Ethics and Responsibilities for Florida Adjusters

By Michael Lustig

This textbook is a study of ethical conduct for insurance adjusters in Florida, examining some of the ethical dilemmas they face and presenting the topics of deceptive trade practices and fair claims handling.

In this book you will learn the general concepts of adjuster ethics, gain an understanding of ethical decision making, compare ethical obligations and legal requirements, identify the duties resulting from the law of agency, examine guidelines and law for Florida adjusters to follow, and learn about adjuster liability.

Major subjects covered include:

* Introduction to Adjuster Ethics
* The Common Law of Agency
* Perspective on the Unauthorized Practice of Law
*Ethics for the Insurance Industry
* Complex Ethical Dilemmas that Challenge Adjusters
* Legal Vs. Ethical Requirements
* Adjuster Liability (Unethical Conduct may lead to Bad Faith Claims)
* Fair Claims Handling Guidelines and Law for FL Adjusters
* Deceptive Trade Practices in General
* Regulating Fair Claims Practices and Unfair Claim Settlement Practices
* Property and Casualty Claims Practices
* Adjusters and the Florida Insurance Code
* The Insurance Adjusters Law
* Adjuster Code of Ethics
* The Unfair Insurance Trade Practices Act
* Authority and Enforcement
* Disciplinary Guidelines for Public Adjusters

• Language: English
• Publisher: Michael Lustig
• Release date: Sep 5, 2011
• ISBN: 9781933891767

Michael Lustig

Michael Lustig is a graduate of the University of San Diego, California and a former Professor at California State University at Pomona and Immaculate Heart College (Los Angeles). He has been a California Real Estate Broker and the Owner and President of Real Estate License Services, a California real estate and insurance licence school, since 1978, offering state-approved license courses in 47 states and the District of Columbia. He is the author of 35 books on real estate and insurance topics.

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Ethics and Responsibilities

for Florida Adjusters

Prepared by Michael Lustig

Contributing Editor: Denise Iona

Distributed by:

Cal State Exams

5059 Newport Ave. #209

San Diego, CA 92107

Phone Toll-Free 1-800-729-0207

Smashwords Edition

Copyright © 2011 - 2005 REAL ESTATE LICENSE SERVICES, INC. Copyright registered. All rights reserved. No part of this material may be reprinted, reproduced, transmitted, stored in a retrieval system, placed in a computer or on the Internet, or otherwise utilized, in any form or by any means electronic or mechanical, including photocopying or recording, now existing or hereinafter invented, nor may any part of this course be used for teaching without permission from the copyright holder. CAL-STATE EXAMS is a division of REAL ESTATE LICENSE SERVICES, INC., holder of the registered copyright.

TABLE OF CONTENTS

LESSON 1: INTRODUCTION TO ADJUSTER ETHICS

INTRODUCTION

THE COMMON LAW OF AGENCY

CREATING THE AGENCY RELATIONSHIP - AUTHORITY OF AGENT - TERMINATION OF AGENCY - AN AGENT’S OBLIGATIONS

PERSPECTIVE ON THE UNAUTHORIZED PRACTICE OF LAW

WHAT CONSTITUTES THE PRACTICE OF LAW? - LEGAL KNOWLEDGE - PROHIBITIONS

LESSON 2: ETHICS FOR THE INSURANCE INDUSTRY

OVERVIEW

THE NEW FOCUS OF BUSINESS ETHICS - ETHICS IN THE INSURANCE BUSINESS - WHO IS RESPONSIBLE?

ENCOURAGING ETHICS

AT THE CORPORATE LEVEL - MIDDLE MANAGEMENT - AGENCY LEVEL

ETHICS CAN BE TAUGHT

KNOWING RIGHT FROM WRONG - A FORUM FOR ETHICS DISCUSSIONS

ETHICS MUST TAKE HIGH PRIORITY

COMPLEX ETHICAL DILEMMAS THAT CHALLENGE ADJUSTERS

WHEN THE PRESSURE IS ON - THE ETHICS OF THE MARKETPLACE - INTERPRETATION - ETHICAL ISSUES OF INDEMNIFICATION - INSURANCE FRAUD - SELECTING INDEPENDENT EXPERTS - CONTAINING COSTS - TIMEFRAMES FOR FAIR CLAIMS SETTLEMENT - THE USE OF SURVEILLANCE - NEGOTIATING IN GOOD FAITH

