Which professional is responsible for determining coverage in insurance claims?

The claims adjuster is responsible for determining coverage in insurance claims because this professional evaluates the specifics of a claim to assess its validity and the extent of coverage. After a claim is filed, the claims adjuster investigates the incident, reviews the relevant policy details, gathers evidence, and may even consult with experts or witnesses. This thorough examination ensures that the determination of coverage aligns with the terms and conditions outlined in the insurance policy.

In contrast, an insurance agent primarily acts as a sales representative, facilitating the process of buying insurance and providing information about different coverage options. The insurance underwriter, on the other hand, assesses risks and decides on the acceptability of applications for insurance, focusing more on the initial underwriting process rather than the claims handling after a policy has been issued. Lastly, the policyholder is the individual or entity that holds the insurance policy and seeks coverage, but does not have the authority or expertise needed to make determinations regarding claims processing.