reglab/statecodes huggingface dataset:
2023 Utah Code › Title 31A - Insurance Code › Chapter 25 - Third Party Administrators › Part 2 - Licensing of Third Party Administrators › Section 206 - Nonresident jurisdictional agreement.

Effective 5/8/2018
31A-25-206.
Nonresident jurisdictional agreement.
(1)
(a) If a nonresident license applicant has a valid license from the nonresident license applicant's home state or designated home state and the conditions of Subsection (1)(b) are met, the commissioner shall:
(i) waive any license requirement for a license under this chapter; and
(ii) issue the nonresident license applicant a nonresident third party administrator license.
(b) Subsection (1)(a) applies if:
(i) the nonresident license applicant:
(A) is licensed in the nonresident license applicant's home state or designated home state at the time the nonresident license applicant applies for a nonresident third party administrator license;
(B) has submitted the proper request for licensure;
(C) has submitted to the commissioner:
(I) the application for licensure that the nonresident license applicant submitted to the applicant's home state or designated home state; or
(II) a completed uniform application; and
(D) has paid the applicable fees under Section 31A-3-103;
(ii) the nonresident license applicant's license in the applicant's home state or designated home state is in good standing; and
(iii) the nonresident license applicant's home state or designated home state awards nonresident third party administrator licenses to residents of this state on the same basis as this state awards licenses to residents of that home state or designated home state.
(2) A nonresident applicant shall execute in a form acceptable to the commissioner an agreement to be subject to the jurisdiction of the Utah commissioner and courts on any matter related to the applicant's insurance activities in Utah, on the basis of:
(a) service of process under Sections 31A-2-309 and 31A-2-310; or
(b) other service authorized in the Utah Rules of Civil Procedure.
(3) The commissioner may verify the third party administrator's licensing status through the database maintained by:
(a) the National Association of Insurance Commissioners; or
(b) an affiliate or subsidiary of the National Association of Insurance Commissioners.
(4) The commissioner may not assess a greater fee for an insurance license or related service to a person not residing in this state based solely on the fact that the person does not reside in this state.
Amended by Chapter 319, 2018 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 25 - Third Party Administrators › Part 2 - Licensing of Third Party Administrators › Section 207 - Form and contents of license.

31A-25-207.
Form and contents of license.
(1) Licenses issued under this chapter shall be in the form the commissioner prescribes and shall set forth:
(a) the name, address, and telephone number of the licensee;
(b) the date of license issuance; and
(c) any other information the commissioner considers advisable.
(2) A third party administrator doing business under any other name than the administrator's legal name shall notify the commissioner prior to using the assumed name in this state.
(3)
(a) An organization shall be licensed as an agency if the organization acts as a third party administrator.
(b) An agency license issued under Subsection (3)(a) shall set forth the names of all natural persons licensed under this chapter who are authorized to act in those capacities for the organization in this state.
Amended by Chapter 116, 2001 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 25 - Third Party Administrators › Part 2 - Licensing of Third Party Administrators › Section 209 - Probation -- Grounds for revocation.

Effective 5/13/2014
31A-25-209.
Probation -- Grounds for revocation.
(1) The commissioner may place a licensee on probation for a period not to exceed 24 months as follows:
(a) after an adjudicative proceeding under Title 63G, Chapter 4, Administrative Procedures Act, for any circumstances that would justify a suspension under Section 31A-25-208; or
(b) at the issuance of a new license:
(i) with an admitted violation under 18 U.S.C. Sec. 1033; or
(ii) with a response to a background information question on a new license application indicating that:
(A) the person has been convicted of a crime that is listed by rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, as a crime that is grounds for probation;
(B) the person is currently charged with a crime that is listed by rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, as a crime that is grounds for probation regardless of whether adjudication is withheld;
(C) the person has been involved in an administrative proceeding regarding any professional or occupational license; or
(D) any business in which the person is or was an owner, partner, officer, or director has been involved in an administrative proceeding regarding any professional or occupational license.
(2) The commissioner may place a licensee on probation for a specified period no longer than 24 months if the licensee has admitted to a violation under 18 U.S.C. Sec. 1033.
(3) A probation order under this section shall state the conditions for retention of the license, which shall be reasonable.
(4) A violation of the probation is grounds for revocation pursuant to any proceeding authorized under Title 63G, Chapter 4, Administrative Procedures Act.
Amended by Chapter 290, 2014 General Session
Amended by Chapter 300, 2014 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 25 - Third Party Administrators › Part 2 - Licensing of Third Party Administrators › Section 210 - License lapse and voluntary surrender.

