Who is responsible for determining the validity of an insurance claim?

The insurance adjuster is responsible for determining the validity of an insurance claim because they are specifically trained to investigate and assess claims after a loss has been reported. Their role involves gathering relevant information, such as statements from the policyholder and any witnesses, inspecting damaged property, and reviewing relevant documentation to evaluate the claim. The adjuster uses this information to determine whether the claim is justified under the terms of the insurance policy and to what extent the insurance company is liable for the loss.

In contrast, the insurance broker primarily acts as an intermediary between clients and insurance companies, helping clients find suitable policies and coverage but not directly involved in claim validation. The underwriter assesses risk and determines the terms under which a policy is issued, focusing on the acceptance of risks at the beginning of the insurance process rather than resolving claims after a loss occurs. The policyholder, while they may report the claim and provide necessary information, does not have the authority to make decisions regarding the validity of the claim itself.