Insurance claims & adjuster review
How insurance adjusters review demands
Adjuster review
Direct answer
A claims reviewer generally confirms coverage and liability exposure, then works through the medical documentation to test causation and the treatment course, then verifies the damages against the attached billing. Anything that cannot be verified quickly — an uncited assertion, an unexplained interval, a total that does not tie — becomes a reason to evaluate conservatively.
NORBU Demand Editorial · Reviewed by Legal reviewer · Last reviewed 2026-08-31
The typical review sequence
01
Coverage and parties
Confirm the policy, limits and the claim's posture.
02
Liability
Assess exposure from the incident evidence attached.
03
Causation
Check initial treatment timing and mechanism consistency.
04
Treatment
Follow the course of care and note intervals or escalation.
05
Damages
Verify the specials against the attached billing.
06
Evaluate
Form a range based on what the documentation supports.
What reviewers flag most
| Observation | Effect |
|---|---|
| Delay to first treatment | Causation argument |
| Gap in treatment | Recovery argument |
| Charges without notes | Line items excluded |
| Prior same-region treatment | Pre-existing condition argument |
| Uncited narrative claims | Assertions discounted |
Writing for the reviewer
- Answer the predictable arguments in the narrative rather than waiting for them
- Cite the page for every number and every clinical statement
- Keep totals identical across the letter, the summary and the exhibits
- Make the index good enough that verification takes seconds
Note
This describes commonly observed claims-review practice. Carrier procedures vary and are not uniform across insurers or jurisdictions.
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FAQ
Common questions
- What do adjusters look for in a demand package?
- Verifiable liability evidence, prompt and continuous treatment, objective findings, and a damages total that reconciles exactly to the attached billing.
NORBU Demand provides analytical support for counsel. It does not determine legal value, predict settlement outcomes, or provide legal advice. Every observation is presented for attorney review.
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