230-RICR-20-50-4
230-RICR-20-50-4. Insurance Claim Adjusters (version Technical Revision, 01/01/2015 to 01/01/2015)
4.1 Authority
This Part is promulgated
pursuant to R.I. Gen. Laws Chapter 27-10.
4.2 Purpose and Applicability
A. This Part shall apply to
all persons who engage for compensation in investigating, negotiating
or settling property & casualty or workers compensation insurance
claims. Unlicensed persons may not advertise, hold themselves out as
or solicit the adjustment of insurance claims. This includes company
adjusters, independent adjusters and public adjusters.
B. The purpose of this Part is
to establish standards and procedures for the issuance of insurance
claim adjuster licenses and to govern the conduct of insurance claim
adjusters.
4.3 Definitions
A. As used in this Part:
1. "Aftermarket part"
means a motor vehicle body replacement part that is not an original
equipment manufacturer part
2. "Applicant" shall
mean a Person filing an application for a Rhode Island insurance
claims adjuster license.
3. “Catastrophic disaster”
according to the Federal Response Plan, means an event that results
in large numbers of deaths or injuries; causes extensive damage or
destruction of facilities that provide and sustain human needs;
produces an overwhelming demand on state and local response resources
and mechanisms; causes a severe long-term effect on general economic
activity; and severely affects state, local and private sector
capabilities to begin and sustain response activities. A catastrophic
disaster shall be declared by the President of the United States, the
Governor of Rhode Island or the Insurance Commissioner of Rhode
Island.
4. “Company adjuster”
means an insurance adjuster who is an employee of an insurance
company.
5. "Damaged motor vehicle
body part" means any part of the body of a motor vehicle which
is damaged as the result of a collision with another vehicle or
object. Such parts shall include fenders, bumpers, windshields,
glass and similar components of motor vehicle bodies as distinguished
from the chassis, seats, motor, transmission, air conditioning
condenser, radiator, and other accessories for propulsion and general
running gear of motor vehicles.
6. “Department” means the
Department of Business Regulation and the Division of Insurance
thereof.
7. “Emergency adjuster”
means a person who is authorized by the Department to perform
adjusting activities in Rhode Island in the event of an emergency,
catastrophe or state of disaster declared in Rhode Island pursuant to
R.I. Gen. Laws § 27-10-8.
8. “Home state” means the
District of Columbia and any state or territory of the United States
in which the adjuster maintains his or her principal place of
residence or principal place of business is located. If neither the
state in which the adjuster maintains the principal place of
residence nor the state in which the adjuster maintains the principal
place of business has a substantially similar law governing
adjusters, the adjuster may declare another state in which it becomes
licensed and acts as an adjuster to be the ‘home state.’
9. “Independent adjuster”
means an insurance adjuster who is hired on a contract basis by an
insurance company to represent the insurance company’s interest in
the settlement of the claim.
10. “License” means the
insurance adjuster license issued by the Department to a Person
engaged in the business of insurance claims adjusting.
11. "Licensee" means
a Person holding an Insurance Adjuster License.
12. “NAIC” means the
National Association of Insurance Commissioners.
13. “NIPR” means National
Insurance Producer Registry.
14. "Original equipment
manufacturer part" or "OEM part" means a motor vehicle
body replacement part manufactured by the manufacturer of the motor
vehicle being repaired.
15. “Public adjuster”
means any person who, for compensation or any other thing of value on
behalf of the insured:
a. Acts or aids, solely in
relation to first party claims arising under insurance contracts,
other than automobile, life, accident & health, that insure the
real or personal property of the insured, on behalf of an insured in
negotiating for, or effecting the settlement of, a claim for loss or
damage covered by an insurance contract;
b. Advertises for employment
as a public adjuster of insurance claims or solicits business or
represents himself or herself to the public as an public adjuster of
first party insurance claims for losses or damages arising out of
policies of insurance that insure real or personal property; or
c. Directly or indirectly
solicits business, investigates or adjusts losses, or advises an
insured about first party claims for losses or damages arising out of
policies of insurance that insure real or personal property for
another person engaged in the business of adjusting losses or damages
covered by an insurance policy, for the insured.
