Claims Examiner

Claims Examiner

Claims Examiner

Claims examiners investigate coverage and liability, set reserves, direct defense counsel, evaluate exposure, and negotiate resolution. Authority levels vary by severity and carrier structure.

The claim file documents their handling.

Alternative Names:

Claim Handler, Claims Representative

Why it Matters?

The examiner is defense counsel's actual client contact even though the insured is the client, which is the tripartite tension defining insurance defense practice. Examiner authority limits also determine what can be resolved at mediation, and appearing with an examiner lacking sufficient authority wastes the session. Confirming the authority level before scheduling is a routine step that is frequently skipped.

Frequently asked questions

Who is defense counsel's client?

Who is defense counsel's client?

The insured, though the examiner is the actual contact and directs the defense, which is the tripartite tension in this practice.

What should be confirmed before mediation?

What should be confirmed before mediation?

The examiner's authority level, since appearing without sufficient authority to resolve wastes the session.