Law:Title 13. Regulation Of Professionals. Subtitle C. Adjusters (Texas)

From Law Delta

Revision as of 21:26, 28 September 2011 by Admin (Talk | contribs)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)
Jump to: navigation, search

Subtitle C. Adjusters

Contents

Chapter 4101. Insurance Adjusters

Subchapter A. General Provisions

Section  4101.001.  Definitions.

(a) In this chapter, "adjuster" means an individual who:

(1)  investigates or adjusts losses on behalf of an insurer as an independent contractor or as an employee of:

(A)  an adjustment bureau;

(B)  an association;

(C)  a general property and casualty agent or personal lines property and casualty agent;

(D)  an independent contractor;

(E)  an insurer; or

(F)  a managing general agent;

(2)  supervises the handling of claims; or

(3)  investigates, adjusts, supervises the handling of, or settles workers' compensation claims, including claims arising from services provided through a certified workers' compensation health care network as authorized under Chapter 1305, on behalf of an administrator, as defined by Chapter 4151, or on behalf of an insurance carrier, as defined by Section 401.011, Labor Code.

(b)  For purposes of this chapter, "insurer" includes a self-insured.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.

Amended by:

Acts 2007, 80th Leg., R.S., Ch. 548, Sec. 2.30, eff. September 1, 2007.

Acts 2007, 80th Leg., R.S., Ch. 1176, Sec. 2.04, eff. September 1, 2007.



Section  4101.002.  General Exemptions.

(a) This chapter does not apply to:

(1)  an attorney who:

(A)  adjusts insurance losses periodically and incidentally to the practice of law; and

(B)  does not represent that the attorney is an adjuster;

(2)  a salaried employee of an insurer who is not regularly engaged in the adjustment, investigation, or supervision of insurance claims;

(3)  a person employed only to furnish technical assistance to a licensed adjuster, including:

(A)  an attorney;

(B)  an engineer;

(C)  an estimator;

(D)  a handwriting expert;

(E)  a photographer; and

(F)  a private detective;

(4)  an agent or general agent of an authorized insurer who processes an undisputed or uncontested loss for the insurer under a policy issued by the agent or general agent;

(5)  a person who performs clerical duties and does not negotiate with parties to disputed or contested claims;

(6)  a person who handles claims arising under life, accident, and health insurance policies;

(7)  a person:

(A)  who is employed principally as:

(i)  a right-of-way agent; or

(ii)  a right-of-way and claims agent;

(B)  whose primary responsibility is the acquisition of easements, leases, permits, or other real property rights; and

(C)  who handles only claims arising out of operations under those easements, leases, permits, or other contracts or contractual obligations;

(8)  an individual who is employed to investigate suspected fraudulent insurance claims but who does not adjust losses or determine claims payments; or

(9)  a public insurance adjuster licensed under Chapter 4102.

(b)  A nonresident adjuster is not required to hold a license under this chapter to:

(1)  adjust a single loss in this state;

(2)  adjust losses arising out of a catastrophe common to all those losses; or

(3)  act as a temporary substitute for a licensed adjuster.

(c)  For purposes of Subsection (a)(6), claims arising under workers' compensation insurance policies, including claims relating to services provided through a certified workers' compensation health care network authorized under Chapter 1305, do not constitute claims arising under life, accident, or health insurance policies.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.

Amended by:

Acts 2005, 79th Leg., Ch. 728, Sec. 11.081(a), eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch. 1176, Sec. 2.05, eff. September 1, 2007.



Section  4101.003.  Temporary Exemption.

An individual who is undergoing training as an adjuster under the supervision of a licensed adjuster may act as an adjuster for a period not to exceed 12 months without having a license issued under this chapter if, at the beginning of the period, the individual has been registered with the commissioner as a trainee.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.004.  Reciprocity.

The department may waive any license requirement imposed under this chapter for an applicant who holds a valid license from another state if the state has license requirements substantially equivalent to the requirements for a license issued under this chapter.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.005.  Rules.

The commissioner may adopt rules necessary to implement this chapter and to meet the minimum requirements of federal law, including regulations.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.006.  Advisory Board.

(a) An advisory board shall make recommendations to the commissioner regarding:

(1)  the scope, time, and conduct of written examinations under Subchapter B;

(2)  the times and locations in this state where the examinations are held; and

(3)  any other matter the commissioner submits to the advisory board for a recommendation.

(b)  The advisory board is composed of nine members appointed by the commissioner as follows:

(1)  the presiding officer of the unauthorized practice of law committee of the State Bar of Texas;

(2)  three members who represent the public;

(3)  two members with knowledge and experience in the profession of insurance adjusting;

(4)  one member from a domestic insurer authorized to engage in business in this state;

(5)  one member from a foreign insurer authorized to engage in business in this state; and

(6)  one member who is an independent adjuster.

