New York State Seal
STATE OF NEW YORK
INSURANCE DEPARTMENT
25 BEAVER STREET
NEW YORK, NEW YORK 10004

The Office of General Counsel issued the following opinion on March 17, 2000, representing the position of the New York State Insurance Department.

Independent Adjuster Licensing for In House Claims Representative

Question Presented:

Must an in-house claims representative who is employed by the attorney-in-fact which manages a reciprocal insurer be licensed as an independent adjuster?

Conclusion:

No. N.Y Insurance Law Section 2101(g)(1)(McKinney 1999-2000) does not require an in-house claims adjuster who is employed by the attorney-in-fact which manages a reciprocal insurer to become licensed as an independent adjuster.

Facts:

A reciprocal insurer is managed by an attorney-in-fact and the in-house claims representative is employed by that attorney-in-fact. The in-house claims adjuster only settles claims that are brought against the reciprocal insurer. Large claims are handled by various outside independent adjusters, however small loses are handled in house by the employee of the attorney-in-fact.

Analysis:

New York Ins. Law Section 2101(g)(1) (McKinney 1999-2000) states:

The term "independent adjuster" means any person, firm, association or corporation who, or which, for money, commission or any other thing of value, acts in this state on behalf of an insurer in the work of investigating and adjusting claims arising under insurance contracts issued by such insurer and who performs such duties required by such insurer as are incidental to such claims and also includes any person who for compensation or anything of value investigates and adjusts claims on behalf of any independent adjuster, except that such term shall not include: (a) any officer, director or regular salaried employee of an authorized insurer, or any manager thereof, individual or corporate, or the manager, agent or general agent of any department thereof, individual or corporate, or attorney in fact of any reciprocal insurer or LLoyds underwriter, or marine underwriting office, unless acting as an auto body repair estimator as defined in subsection (j) of this section. (emphasis added)

Thus, according to the clear language of the statute, the employee of the attorney-in-fact, who is acting as an in-house claims representative for the reciprocal insurer, is not included in the definition of "independent adjuster", and does not have to become licensed to perform in house claims activities on behalf of the reciprocal insurer.

For further information you may contact Associate Attorney Rochelle Katz at the New York City Office.