Advocacy

Federal

The Claims Licensing Advancement for Interstate Matters (CLAIM) Act

Background

Independent claims adjusters today handle thirty percent of the nation’s insurance claims, representing over $150 billion of claims payments. Claimants and insurers alike rely on independent adjusters to resolve claims as they arise in a timely and effective way. Responding to the needs of consumers quickly and efficiently requires flexibility and mobility to apply the right expertise to adjusting losses from natural disasters or individual accidents—especially in cases occurring across state lines in today’s nationwide economy.

Unfortunately, a patchwork of conflicting state laws frustrates interstate claims adjusting and prevents efficient, timely, and cost-effective customer service, whether for workers’ compensation, property and casualty, disability, residential, auto, or other claims.

The Problem

The complex array of state laws and regulations can frustrate the ability of qualified out-of-state adjusters to work on a claim. Adjusters are expected to meet customer needs over the phone, online, and in person, including across state lines. Today, claims adjusters have to deal with the inefficiencies, duplication, and bureaucracy of 34 different state licensing regimes, only a few of which are partially reciprocal. The result is wasted time, effort and expense, and regulatory arbitrage for adjusters who must navigate this patchwork system. Ultimately, otherwise-avoidable costs affect consumers.

What is outdated and inefficient with the current insurance claims process?

• Residency Restrictions: At least two jurisdictions refuse to license an adjuster who is not a resident of that jurisdiction. Such restrictions are likely unconstitutional under the Commerce Clause.
• In-state Office Requirement: Several states require a physical business location for adjusters operating within the state, despite the fact that there is no need for an adjuster to have office space in a state to effectively and efficiently adjust claims within that state.
• Refusal to Recognize Licensing Reciprocity: Approximately nine states do not grant reciprocity for out-of-state adjusters who have passed the licensing exam in their designated home states (so designated because their state of residence does not require licensing).
• Refusal to Adopt Uniform Application: Eleven states use the uniform application for adjuster licenses developed by the National Association of Insurance Commissioners.
• Refusal to Accept Online Applications: Fourteen states do not allow online submissions of applications for nonresident adjuster licenses. Thirteen states do not allow electronic submissions of renewal forms.
• Impediments to Adjusting Disaster Claims: Despite the need for disaster-ravaged consumers to have their claims adjusted quickly, several states require time-consuming, case-by-case state approval before nonresident adjusters can act in that jurisdiction.
• Uncertainty When Adjusting Disaster Claims: In the event of a catastrophe, it is often unclear, particularly in many states, whether temporary licenses for out-of-state adjusters are valid for a set number of days or until a disaster designation has been lifted for an area.
• Discriminatory Reference Requirement: One state requires that out-of-state candidates provide certificates of character signed by “five reputable citizens of the community in which such applicant resides or transacts business, each of whom shall certify that he has personally known the person or individual for a period of at least five years…” This rule effectively denies licensure to new U.S. citizens or legal aliens, since the state in question refuses to consider certificates from persons in the applicant’s prior country of residence.
• Arbitrary Changing of Rules: An adjusting firm in a non-licensing state, selected another state to serve as the “designated home state” for its adjusters for the commonly accepted purpose of achieving reciprocity with other states. However, shortly after several of the firm’s adjusters passed the adopted state’s exam, the state changed its policy and refused to issue home state certifications to them. The adjusters then had to repeat the pre-licensing requirements and examinations elsewhere to qualify in other states.
• Impediments to Assigning Claims: Costly, time-consuming problems also emerge when an adjuster assigns claims to a licensed adjuster in another state. For example, Adjuster #1 in Illinois may assign a Florida claim to be handled by Adjuster #2 in Florida. Adjuster #2 is properly licensed in Florida, but Adjuster #1 is not. Some then argue that, by talking over the phone to Adjuster #2 in Florida, Adjuster #1 still “handled” the Florida claim, even though the claim had been assigned to an adjuster with the proper Florida credentials. Congressional legislation could help to eliminate this ambiguity by enabling Adjuster #1 in Illinois to receive reciprocity more readily in Florida.
• Redundant Filing Requirements: Certain states require insurers to provide names of out-of-state adjusters receiving temporary licenses to handle that insurer’s claims. However, an independent adjusting company contracting with an insurer cannot bring in out-of-state adjusters directly under that same arrangement. Instead, the insurer must file the out-of-state adjuster information on the company’s behalf. This time-consuming step benefits neither consumers, nor independent adjusters, nor the insurers who have already made the decision to delegate their adjusting responsibilities.
• In-State Exam or Local Exam Requirements: Several states require a non-resident who needs to take their exam to take it in their state, which creates travel expenses. Some do allow a person to take the exam in another state, but are limited to a very few states, which still requires travel to another state to take an exam.

The Solution: The CLAIM Act

The CLAIM Act advances uniformity, reciprocity, and consumer protections for claims adjusting across state lines by implementing the following provisions:

Each state has four years to adopt uniform licensing laws for independent claims adjusters and to work with the other states to adopt reciprocity standards to enable adjusters properly licensed in their designated home states to assess and settle claims across state lines without discrimination. The state-based regulation of independent adjusters remains in place, but the states must undertake needed reforms during those four years.

After that time, if such uniformity and reciprocity has not been achieved by a certain state, the CLAIM Act authorizes independent claims adjusters to apply to the National Association of Registered Agents and Brokers (NARAB) for a license under which to operate.

Since its inception, the ACP has been focused on advocating for enactment of legislation to resolve the current inefficiencies with the state adjuster licensing process. The CLAIM Act represents a balanced approach, enabling adjusters to handle claims more efficiently and effectively across states lines with both reciprocal licensing reforms and appropriate state oversight. More importantly, The CLAIM Act protects consumers and accelerates claims resolution by encouraging states to adopt uniform licensing criteria management programs, safer workplaces, and improved accident prevention programs.

Federal Advocacy Toolkit

State

In addition to ACP’s federal advocacy, the Association is actively involved in numerous adjuster and third-party administrator issues at the state level. The Association often engages in important regulatory educational efforts to inform state insurance commissioners and other regulators about the value and business practices of independent adjusters, and their positive impacts on the claims system. ACP also advocates at the state level, seeking uniformity and reciprocity in state adjuster licensing laws and regulations. AAICP’s advocacy to date has resulted in significant changes to state adjuster laws and regulations.

ACP Recent State Advocacy:

California

In 2015, the California Department of Insurance proposed that both public and independent adjusters be subject to a new licensing regime and to extensive revised new regulatory requirements. The California Assembly similarly began considering legislation to enact the Department’s proposed changes. The ACP quickly mobilized in Sacramento, and after extensive advocacy, the ACP successfully convinced the Department and the state Assembly that independent adjusters needed to be separately regulated from public adjusters.

Following the Association’s success in 2015, ACP worked closely with the Department of Insurance, the Assembly, and the State Senate to address the need for reform and to refine the independent adjuster-specific licensing legislation, both to determine whether reform was actually needed and if so, to clarify the scope and application of the legislation. Among the many important changes, ACP was able to clarify with the Department and the legislature that workers’ compensation adjusters are exempt from the new licensing regime. Numerous other changes were also made to improve the legislation. Following ACP’s extensive advocacy, on September 29, 2016, Governor Jerry Brown vetoed the legislation, noting he was “not convinced that an overhaul of the current licensing system [was] warranted.”

California Toolkit