NY Public Adjuster cheat sheet

Indemnity principle: the insured is restored to pre-loss financial position, no better and no worse; a public adjuster's measure of recovery is actual loss, not profit.

Insurable interest must exist at the time of loss for property insurance; a party with no financial exposure at loss date cannot collect, even if named on the policy.

Utmost good faith imposes disclosure duties on both parties; material misrepresentation in the application or proof of loss can void coverage.

Actual cash value (ACV) = replacement cost minus depreciation; replacement cost value (RCV) pays new-for-old without depreciation deduction, subject to policy limits.

Coinsurance clause: payment = (carried insurance / required insurance) x loss, capped at the policy limit; underinsurance reduces recovery proportionally.

Deductible applies per occurrence unless the policy states otherwise; a separate named-peril deductible (for example wind or hurricane) may override the all-other-perils deductible.

Subrogation transfers the insured's recovery rights against a negligent third party to the insurer after payment; the insured must not impair those rights.

Law of large numbers and risk pooling explain why premiums are set on predicted aggregate loss, not on any single policyholder's outcome.

HO-3 covers the dwelling on an open-peril basis and personal property on a named-peril basis; HO-5 covers both on an open-peril basis.

Coverage A (dwelling), B (other structures), C (personal property), and D (loss of use) are typically set as percentages of Coverage A; Coverage E (liability) and F (medical payments) are stated dollar limits.

Replacement cost on a homeowners policy usually requires insurance to at least 80% of full replacement cost at loss time; below that, settlement may drop to ACV.

Commercial property forms use causes-of-loss designations: basic, broad, and special; the special form is open peril and places the burden of proving an exclusion on the insurer.

Business income coverage pays net income loss plus continuing normal operating expenses during the period of restoration, beginning after a waiting period (commonly 72 hours).

CGL Coverage A pays sums the insured becomes legally obligated to pay because of bodily injury or property damage; Coverage B covers personal and advertising injury; Coverage C covers medical payments regardless of fault.

Occurrence vs. claims-made: occurrence policies respond to injury or damage during the policy period; claims-made policies respond to claims first made during the period, subject to retroactive dates.

Flood and earthquake are excluded on standard property and homeowners forms and require separate policies or endorsements; water damage from plumbing systems is treated differently from surface water.

A public adjuster represents the insured for compensation; an independent adjuster represents the insurer, and a company or staff adjuster is an insurer employee.

Fee must be written in the compensation agreement and may not be deducted from an advance or undisputed payment before the claim is settled, per New York limits.

New York caps public adjuster compensation at 12.5% of the amount recovered on a claim arising from a declared disaster or emergency; otherwise the fee is negotiated in writing.

Proof of loss is a sworn statement of the amount claimed; failure to file within the policy's stated period can bar the claim unless the insurer waives the requirement in writing.

Document the claim with a room-by-room inventory, photographs, receipts, and a scope of damage; the burden of proving the amount of loss rests on the insured.

Replacement cost holdback: the insured may recover withheld depreciation by submitting evidence of repair or replacement within the policy's time limit (commonly 180 days, extendable).

Promptly report the claim to the insurer and cooperate with the investigation; material noncooperation or concealment is a policy defense the adjuster must anticipate.

Statute of limitations for suit on a property policy in New York is generally two years from the date of loss for fire policies, and six years for contract actions otherwise.

Public adjusters must be licensed by the New York Department of Financial Services under Insurance Law Article 21; acting without a license is unlawful.

Insurance Law section 2101(g)(2) defines a public adjuster as any person who, for compensation, acts on behalf of the insured in negotiating or effecting settlement of a claim.

Insurance Law section 2108 governs public adjuster licensing, examination, and conduct, and authorizes the Superintendent to prescribe by regulation.

Insurance Regulation 10 (11 NYCRR Part 25) sets public adjuster standards, including written contracts, fee disclosure, and recordkeeping requirements.

Compensation is capped at 12.5% of the amount recovered for claims arising from a declared disaster or emergency; the cap does not apply to other claims.

A public adjuster may not solicit business at the scene of a loss before a reasonable time has elapsed, and may not represent both insurer and insured on the same claim.

Licensees must complete continuing education and renew on the schedule set by DFS; lapsed licenses cannot be used to negotiate claims.

Unfair claim settlement practices under Insurance Law Article 26 and Regulation 64 require timely investigation and good-faith settlement offers; violations can support bad-faith allegations.

Proximate cause links a covered peril to the loss; a loss from an excluded peril is not covered merely because a covered peril also occurred nearby.

Utmost good faith requires disclosure of material facts; concealment or misrepresentation can void the policy from inception.

Insurable interest must exist at the time of loss for property coverage, while life insurance requires interest at policy inception.

The principle of indemnity limits recovery to the actual financial loss, preventing profit from insurance.

Coinsurance formula: (insurance carried / insurance required) x loss = payment, never exceeding the policy limit.

Subrogation lets the insurer pursue a negligent third party after paying the claim, preventing double recovery by the insured.

ACV equals replacement cost minus depreciation; RCV pays the cost to replace without depreciation deduction.