31A-25-210.
License lapse and voluntary surrender.
(1)
(a) A license issued under this chapter shall lapse if the licensee fails to:
(i) pay when due a fee under Section 31A-3-103;
(ii) submit a completed renewal application as required by Section 31A-25-202;
(iii) produce, when due, evidence of compliance with the financial responsibility requirement under Section 31A-25-205; or
(iv) maintain an active license in a resident state if the licensee is a nonresident licensee.
(b)
(i) A licensee whose license lapses due to the following may request an action described in Subsection (1)(b)(ii):
(A) military service;
(B) voluntary service for a period of time designated by the person for whom the licensee provides voluntary service; or
(C) some other extenuating circumstances, such as long-term medical disability.
(ii) A licensee described in Subsection (1)(b)(i) may request:
(A) reinstatement of the license no later than one year from the day on which the license lapses; and
(B) waiver of any of the following imposed for failure to comply with renewal procedures:
(I) an examination requirement;
(II) reinstatement fees set under Section 31A-3-103; or
(III) other sanction imposed for failure to comply with renewal procedures.
(2) If a license issued under this chapter is voluntarily surrendered, the license may be reinstated:
(a) during the license period in which the license is voluntarily surrendered; and
(b) no later than one year after the day on which the license is voluntarily surrendered.
Amended by Chapter 349, 2009 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 25 - Third Party Administrators › Part 3 - Administrative Practices › Section 301 - Written agreements required.

31A-25-301.
Written agreements required.
(1) Every third party administrator shall have a written agreement with each insurer and with each group policyholder represented.
(2) The agreements required by Subsection (1) shall contain provisions which include the requirements of this part, except where those requirements are not applicable to the particular functions carried out by the third party administrator.
(3) If a policy is issued to a trustee, a copy of the trust agreement and its amendments shall be furnished to the third party administrator and kept on file in the offices of the third party administrator.
Amended by Chapter 204, 1986 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 25 - Third Party Administrators › Part 3 - Administrative Practices › Section 302 - Books and records required -- Access.

31A-25-302.
Books and records required -- Access.
(1) Any insurer contracting with an administrator for administrator services has the right of continuing access to those records maintained by the third party administrator which permit the insurer to fulfill all of its contractual obligations to insured persons. The proprietary rights of the parties in the records are governed by the written agreement between the insurer and third party administrator.
(2) Every administrator shall maintain at a location accessible to the commissioner, for at least three years, the administrator's written agreements, and complete books and records of all transactions among the administrator, insurers, and insured persons. The books and records shall be maintained in accordance with prudent standards of insurance recordkeeping. The administrator shall provide copies of the books and records to any successor administrator upon request.
(3) The commissioner shall have access to the books and records maintained by the administrator for the purpose of audit and inspection. Any trade secrets contained in the books and records, including the identity and addresses of policyholders and certificate holders, are confidential, except the commissioner may use that information in any proceeding instituted against the administrator.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 25 - Third Party Administrators › Part 3 - Administrative Practices › Section 302.5 - Place of business and residence address.

Effective 5/12/2015
31A-25-302.5.
Place of business and residence address.
(1) A third-party administrator licensed under this chapter shall register and maintain with the commissioner:
(a) the address and one or more telephone numbers of the licensee's principal place of business;
(b) a valid business email address at which the commissioner may contact the licensee; and
(c) if the licensee is an individual, the licensee's residence address and telephone number.
(2) A licensee shall notify the commissioner within 30 days of a change of any of the following required to be registered with the commissioner under this section:
(a) an address;
(b) a telephone number; or
(c) a business email address.
Enacted by Chapter 244, 2015 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 25 - Third Party Administrators › Part 3 - Administrative Practices › Section 303 - Standards pertaining to advertising and underwriting.

31A-25-303.
Standards pertaining to advertising and underwriting.
(1) A third party administrator may use advertising pertaining to the business underwritten by the insurer only to the extent it has been approved in writing by the insurer in advance.
(2) The agreement required under Subsection 31A-25-301(1) shall include a provision on underwriting or other standards pertaining to the business underwritten by the insurer.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 25 - Third Party Administrators › Part 3 - Administrative Practices › Section 304 - Liability of the insurer if administrator receives premium.

