Be sure to request that they fill out an official RFA (Request
For Assistance) .
The official paperwork must be done before any official action
be taken.
You can also request that they send the RFA on to the Bureau of
Monitoring and Auditing.
(1) Purpose. This rule sets forth the various ethical considerations
and
constraints for various classes of insurance adjusters.
(2) Definitions. The following definitions shall apply
for purposes of
this rule.
(a) “Adjuster,” when used without further specification,
refers to and
includes all types and classes of insurance adjusters,
(company, independent, and public), subject to Chapter 626, Florida
Statutes, and regardless whether resident or nonresident, and
whether permanent, temporary, or emergency licensees.
(b) “Client” refers to and includes both clients
and potential clients;
and means any person who consults with or hires an
adjuster to provide adjusting services.
(c) “Department” refers to the Florida Department
of Insurance.
(d) “Person” includes natural persons and legal
entities.
(3) Violation. Violation of any provision of this rule
shall constitute
grounds for administrative action against the licensee,
upon grounds, that include but are not limited to, that the violation
demonstrates a lack of fitness to engage in the business of
insurance. Additionally, a breach of any provision of this rule
constitutes an unfair claims settlement practice.
The
work of adjusting insurance claims engages the public trust.
An adjuster must put the duty for fair and honest treatment of
the
claimant above the adjuster’s own interests, in every instance.
The
following are standards of conduct that define ethical behavior.
(a) An adjuster shall disclose all financial interest in any direct
or
indirect aspect of an adjusting transaction. For example: an
adjuster shall not directly or indirectly refer or steer any claimant
needing repairs or other services in connection with a loss to
any
person with whom the adjuster has an undisclosed financial interest,
or
which person will or is reasonably anticipated to provide the
adjuster any direct or indirect compensation for the referral
or for any
resulting business.
(b) An adjuster shall treat all claimants equally. An adjuster
shall not
provide favored treatment to any claimant. An adjuster
shall adjust all claims strictly in accordance with the insurance
contract.
(c) An adjuster shall never approach investigations, adjustments,
and
settlements in a manner prejudicial to the insured.
(d) An adjuster shall make truthful and unbiased reports of the
facts
after making a complete investigation.
(e) An adjuster shall handle every adjustment and settlement with
honesty and integrity and allow a fair adjustment or
settlement to all parties without any remuneration to himself
except
that to which he is legally entitled.
(f) An adjuster, upon undertaking the handling of a claim, shall
act
with dispatch and due diligence in achieving a proper
disposition thereof.
(g) An adjuster shall promptly report to the Department any conduct
by
any licensed insurance representative of this state,
which conduct violates any insurance law or Department rule or
order.
(h) An adjuster shall exercise extraordinary care when dealing
with
elderly clients, to assure that they are not disadvantaged in
their claims transactions by failing memory or impaired cognitive
processes.
(i) An adjuster shall not negotiate or effect settlement directly
or
indirectly with any third-party claimant represented by an
attorney, if said adjuster has knowledge of such representation,
except
with the consent of the attorney. For purposes of this
subsection, the term “third-party claimant” does not
include the insured
or the insured’s resident relatives.
(j) An adjuster is permitted to interview any witness, or prospective
witness, without the consent of opposing counsel or party.
In doing so, however, the adjuster shall scrupulously avoid any
suggestion calculated to induce a witness to suppress or deviate
from the truth, or in any degree affect their appearance or testimony
at
the trial or on the witness stand. If any witness making or
giving a signed or recorded statement so requests, the witness
shall be
given a copy thereof.
(k) An adjuster shall not advise a claimant to refrain from seeking
legal advice, nor advise against the retention of counsel to
protect the claimant’s interest.
(l) An adjuster shall not attempt to negotiate with or obtain
any
statement from a claimant or witness at a time that the claimant
or witness is, or would reasonably be expected to be, in shock
or
serious mental or emotional distress as a result of physical,
mental,
or emotional trauma associated with a loss. Further, the adjuster
shall
not conclude a settlement when such settlement would be
disadvantageous or to the detriment of a claimant who is in the
traumatic or distressed state described above.
(m) An adjuster shall not knowingly fail to advise a claimant
of their
claim rights in accordance with the terms and conditions
of the contract and of the applicable laws of this state. An adjuster
shall exercise care not to engage in the unlicensed practice of
law
as prescribed by the Florida Bar.
(n) A company or independent adjuster shall not draft, unless
approved
in writing in advance by the insurer and such written
communication can be demonstrated to the Department, special releases
called for by the unusual circumstances of any settlement
or otherwise draft any form of release. Except as provided above,
a
company or independent adjuster is only permitted to fill in the
blanks in a release form approved by the insurer they represent.
(5) Public Adjusters, Other Ethical
Constraints. In addition to
considerations set out above for adjusters, the following ethical
considerations are specific to public adjusters.
(a) A public adjuster shall advise the insured and claimant in
advance
of their right to choice of counsel to represent the insured
or claimant, and that such choice is to be made solely by the
insured or
claimant.
(b) The public adjuster shall notify the insured or claimant in
advance
of the name and location of any proposed contractor,
architect, engineer, or similar professional, before any bid or
proposal
by any of these persons may be used by the public adjuster in
estimating the loss or negotiating settlement, and the insured
or
claimant may exercise veto power of any of these persons in which
case that person shall not be used in estimating costs.
(c) The public adjuster shall ensure that if a contractor, architect,
engineer, or other licensed professional is used in formulating
estimates or otherwise participates in the adjustment of the claim,
the
professional must be licensed by the Florida Department of
Business and Professional Regulation.
(d) A public adjuster shall not prevent, or attempt to dissuade
or
prevent, a claimant from speaking privately with the insurer,
company or independent adjuster, attorney, or any other person,
regarding the settlement of the claim.
(e) A public adjuster shall not acquire any interest in salvaged
property, except with the written consent and permission of the
insured.
(f) A public adjuster shall not accept referrals of business from
any
person with whom the public adjuster may conduct
business where there is any form or manner of agreement to compensate
the person, whether directly or indirectly, for referring
business to the public adjuster. Except as between licensed public
adjusters, or licensed public adjusters and members of the Florida
Bar, no public adjuster may compensate any person, whether directly
or
indirectly, for the principal purpose of referring business to
the public adjuster.
Specific Authority 624.308, 626.878, 626.9611 FS. Law Implemented
624.307(1), 626.611, 626.621, 626.865(2), 626.878, 626.9541(1)(i)
FS.
History–New 6-2-93, Amended 12-18-01.