16. “Resident” means a
person who either resides in Rhode Island or maintains an office in
Rhode Island where the business of producing insurance is transacted
and designated Rhode Island as the residence for purposes of
licensure.
17. “Uniform individual
application” means the current version of the NAIC Uniform
Individual Application for resident and nonresident individuals.
18. “Uniform business entity
application” means the current version of the NAIC Uniform Business
Entity Application for resident business entities.
4.4 License
Required
A. A person shall not act or
hold him/her or itself out as an adjuster in this state unless the
person is licensed as an adjuster by the State of Rhode Island.
Application for an individual person shall be made using the Uniform
Individual Application as modified and provided by the Department.
B. The Department may issue
business entity licenses to residents on a discretionary basis.
Application shall be made using the Uniform Business Entity
Application as modified and provided by the Department. A business
entity license is not required. All persons associated with a
business entity performing adjuster services must hold a valid
individual license. Before approving the application for a business
entity license, the department shall find that:
1. The business entity is a
resident of the State of Rhode Island;
2. The business entity has
paid the applicable fees; and
3. The business entity has
designated a licensed adjuster responsible for the business entity’s
compliance with the insurance laws, rules and regulations of this
state.
C. An insurance adjuster doing
business under any name other than the adjusters’ legal name is
required to notify and obtain the consent of the Department prior to
using the assumed name.
D. Each adjuster license is
issued on a biennial basis. An adjuster who obtains a license during
the license term shall be issued a license for the time period
remaining and will have to renew at the expiration of the License,
regardless of the period of time he, she or it has been licensed.
The Department does not prorate license fees.
E. A license as an adjuster
shall not be required of the following:
1. An attorney-at-law admitted
to practice in this state, when acting in his or her professional
capacity as an attorney;
2. A person who negotiates or
settles claims arising under a life or health insurance policy or an
annuity contract;
3. An insurance producer
licensed by the Department, when the insurance producer adjusts, or
assists in the adjustment of claims arising only under policies of
insurance or fidelity or surety bonds negotiated, solicited, or
effected by him or her or by the insurance producer, whether the
insurance producer is a person, partnership, or corporation, for
which he or she acts;
4. A person employed for the
purpose of obtaining facts surrounding a loss or furnishing technical
assistance to a licensed adjuster, including but not limited to
photographers, estimators, private investigators, engineers, and
handwriting experts;
5. An individual who is
employed to investigate suspected fraudulent insurance claims but who
does not adjust losses or determine claims payments;
6. A person who solely
performs executive, administrative, managerial, or clerical duties,
or any combination thereof, and who does not investigate, negotiate,
or settle claims with policyholders, claimants, or their legal
representative;
7. A licensed health care
provider or its employee who provides managed care services as long
as the services do not include the determination of compensability;
8. A managed care organization
or any of its employees or an employee of any organization providing
managed care services so long as the services do not include the
determination of compensability;
9. A person who settles only
reinsurance or subrogation claims;
10. A person who investigates,
negotiates, or settles life, accident and health, annuity, or
disability insurance claims;
11. An individual employee,
under a self-insured arrangement, who adjusts claims on behalf of
their employer;
12. A person authorized to
adjust workers' compensation or disability claims under the authority
of a third-party administrator (TPA) license pursuant to R.I. Gen.
Laws Chapter 27-2; and
13. A person who adjusts
claims for portable electronic insurance offered pursuant to R.I.
Gen. Laws Chapter 27-2.
F. A licensed adjuster that is
unable to comply with license renewal procedures due to military
service or some other extenuating circumstance (e.g., a long-term
medical disability) may request a waiver of those procedures. The
adjuster may also request a waiver of any examination requirement,
fine, or other sanction imposed for failure to comply with renewal
procedures.
4.5 Licensing Procedures
A. The Department may contract
with non-governmental entities, including the NAIC or any affiliates
or subsidiaries that the NAIC oversees, to perform any ministerial
functions, including the collection of fees and data, related to
licensing that the Department may deem appropriate.