31A-25-304.
Liability of the insurer if administrator receives premium.
If an insurer utilizes the services of a third party administrator under the terms of a written agreement, as required under this chapter, the payment to the third party administrator of any premiums for insurance by or on behalf of the insured is considered as having been received by the insurer. However, the payment of return premiums or claims by the insurer to the third party administrator is not payment to the insured or claimant. This chapter does not limit any right of the insurer against a third party administrator resulting from the third party administrator's failure to make payments to the insurer, insureds, or claimants.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 25 - Third Party Administrators › Part 3 - Administrative Practices › Section 305 - Fiduciary requirements for third party administrators.

31A-25-305.
Fiduciary requirements for third party administrators.
(1) All money received by a third party administrator in that capacity shall be held by the third party administrator as a fiduciary. The money shall be paid in a timely manner to the persons entitled to it. While any money is being held by the third party administrator, it shall be deposited promptly in one or more fiduciary bank accounts maintained by the third party administrator pursuant to any rules the commissioner adopts to protect the integrity of the funds.
(2) If premiums deposited in a fiduciary account have been collected on behalf of more than one insurer or more than one class of insureds, the third party administrator shall keep records clearly recording the deposits and withdrawals from the account by or for the benefit of persons beneficially entitled to them, if there are not separate accounts for that purpose. The third party administrator shall furnish the insurer or policyholder with copies of the records pertaining to deposits and withdrawals on behalf of the insurer or policyholder.
(3) The third party administrator may not pay any claim by withdrawals from a fiduciary account. Withdrawals from the account may be made as provided in the written agreement between the third party administrator and the insurer, or between the third party administrator and the policyholders, as required under this chapter, for the following:
(a) remittance to an insurer entitled to the remittance;
(b) deposit in an account maintained in the name of the insurer;
(c) transfer to and deposit in a claims-paying account, with claims to be paid as provided by Section 31A-25-306;
(d) payment to a group policyholder for remittance to the insurer entitled to the remittance;
(e) payment to the third party administrator of its commission, fees, or charges; or
(f) remittance of return premiums to the persons entitled to them.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 25 - Third Party Administrators › Part 3 - Administrative Practices › Section 307 - Delivery by administrator of policies and communications from insurer.

31A-25-307.
Delivery by administrator of policies and communications from insurer.
Any policies, certificates, booklets, termination notices, or other written communications delivered by the insurer to the administrator for delivery to its policyholders shall be delivered by the administrator promptly after receipt of instructions from the insurer to do so.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 25 - Third Party Administrators › Part 4 - Compensation of Third Party Administrators › Section 401 - Compensation not to be contingent on claims expense.

31A-25-401.
Compensation not to be contingent on claims expense.
The compensation paid to a third party administrator for any policies under which the third party administrator adjusts or settles claims may be contingent on claims experience only if the third party administrator discloses to the person whose plan is being administered any conflicts of interest which are present on account of the compensation arrangement.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 25 - Third Party Administrators › Part 4 - Compensation of Third Party Administrators › Section 402 - Notice to insureds regarding administration of policies.

31A-25-402.
Notice to insureds regarding administration of policies.
(1) If the services of a third party administrator are utilized, the third party administrator shall provide a written notice to the insureds, advising them of the identity of and relationship among the third party administrator, the policyholder, and any insurer issuing the policy. This notice shall be approved by the policyholder and by the insurer, if any.
(2) If a third party administrator collects funds, the third party administrator shall identify and state separately in writing to the person paying the administrator the amount of the third party administrator's charge and the premium specified by the insurer for the insurance coverage.
Amended by Chapter 204, 1986 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 1 - General Provisions › Section 101 - Purposes.

31A-26-101.
Purposes.
The purposes of this chapter are:
(1) to promote the professional competence of those engaged in claims adjusting;
(2) to encourage fair and rapid settlement of claims;
(3) to protect claimants under insurance policies from unfair claims adjustment practices;
(4) to prevent compensation arrangements for insurance adjusters that endanger the fairness of claim settlements; and
(5) to govern the qualifications and procedures for the licensing of insurance adjusters.
Amended by Chapter 116, 2001 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 1 - General Provisions › Section 102 - Definitions.

