Public Adjuster Release Form for the United States

Public Adjuster Release Form Template for United States

A Public Adjuster Release Form is a legal document used in the United States that formally terminates the professional relationship between a licensed public adjuster and their client (the insured party) upon completion of insurance claim services. This document confirms that all agreed-upon services have been rendered, fees have been paid, and releases the public adjuster from any further obligations or potential claims related to their services. The document must comply with state-specific insurance regulations and often requires specific disclosures as mandated by state insurance departments.

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What is a Public Adjuster Release Form?

The Public Adjuster Release Form serves as a crucial closing document in the insurance claims process. It is typically used when a public adjuster has successfully completed their contracted services in negotiating an insurance claim settlement on behalf of the insured. This document, which must comply with U.S. state insurance regulations, provides legal protection for both parties by clearly documenting the completion of services, confirmation of payment, and mutual agreement to terminate the professional relationship. It includes essential details such as claim information, compensation details, and relevant dates, while ensuring all state-mandated disclosures are properly addressed.

What sections should be included in a Public Adjuster Release Form?

1. Parties: Identification of the public adjuster and the insured party, including full legal names and contact information

2. Background: Brief description of the insurance claim event and the engagement of the public adjuster

3. Definitions: Key terms used in the release form including 'Claim', 'Services', 'Settlement Amount', and 'Release Period'

4. Claim Information: Detailed information about the insurance claim including policy number, date of loss, and type of claim

5. Release Statement: Formal declaration releasing the public adjuster from all claims, demands, and causes of action related to the adjustment services

6. Compensation Confirmation: Confirmation of fees paid and statement that all financial obligations have been satisfied

7. Execution: Signature block with date and notary section where required by state law

What sections are optional to include in a Public Adjuster Release Form?

1. Scope of Services: Detailed outline of all services provided by the public adjuster during the claim process, recommended for complex claims

2. Dispute Resolution: Procedures for handling any future disputes between parties, including jurisdiction and applicable law

3. Confidentiality: Terms regarding the confidentiality of claim details and settlement information

4. State-Specific Disclosures: Additional disclosures or statements required by specific state insurance regulations

What schedules should be included in a Public Adjuster Release Form?

1. Schedule A - Claim Documentation: List of all relevant claim documents, correspondence, and evidence handled during the adjustment process

2. Schedule B - Fee Calculation: Detailed breakdown of public adjuster fees, expenses, and payment records

3. Schedule C - Settlement Statement: Copy of the final settlement statement from the insurance company showing the total claim amount

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Jurisdiction

United States

Publisher

Genie AI

Cost

Free to use
Industries

State-Specific Insurance Laws: Individual state requirements for public adjuster licensing, contracts, release forms, and mandatory disclosures. Each state has its own regulatory framework for insurance matters.

Fair Claims Settlement Practices Act: Federal legislation that sets standards for the fair handling and settlement of insurance claims, which must be considered in public adjuster agreements.

Consumer Protection Laws: Federal and state laws designed to protect consumers from unfair practices in business transactions, including insurance adjusting services.

Privacy Laws (GLBA): The Gramm-Leach-Bliley Act and related privacy regulations governing the handling of personal financial information in the insurance industry.

State Insurance Department Regulations: Specific requirements set by state insurance departments regarding public adjuster contracts, including fee limitations, required disclosures, cooling-off periods, and cancellation rights.

Fee Percentage Regulations: State-specific limitations on maximum fee percentages that public adjusters can charge for their services.

Timing Restrictions: State-mandated restrictions on when public adjusters can solicit business after a loss occurs.

NAPIA Guidelines: Professional standards and guidelines established by the National Association of Public Insurance Adjusters for ethical practice and contract requirements.

Contract Law Fundamentals: Basic contract law principles including consideration, capacity to contract, clear terms and conditions, and mutual understanding between parties.

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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