Deductibles apply per occurrence unless the policy states otherwise, and separate wind or hurricane deductibles may override the standard one.

HO-3 insures the dwelling on an open-peril basis and personal property on a named-peril basis; HO-5 covers both on an open-peril basis.

Coverages A through D are usually expressed as percentages of Coverage A, while Coverages E and F carry flat dollar limits.

Replacement cost settlement on a homeowners policy generally requires carrying at least 80% of full replacement cost at the time of loss.

Commercial property causes-of-loss forms are basic, broad, and special; the special form is open peril with the insurer bearing the burden of proving exclusions.

Business income coverage pays lost net income plus continuing expenses during the period of restoration, after a waiting period.

CGL Coverage A covers bodily injury and property damage liability; Coverage B covers personal and advertising injury; Coverage C pays medical expenses regardless of fault.

Occurrence policies respond to injury or damage during the policy period; claims-made policies respond to claims first made during the period.

Flood and earthquake are excluded on standard property forms and require separate coverage or endorsements.

A public adjuster represents the insured for compensation, while an independent adjuster represents the insurer and a staff adjuster is an insurer employee.

The compensation agreement must be in writing and state the fee; New York caps the fee at 12.5% of the amount recovered on declared-disaster claims.

A sworn proof of loss states the amount claimed; missing the policy deadline can bar the claim unless the insurer waives the requirement in writing.

The insured bears the burden of proving the amount of loss, so the adjuster builds a room-by-room inventory with photographs, receipts, and a scope of damage.

Withheld depreciation on a replacement cost claim is recoverable by showing repair or replacement within the policy's time limit, commonly 180 days.

Prompt notice and cooperation are conditions of coverage; material noncooperation or concealment gives the insurer a defense.

New York generally allows two years to sue on a fire policy and six years on other contract actions, measured from the date of loss.

A public adjuster may not solicit at the scene of a loss before a reasonable time has passed or represent both insurer and insured on the same claim.

Public adjusters must hold a license from the New York Department of Financial Services under Insurance Law Article 21.

Insurance Law section 2101(g)(2) defines a public adjuster as a person who, for compensation, acts for the insured in negotiating or settling a claim.

Insurance Law section 2108 governs licensing, examination, and conduct of public adjusters and authorizes Superintendent regulations.

Regulation 10 (11 NYCRR Part 25) sets standards for written contracts, fee disclosure, and recordkeeping by public adjusters.

The 12.5% compensation cap applies to claims arising from a declared disaster or emergency, not to every claim.

Regulation 64 and Insurance Law Article 26 define unfair claim settlement practices, including delay without good cause and failure to offer a reasonable settlement.

Licensees must complete continuing education and renew on the DFS schedule; a lapsed license cannot be used to negotiate claims.

Solicitation at the scene of a loss before a reasonable time has elapsed is prohibited, and dual representation of insurer and insured is barred.

Indemnity restores the insured to the pre-loss financial position; the measure of recovery is actual loss, not profit.

Insurable interest must exist at the time of loss for property insurance; a party with no financial exposure cannot collect.

Utmost good faith imposes disclosure duties on both parties; material misrepresentation in the application or proof of loss can void coverage.

ACV equals replacement cost minus depreciation; RCV pays new-for-old without a depreciation deduction, subject to policy limits.

Coinsurance payment equals (insurance carried / insurance required) x loss, capped at the policy limit.

Deductibles apply per occurrence unless stated otherwise; named-peril wind or hurricane deductibles may override the standard deductible.

Subrogation transfers the insured's rights against a negligent third party to the insurer after payment; the insured must not impair those rights.

Risk pooling and the law of large numbers explain why premiums reflect predicted aggregate loss rather than any single policyholder's outcome.

HO-3 covers the dwelling on an open-peril basis and personal property on a named-peril basis; HO-5 covers both on an open-peril basis.

Coverages A through D are typically percentages of Coverage A; Coverages E and F are stated dollar limits.

Replacement cost on a homeowners policy usually requires insurance of at least 80% of full replacement cost at loss time, or settlement may drop to ACV.

Commercial property causes-of-loss forms are basic, broad, and special; the special form is open peril and the insurer bears the burden of proving an exclusion.

Business income coverage pays net income loss plus continuing operating expenses during the period of restoration, after a waiting period, commonly 72 hours.

CGL Coverage A covers bodily injury and property damage liability; Coverage B covers personal and advertising injury; Coverage C pays medical expenses regardless of fault.

Occurrence policies respond to injury or damage during the policy period; claims-made policies respond to claims first made during the period, subject to retroactive dates.

Flood and earthquake are excluded on standard property and homeowners forms and require separate policies or endorsements; plumbing water damage is treated differently from surface water.

A public adjuster represents the insured for compensation; an independent adjuster represents the insurer, and a company or staff adjuster is an insurer employee.

The fee must be written in the compensation agreement and cannot be deducted from an advance or undisputed payment before settlement, per New York limits.

New York caps public adjuster compensation at 12.5% of the amount recovered on claims from a declared disaster or emergency; other fees are negotiated in writing.