B. Applications for adjuster
licenses must be made electronically through NIPR. If this
requirement would cause a hardship for any individual (s)he should
contact the insurance division and request permission to apply by
hard copy application. Permission shall be granted to such persons
unless a compelling reason requires otherwise.
C. Company and independent
adjusters shall specify the lines of authority requested at the time
of the application;
D. At the time of application
the applicant shall pay all fees. Failure to pay fees shall be
grounds for revocation of the license.
4.6 Emergency Licenses
A. Emergency company and
independent adjuster licenses may be issued if the requirements of
R.I. Gen. Laws § 27-10-8 and this Part are met. Public adjusters
are not eligible for emergency licensing.
B. Pursuant to R.I. Gen. Laws
§ 27-10-8, the Department may permit an experienced adjuster to act
as a company or independent adjuster in this state on homeowners'
losses if the adjuster is either a licensed adjuster in another state
which requires a license or regularly adjusts in another state where
such licensing is not required and works for an insurance company
authorized to do business in Rhode Island.
C. Those persons issued an
emergency license may only engage in adjustment work during the
period determined by the Department.
D. In order to obtain an
emergency adjuster license the individual shall complete an
application for an emergency adjuster license in NIPR within five (5)
days of deployment to adjust claims arising from the declared
catastrophe. No fee will be assessed by the State, however, the
applicant will be required to pay any fees imposed by NIPR for
services provided.
E. Emergency licenses shall
remain in force for a period specified by the Department not to
exceed ninety (90) days, unless extended by the Department.
F. Any person licensed as an
emergency adjuster must comply with all laws of this state and both
(s)he and the insurer for whom the claim is adjusted are responsible
in the same manner as they would be if the adjuster was a fully
licensed adjuster.
4.7 Examination
A. An individual applying for
an adjuster license shall pass a written examination unless exempt
pursuant to §§ 4.5 and 4.7 of this Part. The examination shall test
the knowledge of the individual concerning the duties and
responsibilities of an adjuster and the insurance laws and
regulations of this state.
B. The Department may make
arrangements, including contracting with an outside testing service,
for administering examinations and collecting the nonrefundable fee
for said examinations.
C. An individual who fails to
appear for the examination as scheduled or fails to pass the
examination, shall register for another examination and is required
to pay the fees and complete the necessary forms before being
rescheduled for another examination.
4.8 Exemptions from Examination
A. A person who applies for an
adjuster license in this state who holds an active license as a
resident adjuster in another state shall not be required to complete
any examination. An adjuster that is exempted from examination is
required to be knowledgeable of Rhode Island law applicable to
adjusters and is required to comply with all such statutes and
regulations. This exemption is only available if the person is
currently licensed if the resident or designated home state certifies
that, the applicant is in good standing in that state or the state's
database records or those records maintained by the NAIC, its
affiliates or subsidiaries, indicate that the adjuster is licensed in
good standing.
B. A person that currently
holds a nonresident adjuster license and moves to this state shall
make application within ninety (90) days of establishing legal
residence to become a resident adjuster. No examination shall be
required of that person to obtain an adjusters license, but the
adjuster shall be required to certify knowledge of Rhode Island law
applicable to adjusters.
C. An adjuster who allows his,
her or its license to expire may, within twelve (12) months from the
due date of the renewal, reinstate this license without the necessity
of passing a written examination. A reinstatement fee is required
along with the unpaid renewal fee which shall be paid at the time of
reinstatement. This exemption is only available if the application
is received within twelve (12) months of the due date and the
Applicant was in good standing in the state of residence or the
state’s database records or those records maintained by the NAIC at
the time of renewal. The Applicant is required to file a
reinstatement application, and pay all applicable fees.
4.9 Conduct - All Adjusters
A. All adjusters must comply
with the following:
1. Any licensee shall
immediately notify the Department by any means acceptable to the
Department if any action is taken by another state against his or her
adjuster license in that state.
2. The licensee shall inform
the Department by any means acceptable to the Department of a change
of address, change of legal name, or change of information submitted
on the application within thirty (30) days of the change.
3. A person shall not accept a
commission, service fee or other valuable consideration for
investigating or settling insurance claims in this state if that
person is required to be licensed under R.I. Gen. Laws Chapter 27-10
and is not so licensed.
