6-D LA CLAIM SETTLEMENT AND ADJUSTER CONDUCT

Question 1

Unfair claims settlement practices

1-3

Answer 1

1. Misrepresenting pertinent facts or policy provisions to insureds
2. Failing to acknowledge and act reasonably promptly upon receiving
   communications about claims from insureds
3. Failing to adopt and implement reasonable standards for prompt claims
   investigation and processing

Question 2

Unfair claims settlement practices (4-6)

Answer 2

4. Refusing to pay claims without conducting a reasonable investigation based upon all available information
5. Failing to settle or deny claims within a reasonable time after receiving proof of loss forms (settlements for covered claims should be paid within ​60 days of receiving a proof of loss,​ unless the insurer has probable cause for failing to do so)
6. Failing to try in good faith to settle a claim promptly once liability has become reasonably clear (insurers should pay claims ​within​ ​30 days​ of reaching a written settlement agreement​ with the claimant)

Question 3

Unfair claims settlement practices (7-9)

Answer 3

7. Offering unreasonably small settlement amounts so that insureds have to bring lawsuits in order to get the insurance payments they deserve
8. Trying to settle a claim for less than the amount to which a reasonable man would have believed he was entitled, based on advertisements accompanying an application
9. Trying to settle claims on the basis of an application that was altered without the insured’s knowledge

Question 4

Unfair claims settlement practices (10-12)

Answer 4

10. Making claims payments to insureds without explaining the coverage under which the payments are being made
11. Trying to compel claimants to accept settlements or compromises by telling them about the insurer’s policy of appealing arbitration awards that favor the claimant
12. Delaying the claim settlement process by requiring a claimant to submit a preliminary claim report ​and then​ requiring formal proof of loss forms, both of which contain substantially the same information

Question 5

Unfair claims settlement practices (13-15)

Answer 5

13. Failing to settle claims promptly under one portion of the policy, where liability has become reasonably clear, in order to influence settlements under other portions of the policy
14. Failing to explain promptly and reasonably why the insurer has denied a claim or offered a compromise settlement
15. Failing to provide any necessary claims forms (and reasonable explanations of how to use them) to clients within ​15 days​ of a request

Question 6

Referral by Insurer

Answer 6

An insurer may not knowingly refer a claim or loss for adjustment to anyone except a licensed insurance adjuster.

Question 7

Standards of conduct for adjusters (1-3)

Answer 7

1. An adjuster may not allow any unlicensed employee or representative to conduct business for which a license is required
2. An adjuster may not have a financial interest in any aspect of a claim, other than the salary or fee established with the insurer
3. An adjuster may not acquire any interest in salvage of property subject to the contract with the insurer

Question 8

Standards of conduct for adjusters (4-6)

Answer 8

4. When an adjuster is adjusting a claim, he or she may not in any way recommend or solicit employment for any attorney at law, contractor, or subcontractor, in connection with the loss or damage
5. When an adjuster is working for an insured, directly or indirectly, the adjuster may not ask for or solicit any kind of compensation from or on behalf of a contractor who is working for the same insured
6. An adjuster may not agree to adjust a claim if he or she is not competent and knowledgeable as to the terms and conditions of the insurance coverage, or if the claim exceeds the adjuster’s current expertise

Question 9

Standards of conduct for adjusters (7-9)

Answer 9

7. An adjuster may not knowingly make any material misrepresentations or statements which are false or maliciously critical and intended to injure any other insurance professional
8. No licensed adjuster may represent or act as a public adjuster
9. An adjuster may not materially misrepresent the terms and coverage of an
   insurance contract to the insured in order to settle the claim under less favorable terms than the insured deserves according to the policy

Question 10

Standards of conduct for public adjusters (1-4)

Answer 10

1. A public adjuster is obligated, under his license, to serve, with objectivity and complete loyalty, the interest of his insured alone and, as far as he is able, to give the insured the information that will best serve the insured’s needs and interest in the claim
2. A public adjuster may not solicit an insured while a loss-producing occurrence is still in progress
3. A public adjuster may not allow any unlicensed employee or representative to conduct business for which a license is required
4. A public adjuster may not have any kind of financial interest in any aspect of the claim, other than the compensation established in the written contract with the insured

Question 11

Standards of conduct for public adjusters (5-8)

Answer 11

5. A public adjuster may not acquire any interest in salvage of property subject to the contract with the insured
6. When a public adjuster is adjusting a claim, he or she may not, in exchange for a fee or some other kind of compensation, recommend or solicit employment for any attorney at law, contractor, or subcontractor, in connection with the loss or damage (the public adjuster ​may ​make recommendations as long as he or she is not receiving a fee or compensation for doing so)
7. When a public adjuster is working for an insured, directly or indirectly, the adjuster may not ask for or solicit any kind of compensation from or on behalf of a contractor who is working for the same insured
8. No licensed public adjuster may act as a company adjuster or independent adjuster in Louisiana

Question 12

Standards of conduct for public adjusters (9-12)

Answer 12

9. A public adjuster shall not enter into a contract or accept a power of attorney that gives the public adjuster the authority to choose who shall perform repair work
10. A public adjuster must ensure that all contracts for his or her own services are in writing and include all the terms and conditions of the engagement
11. A public adjuster shall not file, on behalf of an insured client, any complaint with any court of record or agency of the state
12. A public adjuster may not help an insured with any claim except for a first-party claim against that person’s own insurer

Question 13

Standards of conduct for public adjusters (13-17)

Answer 13

13. A public adjuster shall not adjust personal injury claims
14. A public adjuster may not give the insured legal advice, including legal advice regarding the policy provisions or coverage issues
15. A public adjuster shall not engage in the unauthorized practice of law
16. A public adjuster may not agree to any loss settlement without the insured’s
    knowledge and written consent
17. A public adjuster shall not act as an appraiser or umpire during an appraisal if
    he or she has adjusted any part of the claim or property subject to the appraisal provision