OH Public Adjuster cheat sheet

Ohio public adjuster license is issued by the Ohio Department of Insurance; a separate license is required for each business entity and each individual who solicits, negotiates, or settles claims for compensation.

A public adjuster license is not required for: a licensed attorney adjusting a claim in the course of legal representation; a licensed insurance producer adjusting a claim for an insurer; a person adjusting only under a catastrophic event declaration for a limited period; or an adjuster who receives no compensation for the service.

Nonresident applicants must submit a completed application, pay the fee, and either pass the Ohio exam or hold a substantially similar license in a reciprocal state; Ohio grants reciprocity to states that extend the same privilege.

Prelicensing education: Ohio requires 24 hours of approved prelicensing education for public adjusters, including at least 3 hours of ethics, before sitting for the exam.

Continuing education: 24 hours every two years, including 3 hours of ethics, and at least 12 hours must be in claims or adjusting-related topics; CE is not required in the same biennium as initial licensure.

License term: public adjuster licenses expire on the last day of February of odd-numbered years; renewal applications and fees must be received before expiration to avoid a lapsed license and possible late fee.

Grounds for discipline include: obtaining a license by fraud or misrepresentation; misappropriating premiums or claim funds; rebating or sharing commissions with unlicensed persons; and demonstrating incompetence or untrustworthiness.

A public adjuster must maintain a surety bond or errors and omissions policy in the amount required by the state (Ohio: $20,000 surety bond or E&O policy) and file proof with the Department of Insurance.

A public adjuster contract must be in writing, signed by the insured, and include the adjuster's license number, fee or percentage, a description of services, and a right to rescind within three business days after signing.

Indemnity principle: insurance restores the insured to approximately the same financial position after a loss, not better; actual cash value (ACV) = replacement cost minus depreciation.

Replacement cost value (RCV) pays the cost to repair or replace with new materials of like kind and quality without depreciation deduction; many policies require the insured to actually repair or replace before RCV is paid.

Insurable interest must exist at the time of loss; a person with no financial interest in the property cannot collect under the policy.

Duties after loss typically include: give prompt notice; protect property from further damage; prepare an inventory of damaged property; cooperate with the insurer's investigation; submit to examination under oath if required; and send proof of loss within a specified time (often 60 days).

Common exclusions in homeowners policies: earth movement, flood, ordinance or law, intentional loss, neglect, and wear and tear; flood coverage requires a separate NFIP or private flood policy.

Coinsurance clause in commercial property: if the insured carries less than the specified percentage of insurance to value, the claim payment is reduced by the ratio of carried insurance divided by required insurance, multiplied by the loss.

Deductible applies per occurrence; a separate hurricane or wind deductible expressed as a percentage of the dwelling limit may apply and is calculated on the Coverage A limit, not the claim amount.

Additional living expense (ALE) coverage pays for necessary increases in living costs while the residence is uninhabitable due to a covered loss, typically for a stated time period (e.g., 12 months) and subject to a percentage of Coverage A.

Loss of use, debris removal, and building ordinance coverage are separate coverage extensions with their own limits; the adjuster must apply each limit separately and not commingle them.

Claim investigation sequence: acknowledge the claim, inspect the loss location, photograph and measure damage, obtain a signed non-waiver or reservation of rights if coverage is uncertain, and document every contact.

Proof of loss is a sworn statement by the insured stating the amount claimed and supporting facts; the adjuster should review it for accuracy and completeness before submission to the insurer.

Actual cash value calculation: determine replacement cost using current pricing, subtract depreciation based on age and condition, and apply the deductible; document the depreciation method used.

A claim file should contain: the policy, the adjuster's field notes, photographs, estimates, correspondence, proof of loss, and a payment ledger; incomplete documentation is a common source of disputes and regulatory findings.

When the insurer and insured disagree on the amount of loss, the appraisal provision may be invoked; each party selects a competent appraiser, and the two appraisers select an umpire; the umpire's award is binding only if the appraisers agree to it.

Prompt payment: after receipt of a satisfactory proof of loss, the insurer must pay the claim within the time required by state law (Ohio: 30 days for first-party claims) or provide a written explanation for delay.

Subrogation: after paying a claim, the insurer may pursue the responsible third party; the insured must not release or impair the insurer's subrogation rights without consent.

Salvage and debris removal: the adjuster should document salvage value and coordinate disposal; debris removal costs are often subject to a separate limit or sublimit.

A public adjuster may not settle a claim without the insured's written authorization and must provide the insured with a copy of all estimates and correspondence submitted to the insurer.

Fiduciary duty: a public adjuster represents the insured, not the insurer; the adjuster must act in the insured's best interest and disclose any conflict of interest.

Prohibited conduct includes: charging an unreasonable fee; soliciting a client during a declared emergency at the loss site; using false or misleading advertising; and misrepresenting the adjuster's authority or the insurer's obligations.

Unfair trade practices under state law and the NAIC model include: misrepresentation of policy terms; failure to acknowledge and act promptly on communications; refusal to pay without a reasonable investigation; and offering inducements not specified in the policy.

Fee disclosure: the public adjuster must provide a written contract stating the fee or percentage before performing services, and the fee may not exceed the statutory maximum (Ohio: 10% of the claim payment, or 20% for a declared emergency claim).

Right to rescind: the insured may cancel a public adjuster contract within three business days after signing by written notice; the adjuster must refund any fee paid.

Records retention: public adjusters must keep claim files and contract records for at least five years after the claim is closed, and make them available to the Department of Insurance upon request.

Consumer complaint process: a consumer may file a complaint with the Ohio Department of Insurance; the Department may investigate, hold a hearing, and impose penalties including license suspension or revocation and fines.

Penalties for unlicensed adjusting: operating without a license is a misdemeanor and may result in civil penalties and permanent denial of a license; each act of unlicensed adjusting may be a separate violation.

Privacy: public adjusters must safeguard nonpublic personal information and may not disclose it without the insured's authorization except as required by law or necessary to adjust the claim.