4. Records shall be maintained
for at least five (5) years after the termination of the transaction
and shall be open to examination by the Department at all times.
5. Every adjuster, upon
receipt of any written inquiry (including electronic communications)
from the Department, shall within 21 calendar days of receipt of such
inquiry, furnish the Department with a response to the inquiry in
duplicate.
6. No adjuster may represent
or act as a public adjuster, company adjuster, or independent
adjuster on the same claim.
4.10 Conduct - Company and
Independent Adjusters
A. In addition to the
requirements of § 4.9 of this Part, all Company and Independent
Adjusters must also comply with the following:
1. An adjuster shall promptly
inform an insured or claimant of his or her free choice in the
selection of an auto body repair shop. Once the insured or claimant
has advised the insurer that an auto body repair shop has been
selected, the adjuster may not recommend that a different auto body
repair shop be selected to repair the automobile.
2. No adjuster shall request
or advise any motor vehicle owner or operator to operate his or her
vehicle on any public thoroughfare for the purpose of obtaining a
written estimate of damage at a drive-in claims center, unless it
ascertained that the vehicle meets safety requirements as determined
by the department of transportation. A vehicle is unsafe for driving
under this section if the vehicle has
a. damage to its unitized body
construction;
b. damage to its hood catch
which would probably result in an unexpected opening;
c. damage to the front
suspension;
d. metal in contact with any
tire;
e. any door which can’t be
easily opened or which opens unexpectedly;
f. inoperable tail lights;
g. broken glass affixed to the
vehicle or a cracked windshield or
h. any other condition deemed
to be unsafe by the department of transportation pursuant to rules
and regulations.
3. Whenever an appraisal is
written on behalf of an insurer, an adjuster shall assure that the
appraisal contains the name of the insurance company ordering it, the
insurance file number, the number of the appraiser's license, the
proper identification number of the vehicle being inspected, a clear
indication of all damage unrelated to the incident or accident that
occasioned the appraisal of the vehicle, or old damage, and notice in
boldface type, reading as follows:
PURSUANT
TO RHODE ISLAND LAW, THE CONSUMER HAS THE RIGHT TO CHOOSE THE
REPAIR FACILITY TO COMPLETE REPAIRS TO A MOTOR VEHICLE; AND AN
INSURANCE COMPANY MAY NOT INTERFERE WITH THE CONSUMER'S CHOICE OF
REPAIRER.
4. An adjuster adjusting a
claim for motor vehicle physical damage shall notify the claimant in
writing if he or she intends to specify the use of aftermarket parts.
To comply with this provision written notice may be provided on the
original appraisal of the damaged vehicle.
5. For any automobile which is
less than thirty (30) months beyond the date of manufacturer, the
adjuster must provide, or assure that the insurer has provided,
written notice to the vehicle owner that:
a. he or she may require the
insurer to pay for and the auto body shop to install "original
equipment manufacturer parts " or "OEM parts" in the
repair of a motor vehicle body replacement; or
b. he or she may require the
insurer to pay for and the auto body shop to install "non-original
equipment manufacturer parts" (non-"OEM parts") in the
repair of a motor vehicle body replacement.
(1) To comply with this
provision, written notice may be provided on the appraisal written on
behalf of the insurer.
6. An adjuster shall not
require the use of aftermarket parts when negotiating repairs of
vehicles which are less than thirty (30) months beyond the date of
manufacture, unless written consent from the vehicle owner to install
aftermarket parts has been obtained.