Effective 5/5/2021
31A-26-102.
Definitions.
As used in this chapter, unless expressly provided otherwise:
(1) "Company adjuster" means a person employed by an insurer who negotiates or settles claims on behalf of the insurer or an affiliated insurer.
(2) "Designated home state" means the state or territory of the United States or the District of Columbia:
(a) in which an insurance adjuster does not maintain the adjuster's principal:
(i) place of residence; or
(ii) place of business;
(b) if the resident state, territory, or District of Columbia of the adjuster does not license adjusters for the line of authority sought, the adjuster has qualified for the license as if the person were a resident in the state, territory, or District of Columbia described in Subsection (2)(a), including an applicable:
(i) examination requirement;
(ii) fingerprint background check requirement; and
(iii) continuing education requirement; and
(c) that the adjuster has designated as the insurance adjuster's designated home state.
(3) "Home state" means:
(a) a state or territory of the United States or the District of Columbia in which an insurance adjuster:
(i) maintains the adjuster's principal:
(A) place of residence; or
(B) place of business; and
(ii) is licensed to act as a resident adjuster; or
(b) if the resident state, territory, or the District of Columbia described in Subsection (3)(a) does not license adjusters for the line of authority sought, a state, territory, or the District of Columbia:
(i) in which the adjuster is licensed;
(ii) in which the adjuster is in good standing; and
(iii) that the adjuster has designated as the adjuster's designated home state.
(4) "Independent adjuster" means an insurance adjuster required to be licensed under Section 31A-26-201, who engages in insurance adjusting as a representative of one or more insurers.
(5) "Insurance adjusting" or "adjusting" means directing or conducting the investigation, negotiation, or settlement of a claim under an insurance policy, on behalf of an insurer, policyholder, or a claimant under an insurance policy.
(6)
(a) "Organization" means a person other than a natural person.
(b) "Organization" includes a sole proprietorship by which a natural person does business under an assumed name.
(7) "Portable electronics insurance" means the same as that term is defined in Section 31A-22-1802.
(8) "Public adjuster" means a person required to be licensed under Section 31A-26-201, who engages in insurance adjusting as a representative of insureds and claimants under insurance policies.
Amended by Chapter 252, 2021 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 1 - General Provisions › Section 103 - Workers' compensation claims.

Effective 12/31/2017
31A-26-103.
Workers' compensation claims.
In addition to being subject to this and other chapters of this title, insurers writing workers' compensation insurance in this state are subject to the Labor Commission with respect to claims for and payment of compensation and benefits.
Amended by Chapter 363, 2017 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 2 - Licensing and Registration of Insurance Adjusters › Section 201 - Requirement of license.

31A-26-201.
Requirement of license.
(1) Except as provided in Subsection (2):
(a) a person may not perform, offer to perform, or solicit the opportunity to perform an act of insurance adjusting without a valid license under Section 31A-26-203; and
(b) a person may not use the insurance adjusting services of another if the person knows or should know that the one providing these services does not have a license as required by law.
(2) The following are exempt from the license requirement of Subsection (1), when acting in the indicated capacity:
(a) an individual engaged in insurance adjusting as a regular salaried employee of, and not an independent contractor for, an insurer;
(b) an arbitrator or an umpire selected by the claimant and insurer to decide, alone or with others, whether a claim should be paid and how much should be paid;
(c) an attorney at law acting in an attorney-client relationship;
(d) an insurance producer, but only as to:
(i) a class of insurance for which the insurance producer is licensed under Section 31A-23a-106; and
(ii) a claim adjusted on the request of an insurer for which the insurance producer is a producer;
(e) a regular salaried employee of, and not an independent contractor for, a policyholder or claimant under an insurance policy;
(f) an employee of a licensed insurance adjuster who provides only administrative or clerical assistance;
(g) an individual who does not do insurance adjusting under Section 31A-26-102, but who is specially employed to obtain facts about a loss for or furnish technical assistance to a licensed adjuster or a company adjuster, including:
(i) a photographer;
(ii) an estimator;
(iii) an appraiser;
(iv) a marine surveyor;
(v) a private detective;
(vi) an engineer; and
(vii) a handwriting expert;
(h) a holder of a group insurance policy, with respect to administrative activities in connection with that insurance policy, who receives no compensation for the policyholder's services beyond the actual expenses estimated on a reasonable basis;
(i) an individual engaged in insurance adjusting as a regular salaried employee of, and not an independent contractor for, an administrator licensed under Chapter 25, Third Party Administrators; or
(j) a person who gives advice or assistance without compensation or expectation of compensation, direct or indirect.
(3) A claim settlement between an insurer and an insured or a claimant under an insurance policy may not be considered invalid as a result of a violation of this section.
Amended by Chapter 10, 2010 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 2 - Licensing and Registration of Insurance Adjusters › Section 202 - Application for license.