A sworn proof of loss states the amount claimed; missing the policy deadline can bar the claim unless the insurer waives the requirement in writing.

The insured bears the burden of proving the amount of loss, so the adjuster documents with a room-by-room inventory, photographs, receipts, and a scope of damage.

Withheld depreciation on a replacement cost claim is recoverable by submitting evidence of repair or replacement within the policy time limit, commonly 180 days.

Prompt notice and cooperation are conditions of coverage; material noncooperation or concealment is a policy defense the adjuster must anticipate.

New York generally allows two years to sue on a fire policy and six years on other contract actions, measured from the date of loss.

Public adjusters must be licensed by the New York Department of Financial Services under Insurance Law Article 21; acting without a license is unlawful.

Insurance Law section 2101(g)(2) defines a public adjuster as any person who, for compensation, acts for the insured in negotiating or settling a claim.

Insurance Law section 2108 governs public adjuster licensing, examination, and conduct and authorizes the Superintendent to prescribe regulations.

Regulation 10 (11 NYCRR Part 25) sets public adjuster standards, including written contracts, fee disclosure, and recordkeeping.

Compensation is capped at 12.5% of the amount recovered for claims from a declared disaster or emergency; the cap does not apply to other claims.

A public adjuster may not solicit business at the scene of a loss before a reasonable time has elapsed, and may not represent both insurer and insured on the same claim.

Licensees must complete continuing education and renew on the DFS schedule; a lapsed license cannot be used to negotiate claims.

Unfair claim settlement practices under Insurance Law Article 26 and Regulation 64 require timely investigation and good-faith settlement offers; violations can support bad-faith allegations.

Proximate cause links a covered peril to the loss; a loss from an excluded peril is not covered merely because a covered peril also occurred nearby.

Utmost good faith requires disclosure of material facts; concealment or misrepresentation can void the policy from inception.

Insurable interest must exist at the time of loss for property coverage, while life insurance requires interest at policy inception.

The principle of indemnity limits recovery to the actual financial loss, preventing profit from insurance.

Coinsurance formula: (insurance carried / insurance required) x loss = payment, never exceeding the policy limit.

Subrogation lets the insurer pursue a negligent third party after paying the claim, preventing double recovery by the insured.

ACV equals replacement cost minus depreciation; RCV pays the cost to replace without a depreciation deduction.

Deductibles apply per occurrence unless the policy states otherwise, and separate wind or hurricane deductibles may override the standard one.

HO-3 insures the dwelling on an open-peril basis and personal property on a named-peril basis; HO-5 covers both on an open-peril basis.

Coverages A through D are usually expressed as percentages of Coverage A, while Coverages E and F carry flat dollar limits.

Replacement cost settlement on a homeowners policy generally requires carrying at least 80% of full replacement cost at the time of loss.

Commercial property causes-of-loss forms are basic, broad, and special; the special form is open peril with the insurer bearing the burden of proving exclusions.

Business income coverage pays lost net income plus continuing expenses during the period of restoration, after a waiting period.

CGL Coverage A covers bodily injury and property damage liability; Coverage B covers personal and advertising injury; Coverage C pays medical expenses regardless of fault.

Occurrence policies respond to injury or damage during the policy period; claims-made policies respond to claims first made during the period.

Flood and earthquake are excluded on standard property forms and require separate coverage or endorsements.

A public adjuster represents the insured for compensation, while an independent adjuster represents the insurer and a staff adjuster is an insurer employee.

The compensation agreement must be in writing and state the fee; New York caps the fee at 12.5% of the amount recovered on declared-disaster claims.

A sworn proof of loss states the amount claimed; missing the policy deadline can bar the claim unless the insurer waives the requirement in writing.

The insured bears the burden of proving the amount of loss, so the adjuster builds a room-by-room inventory with photographs, receipts, and a scope of damage.

Withheld depreciation on a replacement cost claim is recoverable by showing repair or replacement within the policy's time limit, commonly 180 days.

Prompt notice and cooperation are conditions of coverage; material noncooperation or concealment gives the insurer a defense.

New York generally allows two years to sue on a fire policy and six years on other contract actions, measured from the date of loss.

A public adjuster may not solicit at the scene of a loss before a reasonable time has passed or represent both insurer and insured on the same claim.

Public adjusters must hold a license from the New York Department of Financial Services under Insurance Law Article 21.

Insurance Law section 2101(g)(2) defines a public adjuster as a person who, for compensation, acts for the insured in negotiating or settling a claim.

Insurance Law section 2108 governs licensing, examination, and conduct of public adjusters and authorizes Superintendent regulations.

Regulation 10 (11 NYCRR Part 25) sets standards for written contracts, fee disclosure, and recordkeeping by public adjusters.

The 12.5% compensation cap applies to claims arising from a declared disaster or emergency, not to every claim.

Regulation 64 and Insurance Law Article 26 define unfair claim settlement practices, including delay without good cause and failure to offer a reasonable settlement.

Licensees must complete continuing education and renew on the DFS schedule; a lapsed license cannot be used to negotiate claims.

Solicitation at the scene of a loss before a reasonable time has elapsed is prohibited, and dual representation of insurer and insured is barred.