MO Public Adjuster cheat sheet

Missouri public adjusters are licensed by the Missouri Department of Commerce and Insurance (DCI) under Chapter 325 RSMo; a separate public adjuster license line exists apart from producer and company adjuster authority.

A public adjuster license applicant must be at least 18, pass the public adjuster exam, submit fingerprints for an FBI/state criminal background check, and pay the license fee; felony convictions involving dishonesty or breach of trust are grounds for denial.

A public adjuster contract must be in writing, signed by the insured, and contain the adjuster's license number, fee or percentage, and a statement of the insured's right to rescind within a stated period (generally three business days after signing).

Fees are capped by statute: a public adjuster may not charge a fee exceeding 10 percent of the insurance claim proceeds on a claim arising from a declared disaster or emergency in Missouri.

Continuing education: Missouri public adjusters must complete 16 hours of CE every two years, including at least 3 hours of ethics, reported to DCI by the biennial license expiration date.

Nonresident public adjusters may be licensed by reciprocity if their home state license is in good standing; DCI may require a letter of certification and payment of the nonresident fee.

Licensees must report a change of name or address to DCI within 30 days and must report administrative actions, criminal charges, and convictions within 30 days of the final disposition.

Acting as a public adjuster without a license is a misdemeanor; contracts entered into by an unlicensed adjuster are unenforceable and may subject the adjuster to civil penalties and restitution.

A public adjuster may not use the title 'insurance adjuster' or imply authority to act for an insurer; solicitations must clearly identify the adjuster as a public adjuster representing the insured.

Missouri's Unfair Trade Practices and Unfair Claims Settlement Practices Act (Sections 375.930-375.948 RSMo) prohibits misrepresenting policy provisions, failing to acknowledge claims promptly, and failing to conduct a reasonable investigation.

The Missouri Department of Commerce and Insurance enforces the insurance code; the director may issue cease-and-desist orders, levy fines up to $1,000 per violation (up to $25,000 per course of conduct), and suspend or revoke licenses.

Missouri's vexatious refusal to pay statute (Section 375.420 RSMo) allows the insured to recover the loss plus damages up to 20 percent of the loss and reasonable attorney fees when the insurer's refusal is without reasonable cause.

The Missouri Merchandising Practices Act (Chapter 407 RSMo) can apply to insurance sales and claims conduct; the attorney general may pursue deceptive practices and consumers may bring private actions.

Missouri's valued policy statute (Section 379.140 RSMo) applies to real property total losses: the insurer is liable for the full policy amount stated on the policy, not the market value, unless the insurer proves the stated value was fraudulently overstated.

Missouri's standard fire policy and the 12-month suit-limitation statute (Section 516.110 RSMo) govern time to sue on a written contract; policy provisions shortening the limitation period must comply with statute.

Prompt payment: Missouri requires insurers to acknowledge notification of a claim within 10 working days and to affirm or deny coverage within a reasonable time after completing the investigation.

The Missouri Guaranty Association (MIGA) covers claims of insolvent insurers up to $300,000 per claimant for most property and liability coverages, with separate limits for workers' compensation and life/health.

Missouri requires insurers to provide a written explanation of the basis for denial or partial denial of a claim, including specific policy provisions relied upon.

Declarations page controls the named insured, policy period, limits, deductibles, and described premises; the insuring agreement grants coverage, and conditions and exclusions limit it.

Coverage A (dwelling) is an open-peril or named-peril structure depending on the form; Coverage B (other structures) is typically 10 percent of Coverage A; Coverage C (personal property) is typically 50-70 percent; Coverage D (loss of use) is typically 20-30 percent.

Replacement cost vs. actual cash value: ACV = replacement cost minus depreciation; most HO forms pay ACV until repair or replacement is completed, then pay the recoverable depreciation withheld.

Coinsurance clause (commercial property): payment = (limit of insurance / coinsurance requirement) x loss, subject to the limit; underinsurance reduces recovery proportionally.

Deductible applies per occurrence, not per item; percentage deductibles (e.g., 2 percent wind/hail) are calculated on the Coverage A limit, not on the loss amount.

Mortgage clause: the lender is named as loss payee and is entitled to receive loss payment to the extent of its interest; the insurer may pay the mortgagee and the insured jointly.

Appraisal provision allows either party to demand appraisal when the amount of loss is disputed; each party selects a competent appraiser, and the appraisers select an umpire; disagreement with the umpire is binding on the amount of loss only.

Suit against the insurer is barred unless the insured has complied with all policy conditions and files within the contractual (usually 12-month) limitation period, which Missouri law may toll for certain claims.

First notice of loss: record date and time of loss, cause, location, contact information, policy number, and whether the loss is a total or partial loss; assign a claim number and confirm coverage in writing.

Document the loss with photographs, measurements, and a room-by-room inventory; obtain the insured's signed non-waiver agreement or reservation of rights before investigating a coverage question.

Proof of loss: a sworn statement of the amount and cause of loss, typically due within 60 days of the insurer's request; public adjuster should prepare and submit it with supporting documentation.

Investigation should include cause-and-origin analysis, comparison of reported damage to weather data or fire reports, and verification of ownership and pre-loss condition of damaged property.

Use replacement cost estimating software and obtain at least two contractor bids for large losses; document depreciation methodology and salvage value for ACV settlements.

Preserve evidence: retain damaged items, photographs, receipts, and expert reports; spoliation of evidence can defeat the claim and expose the adjuster to liability.

Loss of use: document additional living expenses with receipts and a reasonable time to repair or relocate; fair rental value applies when the insured rents the damaged property.

Business interruption: calculate gross earnings loss using the period of restoration, continuing expenses, and extra expense; obtain financial statements and tax returns to verify the projection.

Subrogation: identify third parties responsible for the loss and notify the insurer promptly; the insurer's right of subrogation is preserved by the insured's cooperation and by not releasing liable parties.

A public adjuster owes a fiduciary duty to the insured; the adjuster may not accept compensation from both the insured and the insurer on the same claim, nor from contractors or restoration vendors without full written disclosure and consent.

Missouri prohibits a public adjuster from soliciting a contract at the scene of a loss before the insured has had a reasonable opportunity to consult with the insurer or counsel; door-to-door solicitation within 24 hours of a loss is restricted.

The adjuster may not advance funds to an insured or pay the insured's deductible; doing so constitutes an illegal inducement and may violate the insurance code.

Fee agreements must be in writing and disclose the percentage fee, the method of calculation, and the insured's right to rescind within three business days; the fee is calculated on the gross claim payment, not net of deductible, unless the contract states otherwise.

Confidentiality: the adjuster may not disclose the insured's personal, financial, or medical information without written authorization, except as required by law or to advance the claim.

Conflicts of interest: the adjuster must disclose any family, business, or financial relationship with the insurer, contractors, or experts; undisclosed conflicts are grounds for license discipline.

Recordkeeping: maintain claim files, contracts, correspondence, and settlement records for at least five years after the claim closes; DCI may inspect records during an examination.

Advertising must be truthful and may not imply that the adjuster is affiliated with, endorsed by, or acting on behalf of an insurer or the state; testimonials must be genuine and not misleading.

A public adjuster may not negotiate a claim after the insured has settled and signed a release, nor may the adjuster settle a claim without the insured's written authorization.