7. Whenever aftermarket parts
are used for repairs to physically damaged motor vehicles, the
following standards shall apply:
a. The aftermarket parts shall
be at least equal in kind and quality to the OEM parts in terms of
fit, quality and performance;
b. To the extent practical, an
insurance company shall not require the use of multiple aftermarket
parts distributors to provide parts for a single repair;
c. Insurers specifying the use
of aftermarket parts shall make allowances for the reasonable cost of
any modifications to the aftermarket parts which may become necessary
when making the repair, and for the cost of fitting, removing, and/or
handling aftermarket parts which do not result in the vehicle being
repaired to its condition prior to the loss;
d. If the aftermarket part
specified by the insurer does not result in the vehicle being
repaired to its condition prior to the loss, the insurer shall then
specify the use of an OEM part;
e. The automobile body shop
shall promptly notify the appraiser if the aftermarket part specified
by the insurer does not result in the vehicle being repaired to its
condition prior to the loss and permit the appraiser to reinspect the
vehicle and make appropriate supplemental authorizations, if
necessary;
f. The automobile body shop
shall provide documentation of aftermarket parts, which do not meet
the requirements of this section, as reasonably requested by the
insurer. The insurer shall be permitted to exercise any available
rights of recovery against the aftermarket parts distributor.
8. An adjuster shall not
require that any insured or claimant use a particular rental car
agency. In accordance with R.I. Gen. Laws § 27-9.1-4(17) adjusters
are not precluded from providing the name(s) of Rhode Island licensed
rental car agencies with which arrangements have been made with
respect to rental services.
9 An adjuster shall not refuse
to honor a ‘direction to pay” executed by an insured or claimant
to pay directly his or her motor vehicle replacement benefit,
provided the rental agency is licensed in Rhode Island. In
accordance with R.I. Gen. Laws § 27-9.1-4(18) the adjuster may
question or challenge the amount charged in accordance with its
policy.
10. If the claimant or insured
has elected to have a vehicle repaired at an auto body shop of the
claimant or insureds choice, the adjuster may not:
a. Modify any published manual
(i.e. motors, mitchells, or any automated appraisal system) relating
to auto body repair unless there is prior agreement between the
insurer and the owner of the vehicle to do so. The owner of the
vehicle may delegate the ability to agree to modifications to an auto
body repairer in writing.
b. Refuse to include in the
adjustment of the claim documented charges as identified through
industry recognized software programs or systems for paint and
refinishing materials in auto body repair claims;
c. Fail to use a manual or
system in its entirety in the adjustment of the claim;
d. Limit or discount the
reasonable repair costs based upon the charges that would have been
incurred had the vehicle been repaired by the insurer's chosen
shop(s).
11. § 4.10(A)(10)(a) of this
Part does not apply to direct repair programs where an insurer and
body shop have entered into a contract.
12. Where applicable,
adjusters shall comply with the requirements of R.I. Gen. Laws §
31-46-1.1 regarding the classification of salvage vehicles.
13. Where applicable,
adjusters shall comply with the provisions of the Child Support
Interception Act pursuant to R.I. Gen. Laws Chapter 27-57.
14. A licensed adjuster is
subject to all applicable statutes including but not limited to R.I.
Gen. Laws Chapters 27-9.1 and 27-29 and the regulations promulgated
thereunder.
15. A company or independent
insurance adjuster’s duties include determining the amount of money
that an insurance company will pay for a motor vehicle damage claim.
While a company or independent adjuster may rely upon the written
appraisal in the settlement of the claim, an insurance adjuster
cannot require an appraiser to either include or exclude damage on an
appraisal provided however; the company or independent adjuster may
provide the appraiser with information relating to damage unrelated
to the incident or accident that occasioned the appraisal of the
vehicle, or old damage, if the information to be provided by the
company or independent adjuster is required to be included by the
appraiser in the appraisal pursuant to R.I. Gen. Laws § 27-10.1-6.
4.11 Conduct - Public Adjusters
A. In addition to the
requirements of § 4.9 of this Part, all Public Adjusters must also
comply with the following:
1. A person acting as a public
adjuster shall not misrepresent to a claimant that he or she is an
adjuster representing an insurer in any capacity, including acting as
an employee of the insurer or acting as an independent adjuster
unless so appointed by an insurer in writing to act on the insurer’s
behalf for that specific claim or purpose. A public adjuster is
prohibited from charging that specific claimant a fee when appointed
by the insurer and the appointment is accepted by the adjuster.
2. No public adjuster shall
split any commission, service fee or other valuable consideration for
performing adjusting services to any person unless that person is
required to be licensed under R.I. Gen. Laws Chapter 27-10.