Effective 5/8/2018
31A-26-202.
Application for license.
(1)
(a) The application for a license as an independent adjuster or public adjuster shall be:
(i) made to the commissioner on forms and in a manner the commissioner prescribes; and
(ii) except as provided in Subsection (4), accompanied by the applicable fee, which is not refunded if the application is denied.
(b) The application shall provide:
(i) information about the applicant's identity, including:
(A) the applicant's:
(I) Social Security number; or
(II) federal employer identification number;
(B) the applicant's personal history, experience, education, and business record;
(C) if the applicant is a natural person, whether the applicant is 18 years of age or older; and
(D) whether the applicant has committed an act that is a ground for denial, suspension, or revocation as set forth in Section 31A-25-208; and
(ii) any other information as the commissioner reasonably requires.
(2) The commissioner may require documents reasonably necessary to verify the information contained in the application.
(3) An applicant's Social Security number contained in an application filed under this section is a private record under Section 63G-2-302.
(4) The following individuals are exempt from paying a license fee:
(a) an individual serving in the armed forces of the United States while the individual is stationed within this state, if:
(i) the individual holds a valid license to practice the regulated occupation or profession issued by any other state or jurisdiction recognized by the department; and
(ii) the license is current and the individual is in good standing in the state or jurisdiction of licensure; and
(b) the spouse of an individual serving in the armed forces of the United States while the individual is stationed within this state, if:
(i) the spouse holds a valid license to practice the regulated occupation or profession issued by any other state or jurisdiction recognized by the department; and
(ii) the license is current and the spouse is in good standing in the state or jurisdiction of licensure.
Amended by Chapter 462, 2018 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 2 - Licensing and Registration of Insurance Adjusters › Section 204 - License classifications.

31A-26-204.
License classifications.
A resident or nonresident license issued under this chapter shall be issued under the classifications described under Subsections (1), (2), and (3). A classification describes the matters to be considered under a prerequisite education or examination required of license applicants under Sections 31A-26-206 and 31A-26-207.
(1) Independent adjuster license classifications include:
(a) accident and health insurance, including related service insurance under Chapter 7, Nonprofit Health Service Insurance Corporations, or Chapter 8, Health Maintenance Organizations and Limited Health Plans;
(b) property and casualty insurance, including a surety or other bond;
(c) crop insurance; and
(d) workers' compensation insurance.
(2) Public adjuster license classifications include:
(a) accident and health insurance, including related service insurance under Chapter 7, Nonprofit Health Service Insurance Corporations, or Chapter 8, Health Maintenance Organizations and Limited Health Plans;
(b) property and casualty insurance, including a surety or other bond;
(c) crop insurance; and
(d) workers' compensation insurance.
(3)
(a) The commissioner may by rule:
(i) recognize other independent adjuster or public adjuster license classifications as to other kinds of insurance not listed under Subsection (1); and
(ii) create license classifications that grant only part of the authority arising under another license class.
(b) Notwithstanding Subsection (3)(a), for purpose of title insurance, the Title and Escrow Commission may make the rules provided for in Subsection (3)(a), subject to Section 31A-2-404.
Amended by Chapter 349, 2009 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 2 - Licensing and Registration of Insurance Adjusters › Section 205 - Character requirements.

Effective 5/8/2018
31A-26-205.
Character requirements.
Each applicant for a license under this chapter shall show to the commissioner that:
(1) the applicant has the good faith intent to engage in the type of business the license or licenses applied for would permit;
(2)
(a) if a natural person, the applicant is:
(i) competent; and
(ii) trustworthy; or
(b) if an organization, all the partners, directors, principal officers, or persons in fact having comparable powers are trustworthy, and that the applicant will transact business in such a way that all acts that may only be performed by a licensed adjuster are performed exclusively by natural persons who are licensed under this chapter to transact that business and listed on the organization's license under Section 31A-26-209; and
(3) if a natural person, the applicant is at least 18 years of age.
Amended by Chapter 319, 2018 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 2 - Licensing and Registration of Insurance Adjusters › Section 207 - Examination requirements.

