Fla. Admin. Code Ann. R. 69BER24-4 - Ethical Requirements for All Adjusters and Public Adjuster Apprentices
(1) Definitions.
(a) "Adjuster," when used without further
specification, includes all types and classes of insurance adjusters, (company
employee, independent, and public), subject to Chapter 626, F.S., regardless of
whether permanent, temporary, apprentice, or emergency licensees.
(b) "Department" means the Florida Department
of Financial Services.
(c) "Person"
includes natural persons and legal entities.
(2) Violation.
(a) Violation of any provision of this rule
shall constitute grounds for administrative action against the
licensee.
(b) A breach of any
provision of this rule constitutes an unfair claims settlement
practice.
(3) Code of
Ethics. The work of adjusting insurance claims engages the public trust. An
adjuster shall put the duty for fair and honest treatment of the claimant above
the adjuster's own interests in every instance. The following are standards of
conduct that define ethical behavior, and shall constitute a code of ethics
that shall be binding on all adjusters:
(a) An
adjuster shall not directly or indirectly refer or steer any claimant needing
repairs or other services in connection with a loss to any person with whom the
adjuster has an undisclosed financial interest, or who will or is reasonably
anticipated to provide the adjuster any direct or indirect compensation for the
referral or for any resulting business.
(b) An adjuster shall treat all claimants
equally.
1. An adjuster shall not provide
favored treatment to any claimant.
2. An adjuster shall adjust all claims
strictly in accordance with the insurance contract.
(c) An adjuster shall not approach
investigations, adjustments, and settlements in a manner prejudicial to the
insured.
(d) An adjuster shall make
truthful and unbiased reports of the facts after making a complete
investigation.
(e) An adjuster
shall handle every adjustment and settlement with honesty and integrity, and
allow a fair adjustment or settlement to all parties without any compensation
or remuneration to himself or herself except that to which he or she is legally
entitled.
(f) An adjuster, upon
undertaking the handling of a claim, shall act with dispatch and due diligence
in achieving a proper disposition of the claim.
(g) An adjuster shall not negotiate or effect
settlement directly or indirectly with any third-party claimant represented by
an attorney, if the adjuster has knowledge of such representation, except with
the consent of the attorney. For purposes of this subsection, the term
"third-party claimant" does not include the insured or the insured's resident
relatives.
(h) An adjuster shall
not advise a claimant to refrain from seeking legal advice, nor advise against
the retention of counsel or the employment of a public adjuster to protect the
claimant's interest.
(i) An
adjuster shall not attempt to negotiate with or obtain any statement from a
claimant or witness at a time that the claimant or witness is, or would
reasonably be expected to be, in shock or serious mental or emotional distress
as a result of physical, mental, or emotional trauma associated with a loss.
The adjuster shall not conclude a settlement when the settlement would be
disadvantageous to, or to the detriment of, a claimant who is in the traumatic
or distressed state described above.
(j) An adjuster shall not knowingly fail to
advise a claimant of the claimant's claim options in accordance with the terms
and conditions of the insurance contract.
(k) An adjuster shall not undertake the
adjustment of any claim concerning which the adjuster is not currently
competent and knowledgeable as to the terms and conditions of the insurance
coverage, or which otherwise exceeds the adjuster's current
expertise.
(l) No person shall, as
a company employee adjuster or independent adjuster, represent him- or herself
or any insurer or independent adjusting firm against any person or entity that
the adjuster previously represented as a public adjuster.
(m) In order to ensure fair dealing in
estimating losses, an adjuster must adhere to all of the following requirements
when preparing and submitting a written estimate of loss. These requirements
cannot be waived by the insured or the insurance company.
1. Adjusters must utilize an electronic
estimating program to create or modify an estimate of loss. The electronic
estimating program must provide a report with an itemized, per unit estimate of
damage to the property, including itemized information on equipment, materials,
labor, and supplies. The electronic estimating program must apply price data
that consists of unit-cost breakdowns consistent with those that may be
expected from a contractor or repair company in the relevant geographic market
area. The electronic estimating program's price data must be updated no less
frequently than monthly to reflect current market data.
2. Modification to the prices applied by an
electronic estimating program, or modification to any other progam input or
output, is strictly prohibited unless the adjuster can demonstrate with
additional documentation that modification is required to produce an accurate
estimate and that each and every modification applies current market prices
within the relevant geographic market area for the equipment, materials, labor,
and supplies necesssary to complete the covered repairs. The additional
documentation prepared by the adjuster must be sufficiently detailed to enable
the reviewer to determine that each and every modification is required and
applies current market prices.
3.
Adjusters must provide the written estimate of loss to the insured within the
time prescribed by law. The written estimate of loss provided to the insured
must include the line-item estimate produced by the electronic estimating
program, a variation report or other similar report showing whether and to what
extent the program was modified by the adjuster, and, if applicable, additional
documentation to support any modification to the input or output of the
electronic estimating program.
4.
Modification to an initial estimate of loss is strictly prohibited unless the
revised estimate of loss:
a. indicates any
estimate of loss that has been modified from any prior estimate of
loss;
b. provides a detailed
explanation as to why each change was made; and
c. includes the identity of the adjuster who
is responsible for each change.
5. Adjusters must retain all versions of the
estimate of loss as required by law.
(4) Public Adjusters, Other Ethical
Constraints. In addition to the ethical requirements found in Part VI of
Chapter 626, F.S., and those set out above in subsection (3) for all adjusters,
the following ethical considerations are specific to public adjusters and shall
be binding upon public adjusters:
(a) A public
adjuster shall not prevent, or attempt to dissuade or prevent, an insured or
claimant from speaking privately with the insurer, company employee adjuster,
independent adjuster, attorney, or any other person, regarding the settlement
of the claim.
(b) A public adjuster
shall not enter into a contract or accept a power of attorney which vests in
the public adjuster the effective authority to choose the persons who shall
perform repair work.
(c) 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, including
the terms required by Rule
69B-220.051, F.A.C., and
sections 626.854 and
626.8796, F.S.
(d) No public adjuster who represents a
claimant with regard to a particular claim shall enter into any contract,
agreement or other arrangement with any person, which would allow the public
adjuster to accept an amount that would exceed the limitation of the public
adjuster's compensation imposed by Section
626.854(10),
F.S.
(e) No public adjuster, while
so licensed in the Department's records, shall represent or act as or be
appointed as a company employee adjuster or independent adjuster. A public
adjuster may hold a general lines agent license. However, no public adjuster,
while so licensed in the Department's records, shall represent or act as both a
public adjuster and a general lines agent for the same insurance
claim.
(f) No public adjuster shall
represent any person or entity on a claim if he or she previously adjusted that
claim as an adjuster representing any insurer or independent adjusting
firm.
(g) A public adjuster shall
respond with specific information to a written or electronic request for claims
status from a claimant or insured or their designated representative within
thirty (30) days from the date of the request and shall document the file
accordingly.
Notes
Rulemaking Authority 624.308, 626.878, 626.9611(1) FS. Law Implemented 624.307(1), 626.015(2), 626.611, 626.621, 626.852(2), 626.854, 626.859, 626.864, 626.8651, 626.8695, 626.8698, 626.875, 626.877, 626.878, 626.8795, 626.9521, 626.9541(1)(i), FS.
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