GA Claims Adjuster flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Adjuster license requirement

In Georgia, any person who investigates or settles claims for compensation on behalf of an insurer must hold an adjuster license issued by the Commissioner of Insurance.

Nonresident adjuster license

A nonresident adjuster may be licensed in Georgia based on a home-state license in good standing, subject to Department reporting and compliance requirements.

Continuing education renewal

Georgia adjuster licenses renew biennially; licensees must complete required continuing education, including ethics hours, before the renewal deadline to avoid penalties.

Grounds for discipline

Misrepresentation on the application, fraudulent claim handling, commingling funds, rebating, and felony conviction are grounds for license discipline in Georgia.

Unfair claim practices

O.C.G.A. § 33-6-34 defines unfair claim settlement practices, including misrepresenting policy provisions and unreasonable delay or denial of claims.

Conflict of interest rule

An adjuster may not act on a claim in which the adjuster has a financial interest and must disclose any relationship with the insured, claimant, or contractor.

Public adjuster definition

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

Public adjuster bond

Georgia public adjusters must post a surety bond and maintain errors and omissions coverage; they cannot simultaneously hold a company adjuster license.

Public adjuster fee cap

Georgia limits public adjuster compensation as a percentage of the claim payment, with a lower cap for claims arising from a declared disaster or emergency.

Written contract requirement

Before performing services, a public adjuster must obtain a written contract disclosing the fee, the right to rescind within a stated period, and the representation role.

Solicitation restriction

Public adjusters may not solicit business at the scene of a loss within a prohibited time window and may not use titles implying insurer affiliation.

Fiduciary funds rule

Funds a public adjuster receives on behalf of an insured must be held in a fiduciary capacity, disbursed promptly, and never commingled with the adjuster's own funds.

Settlement authorization

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

Surplus lines broker license

A surplus lines broker is licensed to place coverage with nonadmitted insurers when admitted insurers do not offer the coverage, and must hold the surplus lines endorsement.

Diligent effort search

Before placing with a nonadmitted insurer, the broker must document that admitted insurers refused or could not provide the coverage, recording the search in the file.

Premium tax remittance

Surplus lines placements are subject to premium tax and must be reported to the state surplus lines association with tax remitted within the statutory period.

Nonadmitted insurer disclosure

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

Eligible insurer list

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

Counselor license

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

Counselor written agreement

A counselor must maintain a written agreement specifying the scope and fee, avoid conflicts of interest, and follow dual-licensure restrictions in one transaction.

Record retention

Surplus lines placements, declinations, and counselor engagements must be retained for the period required by the Commissioner, commonly five years, and produced on examination.

Commissioner authority

The Georgia Commissioner of Insurance administers licensing statutes, conducts market conduct examinations, and may issue fines, cease-and-desist orders, or revoke licenses.

Change reporting duty

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

Appointment reporting

Insurers must appoint the adjusters and brokers they use and report termination of appointment to the Department.

Administrative appeal

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

Prompt acknowledgment

An adjuster must acknowledge the claim promptly and begin investigation within the statutory timeframe, communicating coverage decisions in writing.

Written denial basis

An insurer may not deny or delay payment without a reasonable investigation and must state the basis for denial in writing to the insured.

Claim file documentation

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

Bad faith exposure

Unreasonable delay or denial can create bad-faith exposure; third-party claimants are also owed good-faith claim handling.

Fraud reporting

Fraud indicators such as inflated estimates, prior claims, or staged losses must be reported to the insurer's special investigation unit without accusing the insured absent evidence.

Referral fee prohibition

Referral fees, kickbacks, and undisclosed compensation from contractors or vendors are prohibited for adjusters handling claims.

Confidentiality duty

Claim information may be shared only with parties having a legitimate need to know, and misrepresenting the adjuster's authority or coverage is a violation.