Effective 5/13/2014
31A-26-207.
Examination requirements.
(1) The commissioner may require applicants for a particular class of license under Section 31A-26-204 to pass an examination as a requirement to receiving a license. The examination shall reasonably relate to the specific license class for which it is prescribed. The examinations may be administered by the commissioner or as specified by rule.
(2) The commissioner shall waive the requirement of an examination for a nonresident applicant who:
(a) applies for an insurance adjuster license in this state;
(b) has been licensed for the same line of authority in another state; and
(c)
(i) is licensed in the state described in Subsection (2)(b) at the time the applicant applies for an insurance producer license in this state; or
(ii) if the application is received within 90 days of the cancellation of the applicant's previous license:
(A) the prior state certifies that at the time of cancellation, the applicant was in good standing in that state; or
(B) the state's producer database records maintained by the National Association of Insurance Commissioners or the National Association of Insurance Commissioner's affiliates or subsidiaries, indicates that the producer is or was licensed in good standing for the line of authority requested.
(3)
(a) To become a resident licensee in accordance with Sections 31A-26-202 and 31A-26-203, a person licensed as an insurance producer in another state who moves to this state shall make application within 90 days of establishing legal residence in this state.
(b) A person who becomes a resident licensee under Subsection (3)(a) may not be required to meet prelicensing education or examination requirements to obtain any line of authority previously held in the prior state unless:
(i) the prior state would require a prior resident of this state to meet the prior state's prelicensing education or examination requirements to become a resident licensee; or
(ii) the commissioner imposes the requirements by rule.
(4) The requirements of this section only apply to an applicant who is a natural person.
(5) The requirements of this section do not apply to:
(a) a member of the Utah State Bar; or
(b) an applicant for the crop insurance license class who has satisfactorily completed:
(i) a national crop adjuster program, as adopted by the commissioner by rule; or
(ii) the loss adjustment training curriculum and competency testing required by the Federal Crop Insurance Corporation Standard Reinsurance Agreement through the Risk Management Agency of the United States Department of Agriculture.
Amended by Chapter 290, 2014 General Session
Amended by Chapter 300, 2014 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 2 - Licensing and Registration of Insurance Adjusters › Section 208 - Nonresident jurisdictional agreement.

Effective 5/8/2018
31A-26-208.
Nonresident jurisdictional agreement.
(1)
(a) If a nonresident license applicant has a valid license from the nonresident license applicant's home state or designated home state and the conditions of Subsection (1)(b) are met, the commissioner shall:
(i) waive any license requirement for a license under this chapter; and
(ii) issue the nonresident license applicant a nonresident adjuster's license.
(b) Subsection (1)(a) applies if:
(i) the nonresident license applicant:
(A) is licensed in the nonresident license applicant's home state or designated home state at the time the nonresident license applicant applies for a nonresident adjuster license;
(B) has submitted the proper request for licensure;
(C) has submitted to the commissioner:
(I) the application for licensure that the nonresident license applicant submitted to the applicant's home state or designated home state; or
(II) a completed uniform application; and
(D) has paid the applicable fees under Section 31A-3-103;
(ii) the nonresident license applicant's license in the applicant's home state or designated home state is in good standing; and
(iii) the nonresident license applicant's home state or designated home state awards nonresident adjuster licenses to residents of this state on the same basis as this state awards licenses to residents of that home state or designated home state.
(2) A nonresident applicant shall execute in a form acceptable to the commissioner an agreement to be subject to the jurisdiction of the commissioner and courts of this state on any matter related to the adjuster's insurance activities in this state, on the basis of:
(a) service of process under Sections 31A-2-309 and 31A-2-310; or
(b) other service authorized under the Utah Rules of Civil Procedure or Section 78B-3-206.
(3) The commissioner may verify an adjuster's licensing status through the database maintained by:
(a) the National Association of Insurance Commissioners; or
(b) an affiliate or subsidiary of the National Association of Insurance Commissioners.
(4) The commissioner may not assess a greater fee for an insurance license or related service to a person not residing in this state based solely on the fact that the person does not reside in this state.
Amended by Chapter 319, 2018 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 2 - Licensing and Registration of Insurance Adjusters › Section 209 - Form and contents of license.

Effective 5/9/2017
31A-26-209.
Form and contents of license.
(1) Licenses issued under this chapter shall be in the form the commissioner prescribes and shall set forth:
(a) the name, address, and the one or more telephone numbers of the licensee;
(b) the license classifications under Section 31A-26-204;
(c) the date of license issuance; and
(d) any other information the commissioner considers advisable.
(2) An adjuster doing business under any other name than the adjuster's legal name shall notify the commissioner prior to using the assumed name in this state.
(3)
(a) An organization shall be licensed as an agency if the organization acts as:
(i) an independent adjuster; or
(ii) a public adjuster.
(b) The agency license issued under Subsection (3)(a) shall set forth the names of all natural persons licensed under this chapter who are authorized to act in those capacities for the organization in this state.
Amended by Chapter 168, 2017 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 2 - Licensing and Registration of Insurance Adjusters › Section 211 - Claims liaison.

