LA Public Adjuster flashcards
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32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Public adjuster definition
- A licensed person who, for compensation, represents an insured in negotiating and settling a first-party property claim with the insurer.
- Louisiana Insurance Code citation
- Title 22 of the Louisiana Revised Statutes contains the Insurance Code; LAC Title 37, Part XI contains LDI administrative rules.
- Adjuster CE requirement
- Louisiana adjusters complete 24 continuing education credit hours every two years, including at least 3 hours of ethics, plus any public-adjuster-specific hours.
- Unfair trade practices
- R.S. 22:1961 et seq. prohibits misrepresentation, unreasonable delay, and failure to act promptly on claims communications by insurers and adjusters.
- Insurance fraud statute
- R.S. 22:1921 et seq. makes knowing submission of false or inflated claims a crime and grounds for license action.
- LDI enforcement authority
- The commissioner may fine, suspend, revoke, or refuse renewal after notice and hearing, and may act on an emergency basis when needed.
- License application requirements
- Applicants must pass the Louisiana public adjuster exam, submit fingerprints for a background check, and meet character and fitness standards.
- Separate license class
- A public adjuster license is distinct from company and independent adjuster licenses; one does not authorize practice under another.
- Written contract prerequisite
- A public adjuster must have a signed written contract with the insured before representing the insured, stating services, compensation, and cancellation rights.
- Fee disclosure rule
- Compensation, usually a percentage of settlement, must be disclosed in the contract; undisclosed or divided fees are prohibited.
- Conflict of interest bar
- A public adjuster may not represent both insured and insurer on the same claim or act where a personal interest conflicts.
- License renewal conditions
- Renewal requires timely filing, fee payment, CE compliance, and no disqualifying enforcement action; practicing on a lapsed license violates law.
- Indemnity principle
- The insured is restored to pre-loss condition, no better; recovery is limited by policy limits, deductibles, and the valuation method.
- Replacement cost vs ACV
- Replacement cost pays to repair or replace with new like-kind material; actual cash value is replacement cost minus depreciation.
- Coinsurance clause
- Commercial property requires a limit at least equal to the coinsurance percentage times property value at loss, or a penalty reduces recovery.
- Named-peril vs open-peril
- Named-peril policies cover only listed causes; open-peril policies cover all risks except exclusions, with the insurer bearing the burden to prove exclusions.
- Flood exclusion
- Standard property policies exclude flood; coverage must come from the NFIP or a separate private flood policy.
- Business interruption coverage
- Covers lost income and continuing expenses during the period of restoration, subject to a waiting period and a policy limit.
- Louisiana valued policy law
- R.S. 22:1318: fire policies on real property pay the policy limit for a total loss, subject to statutory conditions.
- Claim handling sequence
- Notice, acknowledgment, investigation, damage evaluation, coverage determination, payment or denial, and complete file documentation.
- Loss documentation
- Photographs, measurements, diagrams, and a room-by-room inventory, all dated and labeled, with original evidence preserved.
- Recoverable depreciation
- Under replacement cost coverage, depreciation is withheld at settlement and released when the insured completes replacement within the policy period.
- Cause and origin
- Determine the mechanism and source of damage before pricing, because concurrent causation and workmanship issues affect coverage.
- Insured's duties after loss
- Prompt notice, protection of property from further damage, cooperation, proof of loss, and submission to examination under oath.
- Bad faith exposure
- Unreasonable delay or failure to communicate claim status can expose the insurer to statutory penalties and bad-faith damages in Louisiana.
- Fiduciary duty
- The public adjuster owes loyalty to the insured and may not accept compensation from other parties without full written disclosure.
- Prohibited conduct examples
- Misrepresenting coverage, submitting false or inflated claims, forgery, and unsupported damage estimates are prohibited and sanctionable.
- Contract cancellation right
- The written contract must include the insured's statutory right to rescind or cancel within the period set by Louisiana law.
- Solicitation restrictions
- Door-to-door solicitation during a declared emergency in prohibited areas, and misleading advertising or titles implying official authority, are barred.
- Confidentiality duty
- Claim information and the insured's personal data must be protected and used only for purposes of the claim.
- Recordkeeping requirement
- Contracts, correspondence, estimates, and settlement records must be retained for the period required by LDI rule and produced on request.
- Penalties for violations
- License suspension or revocation, fines, restitution, and criminal referral for fraud may follow proven violations of adjuster rules.