When would a claims adjuster refer a case to the legal department?

A claims adjuster would refer a case to the legal department if there are potential legal ramifications. This situation typically arises when complex legal issues are involved, such as assessing liability, understanding policy coverage that may not be clear-cut, or identifying risky exposures that could lead to legal action against the insurer. By involving the legal department, the adjuster ensures that the claim is handled in compliance with applicable laws and regulations, and that any potential legal disputes are proactively addressed.

Referring a case solely based on the absence of disputes or after the adjustment process is complete does not warrant legal input, as these scenarios do not necessarily involve legal complexities. Additionally, while a denied claim could lead to legal considerations if challenged, it is the presence of potential legal ramifications that primarily triggers the need for legal consultation.