31A-26-211.
Claims liaison.
Authorized insurers with employees engaged in insurance adjusting may be required by the commissioner to designate one or more natural persons to whom the commissioner or his staff may direct inquiries concerning the insurer's claims adjustments. Insurers shall report to the commissioner the name, title, business address, telephone number of, and any changes in its designees under this section.
Amended by Chapter 204, 1986 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 2 - Licensing and Registration of Insurance Adjusters › Section 212 - Emergency license.

31A-26-212.
Emergency license.
In the event of a catastrophe or emergency which arises out of a disaster, act of God, riot, civil commotion, conflagration, or other similar occurrence, the commissioner shall, upon application, issue emergency licenses to persons who are not licensed adjusters. An emergency license shall be applied for within a week of beginning claims adjustment. It may remain in force for not more than 90 days, unless extended by the commissioner before it expires for an additional period of not more than 90 additional days. The insurer who contracts with an independent adjuster who is so licensed is responsible for all his claims practices while so engaged, as if he were a regular salaried employee. The fee for an emergency license is the same as the fee required of other licensed adjusters, unless the commissioner waives the fee.
Enacted by Chapter 242, 1985 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 2 - Licensing and Registration of Insurance Adjusters › Section 214 - Probation -- Grounds for revocation.

Effective 5/13/2014
31A-26-214.
Probation -- Grounds for revocation.
(1) The commissioner may place a licensee on probation for a period not to exceed 24 months as follows:
(a) after an adjudicative proceeding under Title 63G, Chapter 4, Administrative Procedures Act, for any circumstances that would justify a suspension under Section 31A-26-213; or
(b) at the issuance of a new license:
(i) with an admitted violation under 18 U.S.C. Sec. 1033; or
(ii) with a response to a background information question on any new license application indicating that:
(A) the person has been convicted of a crime, that is listed by rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, as a crime that is grounds for probation;
(B) the person is currently charged with a crime, that is listed by rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, as a crime that is grounds for probation regardless of whether adjudication was withheld;
(C) the person has been involved in an administrative proceeding regarding any professional or occupational license; or
(D) any business in which the person is or was an owner, partner, officer, or director has been involved in an administrative proceeding regarding any professional or occupational license.
(2) The commissioner may put a licensee on probation for a specified period no longer than 24 months if the licensee has admitted to violations under 18 U.S.C. Sec. 1033.
(3) A probation order under this section shall state the conditions for retention of the license, which shall be reasonable.
(4) A violation of the probation is grounds for revocation pursuant to any proceeding authorized under Title 63G, Chapter 4, Administrative Procedures Act.
Amended by Chapter 290, 2014 General Session
Amended by Chapter 300, 2014 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 2 - Licensing and Registration of Insurance Adjusters › Section 214.5 - License lapse and voluntary surrender.

Effective 5/13/2014
31A-26-214.5.
License lapse and voluntary surrender.
(1)
(a) A license issued under this chapter shall lapse if the licensee fails to:
(i) pay when due a fee under Section 31A-3-103;
(ii) complete continuing education requirements under Section 31A-26-206 before submitting the license renewal application;
(iii) submit a completed renewal application as required by Section 31A-26-202;
(iv) submit additional documentation required to complete the licensing process as related to a specific license type or license classification; or
(v) maintain an active license in the licensee's home state if the licensee is a nonresident licensee.
(b)
(i) A licensee whose license lapses due to the following may request an action described in Subsection (1)(b)(ii):
(A) military service;
(B) voluntary service for a period of time designated by the person for whom the licensee provides voluntary service; or
(C) some other extenuating circumstances, such as long-term medical disability.
(ii) A licensee described in Subsection (1)(b)(i) may request:
(A) reinstatement of the license no later than one year after the day on which the license lapses; and
(B) waiver of any of the following imposed for failure to comply with renewal procedures:
(I) an examination requirement;
(II) reinstatement fees set under Section 31A-3-103;
(III) continuing education requirements; or
(IV) other sanction imposed for failure to comply with renewal procedures.
(2) If a license issued under this chapter is voluntarily surrendered, the license may be reinstated:
(a) during the license period in which it is voluntarily surrendered; and
(b) no later than one year after the day on which the license is voluntarily surrendered.
Amended by Chapter 290, 2014 General Session
Amended by Chapter 300, 2014 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 2 - Licensing and Registration of Insurance Adjusters › Section 216 - Portable electronics adjusting.

