Insurance Law and Regulations
This domain tests the statutes and regulations that govern claim conduct in Missouri, including the unfair claims settlement practices framework and the public adjuster's own legal duties. DIFP enforces the insurance code; public adjusters are regulated persons, not merely advocates.
Core rules
- Insurers must acknowledge claim communications, investigate promptly, and affirm or deny coverage within a reasonable time after receiving proof of loss. They may not misrepresent policy language or delay for leverage.
- A public adjuster may not represent the insurer and the insured on the same claim, acquire an interest in the claim, or misstate facts to the insurer.
- Settlement communications and offers should be documented in writing. The adjuster's fee must be disclosed and tied to the written contract.
- The adjuster cannot give legal advice or threaten litigation on the insured's behalf unless licensed as an attorney; the adjuster may explain appraisal and complaint processes.
Worked example
An insurer receives a complete proof of loss and does not respond for 90 days despite repeated calls. The public adjuster sends a written timeline, the proof of loss, and a demand for a coverage position, then files a complaint with DIFP. Reasoning: the record shows unexplained delay and failure to communicate, which are classic unfair claim practice allegations. The adjuster's contemporaneous log makes the complaint credible.
Traps
Treating the regulations as advisory. Advising an insured to inflate contents or delay reporting. Relying on oral promises without confirming them in writing. Saying “the policy definitely covers this” before completing a coverage analysis.