(c)  A member who represents the public may not be:

(1)  an officer, director, or employee of:

(A)  an adjuster;

(B)  an agent;

(C)  a broker;

(D)  an insurance agency;

(E)  an insurer; or

(F)  any other business entity regulated by the department;

(2)  a person required to register as a lobbyist under Chapter 305, Government Code; or

(3)  a person related to a person described by Subdivision (1) or (2) within the second degree of affinity or consanguinity.

(d)  A member of the advisory board serves without compensation. If authorized by the commissioner, an advisory board member is entitled to reimbursement for reasonable expenses incurred in attending meetings of the advisory board.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Subchapter B. License Requirements

Section  4101.051.  License Required.

Except as otherwise provided by this chapter, a person may not act as or represent that the person is an adjuster in this state unless the person holds a license under this chapter.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.052.  Application.

(a) An applicant for a license under this chapter must submit to the department an application on a form prescribed and provided by the department, and include as part of or in connection with the application any information that the department reasonably requires, including information about the applicant's:

(1)  identity;

(2)  personal history;

(3)  experience; and

(4)  business record.

(b)  The application must be accompanied by the fee required by Section 4101.057.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.053.  Qualifications; Issuance.

(a) To qualify for a license under this chapter, an applicant must:

(1)  comply with this chapter;

(2)  present evidence satisfactory to the department that the applicant:

(A)  is at least 18 years of age;

(B)  resides in this state or a state or country that permits a resident of this state to act as an adjuster in that state or country;

(C)  has complied with all federal laws relating to employment or the transaction of business in the United States, if the applicant does not reside in the United States;

(D)  is trustworthy; and

(E)  has had experience, special education, or training of sufficient duration and extent regarding the handling of loss claims under insurance contracts to make the applicant competent to fulfill the responsibilities of an adjuster; and

(3)  pass an examination conducted under this subchapter or present evidence that the applicant has been exempted under Section 4101.056.

(b)  The commissioner shall issue a license to an applicant who meets the qualifications prescribed by this section.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.054.  Examination Required.

(a) To be eligible for a license under this chapter, an applicant must personally take and pass, to the satisfaction of the commissioner, a written examination of the applicant's qualifications and competency.

(b)  The department may supplement a written examination under Subsection (a) with an oral examination.

(c)  The commissioner shall prescribe each examination under this section. An examination must be of sufficient scope to reasonably test the applicant's knowledge relative to the kinds of insurance that may be dealt with under the license and of:

(1)  the duties of a licensed adjuster; and

(2)  the laws of this state that apply to a licensed adjuster.

(d)  The commissioner may require a reasonable waiting period before an applicant who fails to pass an examination is eligible to be retested on a similar examination.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.055.  Examination Procedures. (a)

The department shall prepare and make available to applicants instructions specifying in general terms the subjects that may be covered in an examination required under Section 4101.054.

(b)  An examination under this subchapter shall be given at times and locations in this state necessary to reasonably serve the convenience of the department and applicants.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.056.  Exemption From Examination Requirement.

(a) An applicant for a license under this chapter is not required to pass an examination under Section 4101.054 to receive the license if the applicant:

(1)  had been principally engaged in the investigation, adjustment, or supervision of losses on August 27, 1973, and during the 90-day period preceding that date;

(2)  is applying for a renewal license under this chapter;

(3)  is licensed as an adjuster in another state with which a reciprocal agreement has been entered into by the commissioner; or

(4)  has completed a course in adjusting losses as prescribed and approved by the commissioner and it is certified to the commissioner on completion of the course that the applicant has:

(A)  completed the course; and

(B)  passed an examination testing the applicant's knowledge and qualification, as prescribed by the commissioner.

(b)  An applicant wishing to claim an exemption under Subsection (a)(4) is responsible for the scheduling and administration of the examination required under that subsection.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.057.  Fees.

(a) Before issuing or renewing a license under this chapter, the department shall set and collect a nonrefundable license fee in an amount not to exceed $50.

(b)  An applicant must remit the fee required by Subsection (a) biennially after the issuance of the original license. If the applicant's license has been expired for not more than 90 days, an applicant for a renewal license must remit, in addition to the fee assessed under Subsection (a), a fee equal to one-half of the original license fee.

(c)  Before administering an examination under this subchapter, the department shall set and collect a nonrefundable examination fee in an amount not to exceed $50.

(d)  Before issuing a duplicate license requested by an adjuster, the department shall set and collect a duplicate license fee.

(e)  The department shall deposit a fee collected under this chapter to the credit of the Texas Department of Insurance operating account.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.058.  License Form.

(a) The commissioner shall prescribe the form of a license issued under this chapter.

(b)  A license must contain:

(1)  the adjuster's name;

(2)  the address of the adjuster's place of business;

(3)  the date of issuance and the date of expiration of the license; and

(4)  the name of the firm or insurer with whom the adjuster is employed at the time the license is issued.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.059.  Continuing Education: General Requirements.