3. In the event of a
catastrophic disaster, there shall be limits on catastrophic fees.
No public adjuster shall charge, agree to or accept as compensation
or reimbursement any payment, commission, fee, or other thing of
value equal to more than ten percent (10%) of any insurance
settlement or proceeds. No public adjuster shall require, demand or
accept any fee, retainer, compensation, deposit, or other thing of
value, prior to settlement of a claim.
4. Public adjusters shall
ensure that all contracts for their services are in writing and
contain the following terms:
a. Legible full name of the
adjuster signing the contract, as specified in Department records;
b. Permanent home state
business address and phone number;
c. Department license number;
d. Title of “Public Adjuster
Contract”;
e. The insured’s full name,
street address, insurance company name and policy number, if known or
upon notification;
f. A description of the loss
and its location, if applicable;
g. Description of services to
be provided to the insured;
h. Signatures of the public
adjuster and the insured;
i. Date contract was signed by
the public adjuster and date the contract was signed by the insured;
j. Full salary, fee,
commission, compensation or other considerations the public adjuster
is to receive for services.
k. The contract may specify
that the public adjuster shall be named as a co-payee on an insurer’s
payment of a claim.
(1) If the compensation is
based on a share of the insurance settlement, the exact percentage
shall be specified.
(2) Initial expenses to be
reimbursed to the public adjuster from the proceeds of the claim
payment shall be specified by type, with dollar estimates set forth
in the contract and with any additional expenses first approved by
the insured.
(3) Compensation provisions in
a public adjusting contract shall not be redacted in any copy of a
contract provided to the Department upon request. Such a redaction
shall constitute an omission of material fact.
5. If the insurer, not later
than seventy-two (72) hours after the date on which the loss is
reported to the insurer, either pays or commits in writing to pay to
the insured a policy coverage limit(s), the public adjuster shall,
with respect to that coverage:
a. Not receive a commission
consisting of a percentage of the total amount paid by an insurer to
resolve a claim;
b. Inform the insured that
loss recovery amount might not be increased by insurer; and
c. Be entitled only to
reasonable compensation from the insured for services provided by the
public adjuster on behalf of the insured, based on the time spent on
a claim and expenses incurred by the public adjuster, until the claim
is paid or the insured receives a written commitment to pay from the
insurer.
6. A public adjuster shall
provide the insured a written disclosure concerning any direct or
indirect financial interest that the public adjuster has with any
other party who is involved in any aspect of the claim, other than
the salary, fee, commission or other consideration established in the
written contract with the insured, including but not limited to any
ownership of, other than as a minority stockholder, or any
compensation expected to be received from, any construction firm,
salvage firm, building appraisal firm, motor vehicle repair shop, or
any other firm which provides estimates for work, or that performs
any work, in conjunction with damages caused by the insured loss on
which the public adjuster is engaged. The word “firm” shall
include any corporation, partnership, association, joint-stock
company or person.
7. A public adjuster contract
may not contain any contract term that:
a. Allows the public
adjuster’s percentage fee to be collected when money is due from an
insurance company, but not paid, or that allows a public adjuster to
collect the entire fee from the first check issued by an insurance
company, rather than as percentage of each check issued by an
insurance company;
b. Requires the insured to
authorize an insurance company to issue a check only in the name of
the public adjuster;
c. Imposes collection costs or
late fees; or
d. Precludes any party from
pursuing civil remedies.
8. Prior to the signing of the
contract the public adjuster shall provide the insured with a
separate disclosure document regarding the claim process that states:
a. Property insurance policies
obligate the insured to present a claim to his or her insurance
company for consideration. There are three (3) types of adjusters
that could be involved in that process. The definitions of the three
types are as follows:
(1) “Company adjuster”
means the insurance adjusters who are employees of an insurance
company. They represent the interest of the insurance company and are
paid by the insurance company. They will not charge you a fee.
(2) “Independent adjuster”
means the insurance adjusters who are hired on a contract basis by an
insurance company to represent the insurance company’s interest in
the settlement of the claim. They are paid by your insurance company.
They will not charge you a fee.