LEGAL VS. ETHICAL REQUIREMENTS

THE LEGAL REQUIREMENTS - THE ETHICAL REQUIREMENTS

ETHICAL FITNESS SHOULD BEGIN AT THE TOP

LESSON 3: ADJUSTER LIABILITY

INTRODUCTION

PARTIES TO WHOM DUTIES ARE OWED

DUTIES OWED TO THE STATE - DUTIES OWED TO THE INSURER - DUTIES OWED TO INSUREDS AND CLAIMANTS

UNETHICAL CONDUCT MAY LEAD TO BAD FAITH CLAIMS

CONCLUSION

LESSON 4: FAIR CLAIMS HANDLING GUIDELINES AND LAW FOR FLORIDA ADJUSTERS

DECEPTIVE TRADE PRACTICES IN GENERAL

REGULATING FAIR CLAIMS PRACTICES

UNFAIR CLAIM SETTLEMENT PRACTICES

PROPERTY AND CASUALTY CLAIMS PRACTICES

ACKNOWLEDGING COMMUNICATIONS AND IMPLEMENTING STANDARDS FOR THE PROMPT INVESTIGATION OF CLAIMS - COMMUNICATIONS TO OR BY AN AGENT - PROVIDING NECESSARY CLAIM FORMS

CLAIM SETTLEMENT PRACTICES RELATING TO MOTOR VEHICLE INSURANCE

CLAIM SETTLEMENT PRACTICES RELATING TO PROPERTY INSURANCE

CLAIM SETTLEMENT PRACTICES RELATING TO HEALTH MAINTENANCE ORGANIZATIONS

LESSON 5: ADJUSTERS AND THE FLORIDA INSURANCE CODE

INSURANCE REGULATION IN FLORIDA

THE INSURANCE ADJUSTERS LAW

PUBLIC ADJUSTER - INDEPENDENT ADJUSTER - COMPANY EMPLOYEE ADJUSTER - NONRESIDENT COMPANY EMPLOYEE ADJUSTER - CATASTROPHE OR EMERGENCY ADJUSTER - PRIMARY ADJUSTER - OFFICE AND RECORDS - EXCLUSIVE EMPLOYMENT

ADJUSTER CODE OF ETHICS

ETHICAL REQUIREMENTS - SPECIAL CONSIDERATIONS FOR PUBLIC ADJUSTERS

THE UNFAIR INSURANCE TRADE PRACTICES ACT

MISREPRESENTATIONS AND FALSE ADVERTISING OF INSURANCE POLICIES - FALSE INFORMATION AND ADVERTISING GENERALLY - DEFAMATION - BOYCOTT, COERCION, OR INTIMIDATION - FALSE STATEMENTS AND ENTRIES - STOCK OPERATIONS AND ADVISORY BOARD CONTRACTS - UNFAIR DISCRIMINATION - UNLAWFUL REBATES - UNFAIR CLAIM SETTLEMENT PRACTICES - COMPLIANT HANDLING PROCEDURES - MISREPRESENTATION IN INSURANCE APPLICATIONS - TWISTING - ADVERTISING GIFTS PERMITTED - FREE INSURANCE PROHIBITED - ILLEGAL DEALINGS IN PREMIUMS - INSURANCE COST SPECIFIED IN PRICE PACKAGE - CERTAIN INSURANCE TRANSACTIONS THROUGH CREDIT CARD FACILITIES - INTERLOCKING OWNERSHIP AND MANAGEMENT - PROHIBITED ARRANGEMENTS AS TO FUNERALS - CERTAIN LIFE INSURANCE RELATIONS WITH FUNERAL DIRECTORS PROHIBITED - FALSE CLAIMS; OBTAINING OR RETAINING MONEY DISHONESTLY - PROPOSAL REQUIRED - SOLICITING OR ACCEPTING NEW OR RENEWAL INSURANCE RISKS BY INSOLVENT OR IMPAIRED INSURER - REFUSAL TO INSURE - POWERS OF ATTORNEY - SLIDING - CHURNING - DECEPTIVE USE OF NAME

AUTHORITY AND ENFORCEMENT

HEARING - CEASE AND DESIST ORDERS - ADMINISTRATIVE FINES - CIVIL LIABILITY

DISCIPLINARY GUIDELINES FOR PUBLIC ADJUSTERS

CHAPTER QUIZZES

LESSON 1 – INTRODUCTION TO ADJUSTER ETHICS

LESSON 2 – ETHICS FOR THE INSURANCE INDUSTRY

LESSON 3 – ADJUSTER LIABILITY

LESSON 4 – FAIR CLAIMS HANDLING GUIDELINES AND LAW FOR FLORIDA ADJUSTERS

LESSON 5 – ADJUSTERS AND THE FLORIDA INSURANCE CODE

LESSON 1: INTRODUCTION TO ADJUSTER ETHICS

INTRODUCTION

This lesson is intended as a general introduction to the study of adjuster ethics and responsibility. It includes openings to some of the subject areas covered in more detail later in the course.

In this chapter, students will be introduced to the common law of agency, the body of law applicable to consensual relationships in which one person consents to act on behalf of another person and subject to that person's control. The law of agency requires certain standards of behavior within the framework of the principal/agent relationship because agency doctrine governs the consequences, for both the principal and agent, of the agent's interactions with third parties. Insurance adjusters,