NY Claims Adjuster study guide
NY Claims Adjuster · Work through your exam, one topic at a time.
The New York claims adjuster license is a state credential issued by the New York State Department of Financial Services (DFS). It authorizes you to investigate, evaluate, and settle insurance claims in New York - as an independent adjuster working for adjusting firms on insurers' behalf, as a public adjuster representing policyholders, or as staff handling claims inside a carrier or agency. The NY Claims Adjuster study guide has 7 sections and about 2,263 words.
01Insurance Principles and Concepts
Every claim question ultimately asks you to read the policy as a contract of indemnity : the insured is restored - not enriched - to the financial position held before the loss. Learn the characteristics that drive exam logic: a contract of adhesion (ambiguity construed against the drafter), aleatory (values exchanged are unequal and contingent), conditional (duties after loss: prompt notice, proof of loss, cooperation, suit limitation), and one requiring utmost good faith of both parties.
320 words, about 2 min02New York Insurance Law and Regulations
Insurance Law Article 21 governs licensing: independent adjusters, public adjusters, and brokers must be licensed, and a public adjuster's compensation is capped (generally 12.5% of the amount recovered, with a lower cap for declared disasters). An individual may not act as both public adjuster and company adjuster on the same claim.
336 words, about 2 min03Property Insurance Policy Provisions and Coverage
New York property forms incorporate the Standard Fire Policy language: the insuring agreement, the 60-day sworn proof of loss, appraisal, suit limitation, mortgagee rights, and the requirement that the insured protect property from further damage. Homeowners forms layer Coverages A–F (dwelling, other structures, personal property, loss of use, liability, medical payments) over that base, with open-peril coverage on the dwelling and named-peril coverage on contents in most HO-3 forms.
297 words, about 1 min04Casualty Insurance Policy Provisions and Coverage
Read the CGL insuring agreement closely: occurrence forms respond to injury or damage during the policy period, while claims-made forms respond to claims first made during the period and reported within the extended reporting period. Know the trigger theories and how multiple-occurrence versus single-occurrence wording affects the per-occurrence and general aggregate limits.
301 words, about 2 min05Claims Handling Practices and Procedures
A defensible claim file tells a chronological story. Open the file with the date and time of first notice, the identity and authority of the caller, the policy number and date of loss, and a coverage confirmation or reservation of rights.
337 words, about 2 min06Investigation, Evaluation, Negotiation, and Settlement
Resolve coverage first , then liability, then damages - a perfect liability investigation is wasted if the loss falls outside the policy. Establish the loss date, location, and cause; inspect the scene; photograph and diagram; obtain fire, police, and weather reports; interview witnesses; take recorded or sworn statements (an examination under oath where the policy and facts warrant it); and retain independent experts for origin and cause, engineering, or forensic accounting.
300 words, about 2 min07Fiduciary Duties, Ethics, and Unfair Claims Settlement Practices
An adjuster acts in a fiduciary capacity toward the insurer and owes good faith and fair dealing to claimants. That means no personal interest in the outcome, no referral fees from vendors or repair shops, no use of claim information for private gain, and no commingling of funds.
372 words, about 2 min