wasn’t insured — and I was preparing to deny the claim.
I called the agent to give them a heads-up. They explained that the county had recently updated the 911 addressing system, and the street numbers had changed. The property was the same, but the address had been renumbered. The agent provided a letter confirming the change, endorsed the policy correctly and the claim moved forward. Without that conversation, the insured would have received a denial letter for a technicality.
Claims can reveal coverage gaps
Chantal: Sometimes, a claim reveals that a policyholder didn’t have the coverage they thought they had — or needed. Maybe a pipe burst and the damage wasn’t covered because the endorsement for sewer and drain backup wasn’t added. Or maybe your home was insured for less than its actual rebuild cost — and now you’re responsible for part of the loss due to the policy’s coinsurance requirement.
Coinsurance is a difficult concept, even for some insurance professionals. But here’s the short version: if your policy doesn’t insure a property to a high enough percentage of its replacement value, you end up sharing the cost of a loss. This is done to encourage homeowners to carry sufficient coverage, and you might be at risk of underinsuring your home if you haven’t gotten it appraised recently or made upgrades to your home that haven’t been accounted for in your insurance coverage. The coinsurance threshold for standard homeowners policies is 80 percent — meaning you must insure your home for at least 80 percent of its replacement cost or risk a reduced payout in the event of a claim.
When that happens, I’m the one who delivers the bad news. I can’t retroactively fix coverage. But I can point out what was missing and recommend that the insured speak with their agent to address it going forward.
In one claim I handled, a fire partially destroyed the insured’s home. They had a $1,000 deductible — but because the home wasn’t insured to value, they were also subject to the coinsurance condition of the policy. In this case, that meant paying an additional $11,500 out of pocket, on top of the deductible.
When a policyholder is underinsured on a loss, I call the agent. Not just to loop them in, but to make sure they’re prepared to have a difficult conversation about increasing coverage — and with it, premiums. If a policyholder based their insurance decisions strictly on price, a coinsurance issue often brings the tradeoff into sharp relief.
I have questions about why my claim was denied
Chantal: When a claim is denied, it’s my responsibility as the adjuster to explain why. That explanation isn’t simply a formal letter. It should include a breakdown of what part of the policy applies (or doesn’t), what facts we used to make that determination and what options remain, if any.
But let’s be honest — when people get a denial letter, they don’t always call the adjuster first. They often call their agent.
That’s why I make it a practice to notify the agent before a denial is issued. A good agent is a trusted advisor. If they know the claim is being denied, they can prepare for the conversation, answer basic questions and even help the policyholder get the documents they need for an appeal or review.
In some cases, the agent may also catch something I didn’t — a missing endorsement, an old binder that was never updated or even a misreading of how the policy applies. It doesn’t happen often, but when it does, I want that feedback. The purpose of insurance is to pay for covered losses — not stroke my ego.
If you have questions about a denial, reach out to your adjuster first. We’re the ones who made the determination, and we’re required to explain how we arrived at that decision. But involving your agent can be helpful, too — especially if it leads to better understanding, updated coverage, or both.
How do agents and adjusters work together?
Shannon: While agents and adjusters don’t typically work side by side, there are times when agents can help support adjusters by providing context and paperwork. As your agent, I can help the adjuster by providing up-to-date policy information, confirming coverage effective dates or clarifying recent changes you’ve made to your policy. On the flip side, adjusters sometimes loop us in if they discover gaps in coverage that you want to address going forward.
Chantal: In one case, a homeowner experienced water damage after heavy rain, and the agent had told them water damage was “covered.” Unfortunately, the loss resulted from city sewers backing up and overflowing — the policy specifically excluded water back up and overflow from a sewer system. The homeowner didn’t have a separate flood policy or an endorsement that would cover this kind of loss.
The agent was doing their best, but their explanation was too broad. When I walked through the loss details and showed where the exclusion applied, the agent understood. They were still frustrated — and so was the insured — but we were able to realign expectations and get everyone on the same page.
Agents support the relationship. Adjusters interpret the contract. It doesn’t always make the outcome easier to accept, but it does make it easier to explain.
— Chantal M. Roberts, CPCU, AIC, RPA, ITP
Adjusters and agents play different roles, but when we work together, it creates a smoother, more informed experience for the policyholder. I’ve always believed in looping the agent in early, especially when a claim is complicated or heading toward a denial. The agent can offer background, help manage expectations, and serve as a steady point of contact. That’s important — because while your agent may stay the same for years, the adjuster handling your claim might vary depending on the type of claim, location or staffing at the time.
If you’re not sure where to start with a claim or a question, your agent is often a great first call. And if your question has to do with a specific loss or denial, the adjuster assigned to that claim will be the one to explain what’s in the file — and how the policy was applied.
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