GA Claims Adjuster cheat sheet

Georgia licenses adjusters under O.C.G.A. Title 33, Chapter 23; the Commissioner of Insurance (via the Department of Insurance) issues and may revoke licenses.

An adjuster license is required for anyone who, for compensation, investigates or settles claims on behalf of an insurer; company staff adjusters, independent adjusters, and public adjusters each hold distinct license types.

Applicants must be at least 18, complete the required prelicensing education, pass the state exam, submit fingerprints for a background check, and pay the license fee.

Nonresident adjusters may qualify for licensure based on their home-state license, but must be in good standing and comply with Georgia reporting requirements.

A license must be renewed biennially; continuing education (including ethics hours) is required before renewal, and late renewal triggers a penalty or reinstatement process.

Grounds for disciplinary action include misrepresentation on the application, fraudulent claim handling, commingling funds, rebating, and felony conviction.

Adjusters owe duties of good faith and fair dealing to insureds; unfair claim settlement practices are defined in O.C.G.A. § 33-6-34.

An adjuster may not act on a claim in which the adjuster has a financial interest, and must disclose conflicts; commissions or rebates to insureds are prohibited.

A public adjuster is licensed to represent the insured-not the insurer-for compensation in negotiating or settling a first-party property claim.

Georgia public adjusters must be licensed, post a surety bond, and maintain an errors and omissions policy; they cannot also hold a company or independent adjuster license simultaneously.

Compensation is limited: Georgia caps public adjuster fees as a percentage of the claim payment (commonly 10% for claims arising from a declared disaster/emergency; verify current statutory cap).

A written contract signed by the insured is required before the public adjuster performs services; the contract must disclose the fee, the right to rescind within a stated period (typically 3 business days), and that the adjuster represents the insured.

The public adjuster may not solicit business at the scene of a loss within a prohibited time window (e.g., before the insured has had a reasonable chance to consult the insurer) and may not use misleading titles implying insurer affiliation.

Funds received on behalf of an insured must be held in a fiduciary capacity and disbursed promptly; commingling with the adjuster's own funds is prohibited.

Public adjusters must keep records of all transactions and make them available to the Commissioner on request; failure to maintain records is a disciplinary ground.

A public adjuster may not settle a claim without the insured's written authorization, and must provide the insured a copy of any settlement documents.

A surplus lines broker is licensed to place coverage with nonadmitted (unauthorized) insurers when admitted insurers do not offer the coverage; the broker must be licensed as a property/casualty broker and hold a surplus lines endorsement.

Georgia requires a diligent effort (declination search) documenting that admitted insurers refused or could not provide the coverage before placing with a nonadmitted insurer; the search must be recorded on the policy file.

Surplus lines placements are subject to premium tax and must be reported to the Georgia Surplus Lines Association (or state stamping office) with the required filing and tax remittance within the statutory period.

The broker must disclose to the insured in writing that the insurer is not admitted, is not protected by the Georgia guaranty fund, and is not subject to full state regulation.

Eligibility: the nonadmitted insurer must appear on the NAIC/state-approved eligible surplus lines insurer list and meet minimum capital/surplus requirements.

A counselor (insurance consultant) license authorizes advising clients on insurance for a fee without selling; the counselor must disclose compensation and cannot receive commissions from insurers on the same transaction.

Counselors must maintain a written agreement with the client specifying the scope and fee, and must avoid conflicts of interest; dual licensure rules restrict acting as both counselor and producer in one transaction.

Records of surplus lines placements, declinations, and counselor engagements must be retained for the period required by the Commissioner (commonly 5 years) and produced on examination.

The Georgia Commissioner of Insurance administers the licensing statutes; the Department conducts market conduct examinations and may issue cease-and-desist orders, fines, or license revocation.

Licensees must report changes of address, name, or criminal convictions to the Department within the statutory timeframe; failure to report is a violation.

Continuing education requirements apply to all adjuster and broker licenses; excess CE cannot be carried forward beyond the renewal cycle in most cases.

Appointments: insurers must appoint adjusters and brokers they use; termination of appointment must be reported to the Department.

Unfair trade practice statutes (O.C.G.A. § 33-6-4 et seq.) apply across all license types and include misrepresentation, false advertising, and unfair claim settlement.

Hearings and appeals follow the Administrative Procedures Act; a licensee may request a hearing after an administrative order and appeal to superior court.

Acknowledge the claim promptly and begin investigation within the statutory timeframe; communicate coverage decisions in writing.

Do not deny or delay payment without a reasonable investigation; the insurer must state the basis for denial in writing.

The adjuster must document the claim file: photos, estimates, correspondence, and the basis for valuation.

Settlement offers must reflect the policy terms and applicable law; the adjuster cannot settle for less than the amount owed without the insured's informed consent.

Third-party claimants are owed good-faith handling as well; bad-faith exposure can attach to unreasonable delay or denial.

Fraud indicators (inflated estimates, prior claims, staged losses) must be reported to the insurer's SIU; the adjuster should not accuse the insured absent evidence.

An adjuster must avoid representing both the insurer and the insured in the same claim; public adjusters represent only the insured.

Referral fees, kickbacks, and undisclosed compensation from contractors or vendors are prohibited.

The adjuster must disclose any familial or financial relationship with the insured, claimant, or contractor.

Confidentiality: claim information may be shared only with parties with a legitimate need to know.

Misrepresenting the adjuster's authority or the policy's coverage is a violation and grounds for discipline.

Surplus lines policies must be clearly identified as nonadmitted coverage and include the required disclosure notice.

The broker must verify the nonadmitted insurer's eligibility at the time of placement and monitor its financial condition.

Premium tax remittance is the broker's responsibility; failure to remit can result in license suspension.

Multi-state placements may require allocation of premium tax among states based on the insured's risk location.

The broker must maintain evidence of the diligent effort and the declination documentation in the file.

A counselor provides advice for a fee and does not bind coverage or receive commissions on the same engagement.

The counselor must provide a written disclosure of fees and the scope of services before beginning work.

The counselor must avoid recommending products in which the counselor has a financial interest without disclosure.

Counselor records must be retained and made available to the Department on request.

Acting as a counselor while holding a producer license requires careful separation of roles to avoid a conflict.