31A-26-216.
Portable electronics adjusting.
(1) As used in this section, "automated claims adjudication system" means a preprogrammed computer system designed for the collection, data entry, calculation, and final resolution of a portable electronics insurance claim that:
(a) may only be used by a Utah licensed independent adjuster, a Utah licensed producer, or an individual supervised as provided in this section;
(b) complies with the claims payment requirements of this title; and
(c) is certified as compliant with this section by a Utah licensed independent adjuster that is an officer of an organization licensed under this chapter.
(2) An individual is exempt from licensure as an adjuster, if the individual for purposes of a portable electronics insurance claim:
(a) collects claim information from, or furnishes claim information to, insureds or claimants;
(b) conducts data entry, including entering data into an automated claims adjudication system;
(c) is an employee of a licensed independent adjuster or its affiliate; and
(d) is one of no more than 25 individuals who are under the supervision of:
(i) a Utah licensed independent adjuster; or
(ii) a Utah licensed producer who is exempt from licensure pursuant to Section 31A-26-201.
Enacted by Chapter 151, 2012 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 3 - Claim Practices › Section 301 - Timely payment of claims.

31A-26-301.
Timely payment of claims.
(1)
(a) Unless otherwise provided by law, an insurer shall timely pay every valid insurance claim made by an insured.
(b) By rule the commissioner may prescribe:
(i) the kinds of notice and proof of loss that will establish validity;
(ii) the manner in which an insurer may make a bona fide denial of a claim;
(iii) the periods of time within which payment is required to be made to be timely; and
(iv) the reasonable interest rates to be charged upon late claim payments.
(2)
(a) Notwithstanding Subsection (1) and subject to Subsection (2)(b), the payment of a claim is not overdue during any period in which:
(i) the insurer is unable to pay the claim because there is no recipient legally able to give a valid release for the payment; or
(ii) the insurer is unable to determine who is entitled to receive the payment.
(b) Subsection (2)(a) applies only if the insurer:
(i) promptly notifies the claimant of the inability to pay the claim; and
(ii) offers in good faith to pay the claim promptly when the inability to pay the claim is removed.
(3) This section applies only to a claim for first party benefits made by a person who is:
(a) named or defined as an insured under the terms of an insurance policy;
(b) described as a covered person under the terms of a policy of health care insurance as defined in Section 31A-1-301; or
(c) named, defined, or described:
(i) as:
(A) an insured;
(B) a beneficiary;
(C) a policyholder; or
(D) otherwise covered person; and
(ii) under the terms of:
(A) a life insurance policy; or
(B) an annuity.
Amended by Chapter 309, 2002 General Session
2023 Utah Code › Title 31A - Insurance Code › Chapter 26 - Insurance Adjusters › Part 3 - Claim Practices › Section 301.5 - Health care claims practices.

Effective 5/8/2018
31A-26-301.5.
Health care claims practices.
(1)
(a) Except as provided in Section 31A-8-407, an insured retains ultimate responsibility for paying for health care services the insured receives.
(b) If a health care service is covered by one or more individual or group health insurance policies, all insurers covering the insured have the responsibility to pay valid health care claims in a timely manner according to the terms and limits specified in the policies.
(2) A health care provider may:
(a) except as provided in Section 31A-22-610.1, bill and collect for any deductible, copayment, or uncovered service; and
(b) bill an insured for services covered by health insurance policies or otherwise notify the insured of the expenses covered by the policies.
(3) Beginning October 31, 1992, all insurers covering the insured shall notify the insured of payment and the amount of payment made to the health care provider.
(4) A health care provider shall return to an insured any amount the insured overpaid, including interest that begins accruing 90 days after the date of the overpayment, if:
(a) the insured has multiple insurers with whom the health care provider has contracts that cover the insured; and
(b) the health care provider becomes aware that the health care provider has received, for any reason, payment for a claim in an amount greater than the health care provider's contracted rate allows.
(5)
(a) The commissioner shall make rules consistent with this chapter governing disclosure to the insured of customary charges by health care providers on the explanation of benefits as part of the claims payment process.
(b) These rules shall be limited to the form and content of the disclosures on the explanation of benefits, and shall include:
(i) a requirement that the method of determination of any specifically referenced customary charges and the range of the customary charges be disclosed; and
(ii) a prohibition against an implication that the health care provider is charging excessively if the health care provider is:
(A) a participating provider; and
(B) prohibited from balance billing.
Amended by Chapter 203, 2018 General Session