(3) “Public adjuster”
means the insurance adjusters who do not work for any insurance
company. They work for the insured to assist in the preparation,
presentation and settlement of the claim. The insured hires them by
signing a contract agreeing to pay them a fee or commission based on
a percentage of the settlement, or other method of compensation.
b. The insured is not required
to hire a public adjuster to help the insured meet his or her
obligations under the policy, but has the right to do so.
c. The public adjuster is not
a representative or employee of the insurer.
d. The salary, fee, commission
or other consideration is the obligation of the insured, not the
insurer.
9. The contract shall be
executed in duplicate to provide an original contract to the public
adjuster, and an original contract to the insured. The public
adjuster's original contract shall be available at all times for
inspection without notice by the Department.
10. The public adjuster shall
provide the insurer a notification letter, which has been signed by
the insured, authorizing the public adjuster to represent the
insured’s interest.
11. The insured has the right
to rescind the contract within three (3) business days after the date
the contract was signed. The rescission shall be in writing and
mailed or delivered to the public adjuster at the address in the
contract within the three (3) business day period.
12. If the insured exercises
the right to rescind the contract, anything of value given by the
insured under the contract will be returned to the insured within
fifteen (15) business days following the receipt by the public
adjuster of the cancellation notice.
13. A public adjuster who
receives, accepts or holds any funds on behalf of an insured, towards
the settlement of a claim for loss or damage, shall deposit the funds
in a non-interest bearing escrow or trust account in a financial
institution that is insured by an agency of the federal government in
the public adjuster’s home state or where the loss occurred.
14. A public adjuster shall
maintain a complete record of each transaction as a public adjuster.
The records required by this section shall include the following:
a. Name of the insured;
b. Date, location and amount
of the loss;
c. Copy of the contract
between the public adjuster and insured;
d. Name of the insurer,
amount, expiration date and number of each policy carried with
respect to the loss;
e. Itemized statement of the
insured’s recoveries;
f. Itemized statement of all
compensation received by the public adjuster, from any source
whatsoever, in connection with the loss;
g. A register of all monies
received, deposited, disbursed, or withdrawn in connection with a
transaction with an insured, including fees transfers and
disbursements from a trust account and all transactions concerning
all interest bearing accounts;
h. Name of public adjuster who
executed the contract; and
i. Name of the attorney
representing the insured, if applicable, and the name of the claims
representatives of the insurance company.
15. A public adjuster is
obligated, under his or her license, to serve with objectivity and
complete loyalty to the interest of his client alone; and to render
to the insured such information, counsel and service, as within the
knowledge, understanding and opinion in good faith of the licensee,
as will best serve the insured’s insurance claim needs and
interest.
16. A public adjuster shall
not solicit, or attempt to solicit, an insured during the progress of
a loss-producing occurrence, as defined in the insured’s insurance
contract.
17. A public adjuster shall
not permit an unlicensed employee or representative of the public
adjuster to conduct business for which a license is required.
18. A public adjuster shall
not have a direct or indirect financial interest in any aspect of the
claim, other than the salary, fee, commission or other consideration
established in the written contract with the insured, unless full
written disclosure has been made to the insured as set forth in §§
14.1(A)(6) and/or (A)(21) of this Part.
19. A public adjuster shall
not acquire any interest in salvage of property subject to the
contract with the insured unless the public adjuster obtains written
permission from the insured after settlement of the claim with the
insurer as set forth in §§ 14.1(A)(6) and/or (A)(21) of this Part.
20. The public adjuster shall
abstain from referring or directing the insured to obtain needed
repairs or services in connection with a loss from any person, unless
disclosed to the insured:
a. With whom the public
adjuster has a financial interest; or
b. From whom the public
adjuster may receive direct or indirect compensation for the
referral.
21. The public adjuster shall
disclose to an insured if he or she has any interest or will be
compensated by any construction firm, salvage firm, building
appraisal firm, motor vehicle repair shop or any other firm that
performs any work in conjunction with damages caused by the insured
loss. The word "firm" shall include any corporation,
partnership, association, joint-stock company or individual.
22. Any compensation or
anything of value in connection with an insured’s specific loss
that will be received by a public adjuster shall be disclosed by the
public adjuster to the insured in writing including the source and
amount of any such compensation.
