MT Claims Adjuster cheat sheet

Montana Insurance Code is Title 33 of the Montana Code Annotated (MCA); insurer licensing, producer licensing, and trade practices sit in Titles 33 and 37 (MCA 37-1-301 et seq. for producer licensing).

The Montana Commissioner of Insurance heads the Insurance and Securities Division of the state auditor's office; the Commissioner adopts administrative rules under ARM Title 6, Chapter 6.

MCA 33-18-201 et seq. sets unfair trade practice standards: misrepresentation of policy terms, false advertising, and unfair claim settlement practices are violations enforceable by the Commissioner.

MCA 33-18-242 creates a private right of action for third-party claimants against an insurer that violates 33-18-201 with actual malice or fraud, with a 1-year statute of limitations from the date the claimant knew or should have known.

Montana requires producers to complete 24 credit hours of continuing education every 2 years, including at least 3 hours of ethics, per ARM 6.6.4401 et seq.; adjusters licensed under MCA 33-17-101 et seq. must satisfy separate CE requirements.

Montana's annual legislative session (90 legislative days in odd-numbered years) means statutory amendments take effect October 1 unless the bill specifies otherwise; adjusters must verify the effective date of any change before applying it.

MCA 33-15-1103 requires insurers to acknowledge notification of a first-party claim within 15 business days and to accept or deny the claim within 30 business days of receiving proof of loss, with written notice of any extension.

Montana's Unfair Trade Practices Act prohibits an insurer from failing to attempt in good faith to effectuate a prompt, fair, and equitable settlement when liability has become reasonably clear (MCA 33-18-201(6)).

Adjusters owe a fiduciary duty to the insurer and a duty of good faith and fair dealing to the insured; the two duties do not conflict when the claim is handled accurately and promptly.

Conflicts of interest arise when the adjuster has a personal or financial interest in the claim outcome, a family relationship with a claimant, or prior involvement with the loss; disclose and reassign.

Montana law (MCA 33-18-201) prohibits misrepresenting policy provisions and failing to explain the basis for a claim denial; every denial letter must cite the specific policy language relied upon.

Confidentiality: claim files, medical records, and financial information are protected; disclosure is permitted only for legitimate claim-handling purposes or as required by law or subpoena.

An adjuster must not provide legal advice or interpret coverage in a way that overrides the policy; refer coverage questions to the insurer's claims counsel when the policy language is ambiguous.

Documentation ethics: record all contacts, statements, and decisions contemporaneously; an undocumented decision is difficult to defend in a bad-faith action or Department of Insurance market conduct examination.

Settlement authority: never exceed delegated authority or promise a settlement amount before coverage and damages are confirmed; unauthorized commitments can bind the insurer.

Fair-claim handling requires investigating both facts that support and facts that defeat coverage; a one-sided investigation is evidence of bad faith.

Actual cash value (ACV) = replacement cost minus depreciation; replacement cost value (RCV) restores the property without deduction for depreciation, subject to policy limits and conditions.

Coinsurance formula for underinsured property: recovery = (limit carried / limit required) × loss, capped at the policy limit; the required limit equals coinsurance percentage × property value at loss.

Deductibles apply per occurrence unless the policy states otherwise; a percentage deductible (common for wind/hail) is calculated on the dwelling limit, not on the loss amount.

Liability determination requires the four elements: duty, breach, causation, and damages; comparative fault in Montana (MCA 27-1-702) reduces recovery proportionally and bars recovery if plaintiff fault exceeds defendant's.

Montana's modified comparative negligence rule bars a claimant whose fault is greater than 50% from recovering; adjusters must allocate fault before evaluating a third-party liability claim.

Business income loss = net income lost plus continuing normal operating expenses, minus noncontinuing expenses, for the period of restoration (the time reasonably required to repair or replace with due diligence).

Subrogation: the insurer steps into the insured's shoes after paying a loss; the insured must not impair subrogation rights, and the statute of limitations runs from the date of loss under the applicable tort statute.

Total loss handling: for a vehicle total loss, the settlement equals actual cash value plus applicable taxes and fees, less deductible and salvage value if the insured retains the salvage.