The rights and obligations of the parties are set out in the insurance policy contract. Both parties to an insurance contract have obligations to each other. For example, the insurer has an obligation to timely investigate claims filed by an insured and to pay properly filed claims which are covered by the insurance policy. On the other hand, the insured has an obligation to timely notify the insurance company in case of a loss and to cooperate with the investigation of the insurance company. However, since the insurance policy is written by attorneys and insurance professionals who work for the insurance company, the policy provisions are often heavily in favor of the insurance company.
When a consumer or business files a claim for a loss under their insurance policy, the agent usually plays little or no part in determining whether the claim will be paid. The employees of the insurance company called Aadjustors@ work in the Aclaims@ department of the insurance company. Insurance adjustors evaluate the claim filed by the insured in light of the provisions in the insurance policy. If the insurance adjustor determines that the claim is covered under the terms of the insurance policy, then the claim will be paid. If the insurance adjustor believes that the claim is not covered under the policy, then the claim will be denied.
