Catastrophe Field Staff, a Roofing Company, and a Pending License
A Category 4 hurricane makes landfall in southwest Florida on September 28. Ten days later, the claims manager of an admitted Florida carrier reviews three field reports on the same catastrophe: (1) Marcus, a Georgia-licensed independent adjuster, has inspected 12 homes in Lee County since October 3 but has never applied for a Florida license; (2) a roofing company, SunCoast Roofing, is canvassing damaged neighborhoods offering to "handle the whole claim" for 15% of whatever the carrier pays, and has already emailed the carrier a scope of loss on a mutual customer; (3) Priya, hired September 20 as an inside claims representative, is issuing payments on 30 open files while her Florida all-lines adjuster license application is still pending. The governor's emergency declaration is in effect and DFS has opened catastrophe licensing.
1. For each of the three situations, is a Florida license required, what type, and what must the carrier do right now?
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Marcus. Florida does not give automatic reciprocity to an out-of-state adjuster license. To investigate or settle Florida claims he needs a Florida resident or nonresident adjuster license, or a temporary/emergency catastrophe license issued by DFS after a declared emergency (application required; limited duration). He holds neither, so the 12 inspections are unlicensed activity. Action: pull him off the field today, verify status in the DFS licensee search, and have a Florida-licensed adjuster re-inspect and adopt or correct each of the 12 estimates before any payment. Reasoning: the payment decision must trace to a licensed person, not just to a report in the file.
SunCoast Roofing. Investigating, negotiating, or settling a first-party claim for compensation on the insured's behalf is public adjusting and requires a Florida public adjuster license. A roofing contractor may inspect, bid, and discuss repairs, but may not "handle the claim" or charge a fee contingent on insurance proceeds. Florida also caps public adjuster compensation, with a lower cap for claims arising from a declared emergency. Action: decline to negotiate scope or settlement with SunCoast, confirm to the homeowner in writing that the contractor is not licensed to represent her, and report the unlicensed activity to DFS.
Priya. A pending application is not a license. Adjusting and settling claims requires licensure, so her payment authority must be suspended and her files re-authorized by licensed staff.
2. The carrier already paid $84,000 across the 30 files Priya handled and relied on Marcus's inspections on 12 claims. What is the exposure, and what corrective steps and documentation should follow?
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Payments made by an unlicensed person are not automatically void - the carrier still owes its insureds the coverage it promised, and the insureds did nothing wrong. But the activity itself is a licensing violation that supports administrative penalties against the carrier and the individuals, market-conduct findings, and, in a later bad-faith suit, the argument that claim decisions were made by unqualified personnel.
Corrective steps, in order: (1) freeze payment authority for Priya and Marcus; (2) have a Florida-licensed adjuster re-review all 30 files for scope, pricing, depreciation, and deductible; (3) issue supplements where the review shows underpayment, and document why any file is unchanged; (4) place in each file the re-inspection photos, the reviewer's credential, and a memo adopting or correcting the original estimate; (5) license and train staff, and consider a self-report to DFS. Reasoning: the regulatory concern is consumer protection, not paperwork, so the cure is licensed re-adoption of the work - a clean file trail is the only way to show the insured was not harmed by the staffing error.
3. SunCoast Roofing asks to be named as payee on the dwelling draft and to sign the sworn proof of loss. How should the adjuster respond, and why?
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Refuse both requests. A sworn proof of loss is the insured's statement; signing it for compensation on the insured's behalf is public adjusting, and an unlicensed contractor doing so compounds the licensing problem with a potential misrepresentation on the claim. Payment must run to the named insured (and the mortgagee to the extent of its interest), not to a contractor that has no insurable interest.
The adjuster may honor a direction-to-pay or assignment of benefits only with the insured's written, informed authorization and only where the policy and Florida law permit it - and should verify the signature directly with the insured rather than taking the contractor's word. The adjuster should also explain to the insured, in writing, that the 15% contingency fee is the kind of arrangement Florida licenses and caps, and that the carrier will not pay a fee contingent on claim proceeds to an unlicensed entity.