NM Claims Adjuster study guide
NM Claims Adjuster · Work through your exam, one topic at a time.
The New Mexico Claims Adjuster credential is a state license administered through the New Mexico Office of the Superintendent of Insurance (OSI), the agency that regulates most kinds of insurance in New Mexico and licenses the individuals and agencies that sell insurance in the state. Adjusters work for insurers, independent firms, or as public adjusters on behalf of policyholders, and their work centers on investigating losses, evaluating coverage, and settling claims fairly under New Mexico law and OSI rules. The NM Claims Adjuster study guide has 4 sections and about 1,407 words.
01New Mexico Insurance Law and OSI Regulation
The New Mexico Office of Superintendent of Insurance (OSI) administers the Insurance Code, NMSA Chapter 59A. The Superintendent, appointed by the Governor, supervises insurers, producers, adjusters and other licensees; adopts rules; examines market conduct; and enforces unfair-practice prohibitions.
364 words, about 2 min02Claims Handling and Consumer Complaint Practice
New Mexico’s unfair claims practices provisions require insurers to acknowledge and act promptly on claims, conduct reasonable investigations, and affirm or deny coverage within a reasonable time. The adjuster must explain denials in writing with the policy language and factual basis, and must not misrepresent policy provisions or claim deadlines.
328 words, about 2 min03Property and Casualty Coverage and Adjusting
Property and casualty policies are read as a whole: declarations, insuring agreement, conditions and exclusions. The claimant generally bears the burden to show a covered loss; the insurer bears the burden to prove an exclusion.
351 words, about 2 min04Insurance Fraud and Enforcement
Insurance fraud includes false claims, inflated damages, staged accidents, phantom medical treatment, premium fraud and misrepresentation on applications. Adjusters should watch for inconsistent loss descriptions, late reporting after a prompt deadline, altered receipts, duplicate photographs, prior similar claims, and pressure for quick cash settlement.
364 words, about 2 min