What must an adjuster always do before making a coverage decision?

Before making a coverage decision, it is essential for an adjuster to fully review the terms and conditions of the insurance policy. This step is crucial because the policy outlines the specific coverages, exclusions, and limitations that apply to the claim. Understanding these details ensures that the adjuster can accurately determine whether the claim falls within the policy's scope of coverage.

A thorough review allows the adjuster to know what circumstances the policy covers, what definitions apply (such as “property damage” or “theft”), and any special conditions or endorsements that may modify the standard terms. This foundational knowledge is vital to ensure that the adjuster's decision is compliant with the policy's stipulations and supports fair treatment of the insured.

While consulting with contractors for estimates can provide insight into the claim's damages, and engaging with the insured can offer context about the incident, these actions should occur after confirming the coverage framework defined in the policy. Additionally, assessing potential fraud is an important part of the claims process but does not take precedence over understanding the policy details. Without that crucial policy insight, an adjuster's other actions may be misguided or premature.