Current through Register Vol. XLI, No. 38, September 20, 2024
3.1. No person
shall in West Virginia act as or hold himself to be an adjuster unless licensed by
the Commissioner.
3.2. Notwithstanding
any other provisions of this rule, a company adjuster's license or independent
adjuster's license shall not be required of, the following:
3.2.a. An attorney-at-law admitted to practice in
this state, when acting in their professional capacity as an attorney;
3.2.b. A person employed solely to obtain facts
surrounding a claim or to furnish technical assistance to a licensed company or
independent adjuster;
3.2.c. An
individual who is employed to investigate suspected fraudulent insurance claims but
who does not adjust losses, investigate or determine coverage, or determine claims
payments;
3.2.d. A person who solely
performs executive, administrative, managerial or clerical duties or any combination
thereof and who does not investigate, negotiate or settle claims with policyholders,
claimants or their legal representative;
3.2.e. A licensed health care provider or its
employee who provides managed care services so long as the services do not include
the determination of compensability;
3.2.f. A managed care organization or any of its
employees or an employee of any organization providing managed care services so long
as the services do not include the determination of compensability;
3.2.g. A person who settles only reinsurance or
subrogation claims;
3.2.h. An officer,
director or manager of an authorized insurer or surplus lines insurer or a risk
retention group or of a related holding company or an affiliated insurer, in the
state, whether an individual or a business entity, or an attorney-in-fact of a
reciprocal insurer;
3.2.i. A U.S.
Manager of the United States branch of an alien insurer;
3.2.j. A person who investigates, negotiates or
settles life, accident and sickness, annuity or disability insurance claims;
3.2.k. An individual employee, under a
self-insured arrangement, who adjusts claims on behalf of his or her
employer;
3.2.l. A licensed insurance
producer, attorney-in-fact of a reciprocal insurer or managing general agent of the
insurer to whom claim authority has been granted by the insurer;
3.2.m. A person who adjusts claims for licensed
farmers' mutual fire insurance companies;
3.2.n. A business entity licensed under the
authority of W.Va. Code §
33-46-1, et seq. of this
code;
3.2.o. An individual who collects
claims information from, or furnishes claim information to, insureds or claimants
and who conducts data entry, including data into an automated claims adjudication
system, so long as the individual is under the supervision of a licensed adjuster or
producer and, further, that the licensed adjuster or licensed producer supervises no
more than 25 unlicensed persons; or
3.2.p. A company adjuster employed by an insurer
outside of the state of West Virginia who adjusts claims solely by telephone, fax,
United States mail, and electronic mail, and who does not physically enter this
state in the course of adjusting such claims.
3.3. Notwithstanding any other provisions of this
rule, a public adjuster's license shall not be required of the following:
3.3.a. An attorney-at-law admitted to practice in
this state, when acting in their professional capacity as an attorney;
3.3.b. A person who negotiates or settles claims
arising under a life of health insurance policy or annuity contract;
3.3.c. A person employed only for the purpose of
obtaining facts surrounding a loss or furnishing technical assistance to a licensed
public adjuster;
3.3.d. A licensed
health care provider, or employee of a licensed health care provider, who prepares
or files a health claim form on behalf of a patients; or
3.3.e. A person who settles subrogation claims
between insurers.
3.4. Claims
arising out of a particular loss of unique or unusual character may be adjusted by a
non-licensed adjuster upon registration with the Commissioner as long as the work of
the non-licensed person is supervised by either an adjuster licensed in this state
or an insurance company authorized to do business in this state;
Provided, That the authority to work granted as provided herein to
unlicensed persons is limited to three losses within any twelve month
period.
3.5. A company adjuster who is
exempt from licensing requirements pursuant to section 3.2.p and W.Va. Code §
33-12B-3(a)(15)
is subject to the jurisdiction of, and regulation by, the Commissioner in regard to
his or her adjustment of West Virginia claims. The Commissioner may require such
exempt adjusters to complete continuing education courses, not to exceed 24 hours
per biennium, to address any deficiencies with respect to his or her claims handling
practices.
