OK Claims Adjuster cheat sheet

Oklahoma Insurance Code is Title 36 of the Oklahoma Statutes; the Insurance Commissioner heads the Oklahoma Insurance Department (OID) and is elected to a four-year term.

Producer licensing: a resident license requires completion of prelicensing education, a passing exam, and a fingerprint-based background check; a license must be renewed every two years with continuing education.

Continuing education for resident producers is 24 credit hours per two-year license term, including at least 3 hours of ethics; adjusters must satisfy the CE requirement applicable to their license type.

Adjuster licensing: Oklahoma licenses public adjusters; staff/corporate adjusters and independent adjusters acting for insurers are licensed under Title 36 with exam and CE requirements.

Unfair claims settlement practices (36 O.S. §1250.1 et seq.) prohibit misrepresenting policy provisions, failing to acknowledge communications, and unreasonable delay or denial of claims.

Prompt-payment rule: an insurer must acknowledge a claim notification within a set number of days and must pay or deny a clean claim within the statutory period; failure can trigger interest and unfair-practice penalties.

Notice of cancellation: a policy in force more than 60 days may be cancelled only for specified reasons, and the insurer must mail written notice at least 30 days before the effective date (10 days for nonpayment of premium).

Commissioner may examine insurers, issue cease-and-desist orders, impose fines, and place insurers in rehabilitation or liquidation under the Uniform Insurers Liquidation Act.

Oklahoma is a modified prior-approval / file-and-use state for many property and casualty forms and rates; rates must not be excessive, inadequate, or unfairly discriminatory.

Claim handling sequence: acknowledge and verify coverage, investigate facts, document the file, evaluate damages, negotiate/settle, and close with a written record of the basis for payment.

Coverage analysis uses the policy's insuring agreement, exclusions, conditions, and definitions; the burden is on the insurer to prove an exclusion applies once the insured shows a covered loss.

Indemnity principle: the insured should be restored to pre-loss condition, not enriched; indemnity is measured by actual cash value (ACV) or replacement cost value (RCV) as the policy specifies.

ACV formula: ACV = replacement cost new − depreciation (physical, functional, and economic); RCV pays full repair/replacement cost without depreciation, often after repair is completed.

Coinsurance formula for property: recovery = (insurance carried ÷ insurance required) × loss, subject to the policy limit and deductible; insurance required = coinsurance % × value of property.

Deductible applies before the policy limit and reduces the payable loss; a percentage deductible (e.g., 1–5% for wind/hail) is computed on the Coverage A dwelling limit.

Reservation-of-rights letter preserves the insurer's defenses while investigation continues; a denial must be in writing, cite specific policy provisions, and state appeal/Department of Insurance rights.

Subrogation allows the insurer, after paying a loss, to pursue the responsible third party in the insured's name; the insured must not impair that right (e.g., by signing a release).

Documentation standards: photographs, measurements, scope of loss, witness statements, expert reports, and a claim diary showing every contact, decision, and payment.

Insurable interest requires a financial stake in the property at the time of loss; a person with no economic interest cannot collect.

HO-3 (special form) covers the dwelling and other structures on an open-peril basis and personal property on a named-peril basis; HO-5 covers both dwelling and personal property on an open-peril basis.

HO-4 (renters) covers personal property and liability but not the building; HO-6 (condo) covers unit interior, improvements, and personal property.

Coverage A = dwelling; Coverage B = other structures (typically 10% of A); Coverage C = personal property (typically 50–70% of A); Coverage D = loss of use; Coverage E = personal liability; Coverage F = medical payments.

Homeowners exclusions commonly include earth movement, flood, ordinance or law, intentional loss, neglect, and business pursuits; flood requires a separate NFIP or private flood policy.

Commercial property: Building and Personal Property Coverage Form covers building, business personal property, and personal property of others; Business Income covers lost earnings during restoration.

CGL occurrence form: Coverage A bodily injury/property damage, Coverage B personal and advertising injury, Coverage C medical payments; the aggregate limit caps total payments in a policy period.

Auto liability: split limits (e.g., 25/50/25) state per-person BI, per-accident BI, and property damage; combined single limits state one total per accident.

Negligence elements: duty, breach of duty, proximate cause, and damages; comparative negligence reduces recovery in proportion to the claimant's fault.

Fiduciary duty: an adjuster owes loyalty and good faith to the insurer and fair, prompt, and honest treatment to the claimant; misrepresentation of policy provisions is an unfair practice.

Prohibited conduct includes offering inducements to settle, advising a claimant to forgo an attorney, and settling without a reasonable investigation of the facts.

Oklahoma requires written notice of the reason for denial and the policy provisions relied upon; the claimant must be told of any right to review by the Insurance Department.

Privacy: adjusters must protect nonpublic personal information (GLBA) and may share claim details only with those with a legitimate need to know.

Conflicts of interest: an adjuster must disclose any financial interest in a repair vendor, and cannot steer repairs to an affiliated shop without disclosure and consent.

Prompt communication: return calls and emails, document every contact, and avoid unreasonable delay; delay without justification is an unfair claims practice.

Good-faith settlement: an insurer that unreasonably refuses a settlement within limits may face a bad-faith action; the adjuster's file must show a reasoned evaluation.

Records retention: maintain claim files for the period required by statute and regulation, and produce them for Department of Insurance examination on request.

Fraud reporting: suspected insurance fraud should be referred to the insurer's special investigation unit and may be reported to the Oklahoma Insurance Department's fraud unit.