6-E LA ADJUSTER LICENSING, COMMISSIONER OF INSURANCE, AND DISCIPLINARY ACTIONS

Question 1

Adjuster: ​an individual who investigates or adjusts losses on behalf of an insurer as an independent contractor or as an employee of:

Answer 1

● An adjustment bureau
● An association
● A property and casualty producer 
● An independent contractor
● An insurer
● A managing general agent

Question 2

Business entity

Answer 2

​a corporation, association, partnership, limited liability company, limited liability partnership, or other legal entity.

Question 3

Home state

Answer 3

the District of Columbia and any state or territory of the United States in which the adjuster’s principal place of residence or principal place of business is located.

Question 4

In order to get a ____license in Louisiana, an adjuster who lives or works in a state that does not have similar laws to Louisiana regarding adjusters may designate a different home state for licensing purposes.

Answer 4

nonresident

Question 5

Individual

Answer 5

a natural person.

Question 6

Insurer

Answer 6

​any type of insurer, whether authorized or unauthorized,

conducting business in this state.

Question 7

Person

Answer 7

​an individual or a business entity.

Question 8

Producer

Answer 8

an individual who is licensed to sell insurance in Louisiana. A producer may be captive, meaning he only works for one insurance company, or independent, selling insurance on behalf of several companies.

Question 9

Uniform individual application

Answer 9

​the current version of the National Association of Insurance Commissioners (NAIC) Uniform Individual Application for resident and nonresident individuals.

Question 10

Uniform business application

Answer 10

the current version of the National Association of Insurance Commissioners (NAIC) Uniform Business Entity Application for resident and nonresident business entities.

Question 11

Adjuster Licensing

Answer 11

In Louisiana, any person claiming to be an adjuster or engaging in the practice of adjusting insurance losses must have an adjuster license.

Question 12

Adjuster licensing

Claims adjusters​:

Answer 12

Claims adjusters​:

● Represent insurer in the claim process
● Six types:
○ automobile adjuster
○ personal lines adjuster
○ commercial lines adjuster
○ crop adjuster
○ workers’ compensation adjuster
○ property and casualty adjuster (comprehensive adjuster)

Question 13

Adjuster licensing

Public adjusters​:

Answer 13

represent the insured in the claim process

Question 14

Adjuster licensing

Catastrophe or emergency adjusters​:

Answer 14

brought in by insurers temporarily to adjust catastrophe claims

Question 15

Adjuster licensing

Limited claims adjuster license

Answer 15

● Can be granted by the commissioner

● Only gives the authority to handle certain types of insurance

Question 16

Adjuster licensing

Temporary/catastrophe adjuster permit

Answer 16

● Commissioner can grant temporary licenses to adjust catastrophe-related
claims in LA for ​180 days​ (with 90-day extension possible)
● $25​ fee
● Required before catastrophe adjusters begin working in the state

Question 17

In order to get a ​resident adjuster​ ​license​ in Louisiana, a person must meet these requirements:

Answer 17

● Be able to designate Louisiana as home state, or be a resident of a state that does not license adjusters
● Have a record with no grounds for denial, suspension, or revocation of a license in Louisiana
● Submit the proper licensing application and ​$55​ fee
● Keep an office in home state that is accessible to the public
● Report any convictions of a felony, and, when applicable, acquire 18 USC 1033
written consent by the Commissioner of Insurance
● Provide all documentation needed to verify the details in the application
● If an ​individual​ (i.e. not a business), the applicant must also:
○ be at least 18 years old
○ pass the Louisiana Adjuster Exam (or qualify for one of the exemptions)
○ be fingerprinted for a background check
● If a ​business entity​, the applicant must also:
○ designate a licensed individual to be in charge of staying in compliance
with insurance laws and regulations
○ only allow licensed individuals to use the business’ license

Question 18

Someone who lives in another state can get a Louisiana ​nonresident adjuster license​ by meeting these requirements:

Answer 18

● Hold (and maintain) a resident adjuster license in good standing in home state
● If home state does not require an exam for licensure, pass the Louisiana
Adjuster Exam
● Submit the proper licensing application and​ $55 ​fee
● Live in a state that offers nonresident adjuster licenses to Louisiana residents
on the same basis

Question 19

Louisiana can waive the exam requirement for the following applicants:

Answer 19

● Anadjusterlicensedbyexaminationinanotherstatewhomovesto Louisiana and applies for a resident license within ​90 days
○ thisexemptiononlyappliesifthelicenseewasingoodstanding in the prior state
● ALouisianaresidentwhoheldanadjusterlicensewithinthepast​24 months ​and was in good standing when the license was cancelled ● Anapplicantforaworkers’compensationadjusterlicensewhohas
had​ 3 years’ ​experience within the last​ 5 years

Question 20

The following people do ​not​ need a license to adjust claims in Louisiana:

Answer 20

● An attorney admitted to practice law in Louisiana
● An employee of an insurer who does not regularly adjust or investigate claims
● A person employed only to give an adjuster technical assistance
● A producer of an authorized insurer or employee of said producer, when
processing an uncontested loss under a policy that the producer issued
● A person who performs clerical duties and does not negotiate with parties of
the claim
● An employee of a licensed business entity who collects information about
claims and performs data entry (only 25 such employees are allowed for each
licensed individual adjuster in the business)
● A person who is employed as a right-of-way agent
● A person employed to investigate fraudulent insurance claims but who does
not adjust the claims or determine payment on claims
● A salaried employee of a property owner who represents the property owner’s
interests and:
○ was not hired just to handle a specific claim, or
○ doesn’t advertise himself as an adjuster
● A person who handles claims arising under only:
○ life, accident, and health insurance policies
○ vehicle mechanical breakdown insurance policies
○ property residual value insurance policies
○ commercial policies providing excess coverages as classified by LRS
22:47 (14)
○ reinsurance and subrogation only

Question 21

License renewal

Answer 21

● Claims adjuster licenses last ​2 years​ and expire on the last day of the
adjuster’s birth month
● Renewal fee:​ $50
● Reinstatement: allowed within ​24 months​ of expiration with the
commissioner’s permission and double the renewal fee

Question 22

Continuing education

Answer 22

● 24 hours​ of CE required for renewal
● 3 hours​ must be in Ethics
● Exemptions:
○ adjusters who got their licenses less than a year before CE is due
○ non-residents from reciprocal states who meet their home states’ CE
requirements

Question 23

Reporting

Answer 23

Within ​30 days​, an adjuster ​must​ report:
● Any change of name, address, or any info on the license application (or face a $50 ​fine or revocation of license)
● Any administrative action taken against him after the final disposition of the matter
● The conviction of any criminal prosecution against him for:
○ violation of insurance laws or regulations
○ felony
○ misdemeanor involving misappropriation of funds

Question 24

Assumed Names

Answer 24

When doing business under any name that is not legal name:
● Adjuster must register trade name with secretary of state and notify
commissioner before using the trade name
● Fine for using unapproved name: ​$250​ (or up to $5,000 if disobeying order to
stop using that name)

Question 25

The Louisiana claims adjuster license is a _____ license which expires on the last day of the adjuster’s birth month, either in odd or even years depending on the license number. If the license number ends in an odd number, it will expire in the next odd-numbered year; if it ends in an even number, it will expire in the next even-numbered year.

Answer 25

2-year

Question 26

In order to become a ​producer​ and sell insurance in Louisiana, a person must:

Answer 26

● Be at least 18 years old
● Live in Louisiana
● Take a pre-licensing course, and, for some kinds of insurance, pass an exam
● For bail-bond applicants, work as an apprentice for ​3 months
● Submit all necessary forms and fees
● Get fingerprinted
● Report any felony convictions

Question 27

The Commissioner of Insurance:

Answer 27

● Oversees the licensing and regulation of insurance professionals
● Elected for a ​4 year term
● Can appoint a chief deputy commissioner and an assistant

Question 28

The Commissioner has the authority to:

Answer 28

● Investigate whether anyone in the insurance business has committed illegal,
unfair, or deceptive practices
● Suspend, revoke, or refuse to issue or renew a claims adjuster’s license
● Impose fines: up to ​$500 ​for each violation (up to ​$10,000 ​in one year)
● Place an adjuster on probation
● Suspend, revoke, or refuse to renew a business’ claims adjuster license if the
business fails to report a violation

Question 29

An adjuster must also report to the commissioner any criminal prosecution in any jurisdiction for:

Answer 29

● Violation of insurance laws or regulations
● Any felony
●Any misdemeanor involving misappropriation of funds