(a) To renew a license under this chapter a licensed adjuster must participate in a continuing education program relating to consumer protection. The program must include education relating to consumer protection laws, including:

(1)  Chapter 541;

(2)  Chapter 547;

(3)  Subchapter A, Chapter 542;

(4)  Subchapter E, Chapter 17, Business & Commerce Code; and

(5)  any other similar laws specified by the department.

(b)  The department may certify continuing education programs.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.060.  Continuing Education: Exemptions And Waivers.

(a) On written request of a licensed adjuster and if the department determines that the adjuster is unable to comply with continuing education requirements under this subchapter because of illness, medical disability, or another extenuating circumstance beyond the control of the adjuster, the department may:

(1)  extend the time for the adjuster to comply with the continuing education requirements; or

(2)  exempt the adjuster from any of the requirements for a licensing period.

(b)  The commissioner by rule shall establish the criteria for an extension or exemption under Subsection (a).

(c)  The department may waive any continuing education requirement imposed under this chapter for a nonresident adjuster who holds a valid license from another state if the state has continuing education requirements substantially equivalent to the requirements for a license issued under this chapter.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.061.  Expiration; Renewal.

Expiration and renewal of a license issued under this chapter are governed by rules adopted by the commissioner or any applicable provision of this code or another insurance law of this state.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Subchapter C. Special Licenses

Section  4101.101.  Emergency License.

(a) If a catastrophe or an emergency arises out of a disaster, act of God, riot, civil commotion, conflagration, or other similar occurrence, the commissioner shall, on application, issue an emergency license to a person if the application is certified to the commissioner not later than the fifth day after the date on which the person begins work as an adjuster by:

(1)  a person who holds a license under this chapter; or

(2)  an insurer that maintains an office in this state and holds a certificate of authority to engage in the business of insurance in this state.

(b)  The person or insurer that certifies an application under Subsection (a) is responsible for the loss or claims practices of the emergency license holder whom the person or insurer certifies.

(c)  The commissioner may, after notice and hearing, revoke an emergency license on grounds specified by Section 4101.201.

(d)  An emergency license is effective for a period not to exceed 90 days. The commissioner may extend the term of the emergency license for an additional period of 90 days.

(e)  The commissioner shall establish a fee for an emergency license in an amount not to exceed $20. A person issued an emergency license shall remit the fee to the department not later than the 30th day after the date on which the department issues the license.

(f)  The commissioner may issue an emergency license to an applicant who meets the requirements of Subsection (a) regardless of whether the applicant is:

(1)  a resident of this state; or

(2)  an otherwise licensed adjuster.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.102.  Limited License.

(a) If considered necessary by the commissioner, the department may issue a limited license to an applicant in the manner otherwise provided for the issuance of a license under this chapter.

(b)  The license shall specifically limit the kinds of insurance that may be handled by the person.

(c)  The person may not adjust claims in a kind of insurance other than that for which the adjuster is specifically licensed.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Subchapter D. Powers And Duties Of Adjuster

Section  4101.151.  Place Of Business.

(a) A licensed adjuster shall maintain a place of business that is:

(1)  located at the place at which the adjuster principally conducts transactions under the license; and

(2)  accessible to the public.

(b)  A licensed adjuster shall promptly notify the commissioner if the adjuster changes the location of the adjuster's place of business.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.152.  Referral By Insurer.

(a) An insurer may not knowingly refer a claim or loss for adjustment in this state to a person purporting to be or acting as an adjuster unless the person holds a license under this chapter.

(b)  Before referring a claim or loss for adjustment, an insurer must ascertain from the commissioner whether the person performing the adjustment holds a license under this chapter. Once the insurer has ascertained that the person holds a license, the insurer may refer the claim or loss to the person and may continue to refer claims or losses to the person until the insurer has knowledge or receives information from the commissioner that the person no longer holds a license.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Subchapter E. Enforcement

Section  4101.201.  Grounds For Disciplinary Action.

(a) The commissioner may discipline an adjuster or deny an application for a license under this chapter under a department rule or any applicable insurance law of this state.

(b)  Department rules may specify grounds for discipline that are comparable to grounds for discipline of other license holders under this title.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.202.  Reinstatement Or Reissuance Of License.

The commissioner may not reinstate or reissue the license of a license holder or former license holder whose license has been suspended, revoked, or refused renewal until the commissioner determines that the cause for a suspension, revocation, or refusal of a license issued under this chapter no longer exists.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.



Section  4101.203.  Criminal Penalty.

A person commits an offense if the person violates Section 4101.051 or 4101.102(c). An offense under this section is a misdemeanor punishable by:

(1)  a fine of not more than $500;

(2)  confinement in the county jail for not more than six months; or

(3)  both the fine and the confinement.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.


Personal tools
Laws
Variants
Actions
Navigation
Toolbox