2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 13 - Adjusters › Section 59A-13-2 - Definitions.

A. For the purposes of Chapter 59A, Article 13 NMSA 1978:
(1) "adjuster" means a person that:
(a) investigates, negotiates, settles or adjusts a loss or claim arising under an insurance contract on behalf of an insurer, insured or self-insurer, for a fee, commission or other compensation; however, an adjuster acting on behalf of an insured shall not investigate, negotiate, settle or adjust a claim involving personal injury to the insured; and
(b) advises the insured of the insured's rights to settlement and the insured's rights to settle, arbitrate and litigate the dispute;
(2) "automated claims adjudication system" means a preprogrammed computer system designed for the collection, data entry, calculation and final resolution of portable electronics insurance claims that shall:
(a) only be used by a licensed independent adjuster, licensed agent or supervised individuals operating pursuant to Subsection C of Section 59A-13-3 NMSA 1978;
(b) comply with all claims payment requirements of the Insurance Code [Chapter 59A NMSA 1978]; and
(c) be certified as compliant with the Portable Electronics Insurance Act [59A-60-1 to 59A-60-7 NMSA 1978] by a licensed independent adjuster who is an officer of a licensed business entity pursuant to the Insurance Code;
(3) "business entity" means a corporation, association, partnership, limited liability company, limited liability partnership or other legal entity;
(4) "home state" means the District of Columbia and any state or territory of the United States in which the adjuster's principal place of residence or principal place of business is located. If neither the state in which the adjuster maintains the principal place of residence nor the state in which the adjuster maintains the principal place of business has substantially similar laws governing adjusters, the adjuster may declare another state in which it becomes licensed and acts as an adjuster to be the home state;
(5) "independent adjuster" means an adjuster who is not a staff adjuster or a public adjuster and includes a representative and an employee of an independent adjuster;
(6) "public adjuster" means an adjuster who acts or aids, solely in relation to first-party claims arising under insurance contracts that insure the real or personal property of the insured, on behalf of an insured in negotiating for, or effecting the settlement of, a claim for loss or damage covered by an insurance contract;
(7) "resident adjuster" means an adjuster who resides principally in New Mexico and who conducts business primarily in New Mexico; and
(8) "staff adjuster" means an adjuster individual who is a salaried employee of an insurer or affiliate of the employer insurer, representing and adjusting claims solely under the authority of the employer insurer.
B. Except as otherwise provided, "adjuster" does not include:
(1) an attorney-at-law who adjusts insurance losses or claims from time to time incidental to practice of law and who does not advertise or represent as an adjuster;
(2) a licensed agent or general agent of an authorized insurer or an employee of an agent or general agent who adjusts claims or losses under specific authority from the insurer and solely under policies issued by the insurer;
(3) an agent or employee of a life or health insurer who adjusts claims or losses under the insurer's policies or contracts to administer policies or benefits of that type;
(4) a salaried or part-time claims agent or investigator employed by a self-insured person;
(5) an individual who, for purposes of portable electronics insurance claims, collects claim information from, or furnishes claim information to, insureds or claimants, and who conducts data entry, including entering data into an automated claims adjudication system; provided that the individual is an employee of a licensed independent adjuster or its affiliate where no more than twenty-five such persons are under the supervision of one licensed independent adjuster or licensed agent who is exempt from licensure pursuant to Paragraph (2) of this subsection;
(6) a property damage appraiser or other individual who is employed by an insurer, third-party administrator, independent adjuster or self-insurer who inspects and provides monetary estimates of damages sustained by an insured or third party and does not investigate, negotiate, settle or adjust claims;
(7) a person who is employed solely for the purpose of obtaining facts surrounding a loss or furnishing technical assistance to an adjuster, such as a photographer, estimator, private investigator, engineer or handwriting expert;
(8) a licensed health care provider or employee of a licensed health care provider who prepares or files a health claim on behalf of a patient;
(9) a person who settles subrogation claims between insurers;
(10) a person who is employed to investigate suspected fraudulent insurance claims but does not adjust losses or determine claim payments; or
(11) an employee of an insurer who receives loss reports from insureds and who may advise an insured regarding the claim process or coverage available to the insured but who does not act as an adjuster on the claim.
History:
Laws 1984, ch. 127, § 230; 1989, ch. 274, § 1; 2003, ch. 306, § 6; 2007, ch. 282, § 8; 2011, ch. 127, § 8; 2013, ch. 140, § 11; 2017, ch. 76, § 1.
ANNOTATIONS
The 2017 amendment,
effective June 16, 2017, clarified that the definitions of the listed terms were for the purposes of Chapter 59A, Article 13 NMSA 1978, added definitions for "business entity", "home state", and "public adjuster", revised the definitions of "staff adjuster" and "independent adjuster", and added exceptions to the definition of "adjuster"; in Subsection A, in the introductory clause, after "purposes of", deleted "the Insurance Code" and added "Chapter 59A, Article 13 NMSA 1978", deleted former Paragraph A(3), added new Paragraphs A(3) and A(4), and redesignated former Paragraph A(4) as Paragraph A(5), in Paragraph A(5), after "staff adjuster", added "or a public adjuster", added Paragraph A(6) and redesignated former Paragraph A(5) as Paragraph A(7), and added Paragraph A(8); and in Subsection B, at the end of Paragraph B(4), deleted "or", and added Paragraphs B(6) through B(11).
The 2013 amendment,
effective July 1, 2013, defined "automated claims adjudication system" and modified the definition of "adjustor", added Paragraph (2) of Subsection A; and added Paragraph (5) of Subsection B.
The 2011 amendment,
effective July 1, 2011, added a definition of "resident adjuster".
The 2007 amendment,
effective June 15, 2007, defined "staff adjuster" to include affiliates of the employer insurer.
The 2003 amendment,
effective June 20, 2003 added "that" at the end of Subsection A(1); deleted "who or which" at the beginning of Subsection A(1)(a); substituted "otherwise provided" for "provided hereafter" near the beginning of Subsection B; inserted "or contracts to administer policies or benefits of that type" following "insurer's policies" near the end of Subsection B(3); and substituted "person" for "persons subject to regulation pursuant to Section 7, Article 11 of the constitution of New Mexico" at the end of Subsection B(4).
An attorney who represents an insurer in an arbitration proceeding
with the insured is not an adjuster and is not liable for direct violations of the Trade Practices and Frauds Act.
Durham v. Guest
, 2007-NMCA-144, 142 N.M. 817, 171 P.3d 756,
rev'd on other grounds
, 2009-NMSC-007, 145 N.M. 694, 204 P.3d 19.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
44 Am. Jur. 2d Insurance §§ 1701, 1702.