Question 30

To renew, you must:

Answer 30

● Filearenewalapplication
● Complete24hoursofContinuingEducationwith3ofthosehours being Ethics
● CEExemptions:
○ adjusterswhogottheirlicenseslessthanayearbeforethedue
date for CE
○ non-residentsfromreciprocalstateswhomeettheirhome
state’s CE requirements
● Payarenewalfeeof$50
● Ifanadjuster’slicenselapses,shemayreinstateitwithin24months by paying double the renewal fee, with the commissioner’s permission
● Anadjusterwhocannotmeetrenewalrequirementsbecauseof military service, disability, or other circumstances may request a waiver of these requirements and any penalties or exams that may result from not meeting them

Question 31

Change of Name or Address

Answer 31

An adjuster must report any change of name, address, or any info that was on the licensee’s application via NIPR within 30 days to avoid a $50 fine or revocation of license.

Question 32

Assumed Names

Answer 32

An adjuster who wants to do business under any name other than his legal name must notify the commissioner of the assumed name beforehand.

Question 33

Reasons for disciplinary actions

Answer 33

1. Providing false, misleading, or incomplete information in the license application
2. Violating any state insurance law or regulation, or an order of the commissioner
   (or of another state’s insurance commissioner)
3. Obtaining or trying to obtain a license through misrepresentation or fraud,
   including cheating on a licensing exam
4. Improperly withholding, misappropriating, or converting any money or property
   received while conducting insurance business
5. Intentionally misrepresenting the terms of an insurance contract or application
6. Being convicted of (or pleading no contest to) a felony, or being convicted of a misdemeanor involving moral turpitude, public corruption, or insurance claims adjusting
7. Admitting to or committing fraud or unfair trade practices
8. Using fraudulent, coercive, or dishonest practices or demonstrating
   incompetence, untrustworthiness, or financial irresponsibility while conducting
   business that could endanger the public
9. Having an insurance license denied, suspended, or revoked in any other state,
   province, district, or territory
10. Forging a name on an application for insurance or any document related to an
    insurance transaction
11. Knowingly accepting insurance business from someone who should be
    licensed, but is not
12. Failing to pay child support
13. Failing to pay state income tax
14. Refusing to submit fingerprints or undergo a criminal background check 15. Employing, or professionally associating with, someone in the insurance
    industry who has been convicted of a felony
15. Being convicted of a felony involving dishonesty or breach of trust, if the
    person has not gotten the commissioner’s written permission to do insurance
    business under 18 U.S.C. 1033
16. Violating the adjuster standards of conduct
17. Failing to complete a claim adjustment assignment in a thorough and timely
    manner, including submitting the adjustment to the party that made the assignment

Question 34

Disciplinary actions

If the commissioner determines that someone has committed illegal or unfair practices, he can:

Answer 34

● Serve a ​cease and desist order
● Impose a fine:
○ up to​ $1,000​ for each act/violation, up to​ $100,000
○ for those aware that their actions violated the insurance code: up to
$25,000​ for each violation, up to a total of​ $250,000​ in any ​6 month
period
● Suspend ​or​ revoke​ the person’s license

Question 35

Disciplinary actions

Penalty for violating a ​cease and desist order​:

Answer 35

● Fine of up to ​$25,000 ​for each violation (maximum of ​$250,000​)
● Suspension or revocation​ of license or certificate of authority

Question 36

Examination of insurers and producers

● The commissioner ​must​ examine:

Answer 36

○ each ​insurer​ at least ​once every 5 years
○ any given insurer at the request of the Louisiana Insurance Guaranty
Association or the Louisiana Life and Health Insurance Guaranty
Association

Question 37

Examination of insurers and producers

● The commissioner can examine:

Answer 37

○ any ​producer​ when he has received at least ​3 complaints ​within a ​30 day ​period​ ​about violations of the insurance code
○ any ​person​, if necessary for the examination of an insurance company`

Question 38

The Federal Violent Crime Control and Law Enforcement Act

Answer 38

Those convicted of a felony involving dishonesty or breach of trust must get the commissioner’s written consent before engaging in insurance business
● Applicants for licensure must get an application for written consent ​before applying for licensure
● Anyone already licensed in LA who commits a criminal felony must get permission to continue in insurance business through the Department of Insurance