FL Adjuster Claim Professional Exam Study Guide

Florida Regulation of Property and Casualty Insurance and Adjusters

Conduct of Adjusters

Adjusters may be employed by insurance companies to investigate claims and determine payouts or settlements. Independent adjusters may be hired if the insurer lacks in-state adjusters. Public adjusters represent policyholders, acting as liaisons with insurance companies.

• Records: Licensed adjusters must keep business transaction records for at least 3 years at their place of business, which may be their home.
• Public Adjusters: Must review advertisements for compliance, respond to claim status requests within 30 days, and obtain claimant approval before settling claims.
• Code of Ethics: Adjusters must deal fairly, avoid conflicts of interest, and preserve claimant rights.

Dismantling, Destruction, or Change of Identity of Motor Vehicle or Mobile Home; Salvage

A derelict motor vehicle or mobile home is valued under $1,000 ($5,000 for travel trailers), at least 10 model years old, and primarily valuable for scrap or parts.

A total loss vehicle occurs when:

• Insurer pays to replace a wrecked/damaged vehicle.
• Insurer pays for a stolen vehicle.
• An uninsured vehicle’s repair cost is 80% or more of replacement cost.

Salvage: Total loss vehicles are treated as salvage. Owners must surrender titles for dismantled vehicles, and fraud in these transactions is a third-degree felony (up to $5,000 fine or 5 years imprisonment).

Unfair Methods of Competition; Unfair or Deceptive Acts

Sliding

Sliding includes:

• Requiring unneeded ancillary coverage.
• Claiming ancillary coverage is free when it incurs a charge.
• Charging for unconsented coverage.

Coercion

Agreements to boycott, coerce, or intimidate that restrain or monopolize the insurance business are prohibited.

Misrepresentation

Misrepresentation can void recovery if fraudulent or material, or if the insurer would not have issued the policy or would have altered terms. Includes false statements in applications or omitting material facts.

Defamation

Publishing false or misleading statements about an insurer’s financial condition to injure someone in the insurance business is unlawful.

Unfair Discrimination

Charging different premiums or offering different benefits to policyholders of the same class and risk, or refusing coverage due to abuse-related treatment, is prohibited.

Unfair Claims Settlement Practices

Prohibited practices include:

• Settling claims based on altered applications without consent.
• Misrepresenting facts or policy provisions.
• Failing to acknowledge claims promptly or investigate reasonably.
• Denying claims without explanation or within 30 days after proof of loss.

Fraudulent Practices

Submitting false or misleading claim/application information is a third-degree felony. All forms must include a fraud warning statement.

Controlled Business

Licenses cannot be used primarily for insuring the licensee’s family, employer, or associates.

Twisting

Making false statements to induce policy lapse, surrender, or purchase is unlawful.

Excessive Charges

Collecting unprovided-for premiums is illegal, with fines up to $2,500 (nonwillful) or $20,000 (willful) per violation.

Commission Rebates

Rebates are allowed if available to all in the same actuarial class and filed with the insurer. Inducements not in the contract are prohibited.

Comprehensive Coverage

Covers losses from:

• Natural disasters (e.g., earthquakes, tornados).
• Falling objects (e.g., hail).
• Theft, vandalism, fire, or animal collisions.
• Glass damage (e.g., windshields).

Florida requires $10,000 PIP and $10,000 PDL, but comprehensive coverage is optional.

Mediation of Claims

Service representatives and managing general agents must be accompanied by a licensed Florida agent when settling claims.

Insurer Responsibilities

• Acknowledge Claims: Within 14 days unless paid or prevented by uncontrollable factors.
• Investigate Claims: Begin within 10 business days of receiving completed forms.
• Respond to Inquiries: Reply to Office of Insurance Regulation within 21 days.

Anti-Fraud Efforts

Insurers with $10M+ in premiums must have a fraud investigation unit or third-party service. Others need an anti-fraud plan, including fraud detection, reporting, and training procedures. Non-compliance fines up to $2,000/day.

Florida Motor Vehicle No-Fault Law (PIP)

Requires $10,000 PIP and $10,000 PDL for vehicles with 4+ wheels. PIP covers insureds, household members, passengers without PIP, and certain drivers using the insured’s vehicle.

Residual Markets

Provide coverage for those rejected by voluntary insurers.

Florida Automobile Joint Underwriting Association (FAJUA)

Insurer of last resort for auto insurance. All insurers share premiums, profits, and losses.

Citizens Property Insurance Corporation

Provides property insurance when private markets are unavailable.

Florida Workers Compensation Joint Underwriting Association (FWCJUA)

Offers workers compensation for employers unable to secure private coverage.