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

George E. Pataki
Governor

Gregory V. Serio
Superintendent

 The Office of General Counsel issued the following opinion on April 20, 2004, representing the position of the New York State Insurance Department.

RE: Independent Adjuster Licensing

Question Presented:

Must a director, officer or employee of a medical expense indemnity corporation that is licensed in accordance with New York Insurance Law § 4302(b) (McKinney 2000) be licensed as an independent adjuster if such individual settles claims on behalf of his or her employer?

Conclusion:

In accordance with the provisions of New York Insurance Law § 2101(g)(1), as amended by 2003 N.Y. Laws 692, such an individual would not have to be licensed as an independent adjuster.

Facts:

Since this was a general inquiry, no facts were furnished.

Analysis:

New York Insurance Law § 2101(g)(1) defines the term "independent adjuster":

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 . . .; (B) any officer, director or regular salaried employee of an authorized health insurer . . . or any manager thereof, individual or corporate, when the claim to be adjusted is submitted for payment under a health benefit plan that is issued or administered by another health insurer . . . within the same holding company system as the authorized insurer or health maintenance organization adjusting the claim; . . . .

Accordingly, since the medical expense indemnity company is an authorized insurer, it would not have to be licensed as an independent adjuster in New York to settle claims of that company or a corporate affiliate.

For further information you may contact Principal Attorney Alan Rachlin at the New York City Office.