23. A public adjuster shall
not enter into a contract or accept a power of attorney that vests in
the public adjuster the effective authority to choose the persons who
shall perform repair work.
24. A public adjuster shall
ensure that all contracts for the public adjuster’s services are in
writing and set forth all terms and conditions of the engagement.
25. A public adjuster may not
agree to any loss settlement without the insured’s knowledge and
consent.
26. The contract entered into
by a public adjuster shall not be construed to prevent an insured
from pursuing any civil remedy after the three-business day
revocation or cancellation period.
4.12 License Denial, Non-Renewal
or Revocation
A. The Department may place on
probation, suspend, revoke or refuse to issue or renew an adjuster’s
license or may levy a civil penalty in accordance with R.I. Gen. Laws
§ 42-14-16 for any one or more of the following causes:
1. Failing to respond to any
written inquiry (including electronic communications) from the
Department within 21 calendar days of receipt of such inquiry.
2. Providing incorrect,
misleading, incomplete, or materially untrue information in the
license application.
3. Violating any insurance
laws, or violating any regulation, subpoena, or order of the
Department or of another state’s insurance commissioner.
4. Obtaining or attempting to
obtain a license through misrepresentation or fraud.
5. Improperly withholding,
misappropriating, or converting any monies or properties received in
the course of doing insurance business.
6. Having been convicted of a
felony.
7. Having admitted or been
found to have committed any insurance unfair trade practice or
insurance fraud.
8. Using fraudulent, coercive
or dishonest practices; or demonstrating incompetence,
untrustworthiness or financial irresponsibility in this state or
elsewhere.
9. Having an insurance
license, or its equivalent, denied, suspended, or revoked in any
other state, province, district or territory.
10. Forging another’s name
to any document.
11. Cheating, including
improperly using notes or any other reference material, to complete
an examination for an insurance license.
12. Failing to comply with an
administrative or court order imposing a child support obligation.
13. Failing to pay state
income tax or comply with any administrative or court order directing
payment of state income tax.
B. In the event that the
action by the Department is to deny an application for or not renew a
license, the Department shall notify the Applicant or licensee, in
writing, of the reason for the non-renewal or denial of the license.
The Applicant or licensee may make written demand upon the Department
within ten days for a hearing before the Department to determine the
reasonableness of the Department’s action. The hearing shall be
held pursuant to R.I. Gen. Laws Chapter 42-35.
C. The license of a business
entity may be suspended, revoked or refused if the Department finds,
after hearing, that an individual licensee’s violation was known or
should have been known by one or more of the partners, officers or
managers acting on behalf of the business entity and the violation
was neither reported to the Department nor corrective action taken.
D. In addition to or in lieu
of any applicable denial, suspension or revocation of a license, a
person may, after hearing, be subject to a fine and/or any other
appropriate remedies according to R.I. Gen. Laws § 42-14-16.
E. The Department shall retain
the authority to enforce the provisions of and impose any penalty or
remedy authorized by R.I. Gen. Laws Chapter 27-10, R.I. Gen. Laws §
42-14-16 and/or this Part against any person who is under
investigation for or charged with a violation even if the person’s
license or registration has been surrendered or has lapsed by
operation of law.
4.13 Reporting of Actions
A. The adjuster shall report
to the Department any administrative action taken against the
adjuster in another jurisdiction or by another governmental agency in
this state within thirty (30) days of the final disposition of the
matter. This report shall include a copy of the order, consent to
order, or other relevant legal documents.
B. Within thirty (30) days of
the initial pretrial hearing date, the adjuster shall report to the
Department any criminal prosecution of the adjuster taken in any
jurisdiction. The report shall include a copy of the initial
complaint filed, the order resulting from the hearing, and any other
relevant legal documents.
4.14 Severability
If any provision of this Part
or the application thereof to any person or circumstances is held
invalid or unconstitutional, the invalidity or unconstitutionality
shall not affect other provisions or applications of this Part which
can be given effect without the invalid or unconstitutional provision
or application, and to this end the provisions of this Part are
severable.