New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter II - Agents, Brokers And Adjusters › Part 25 - Public Adjusters › Section 25.13 - Exhibits

Current through Register Vol. 46, No. 28, July 10, 2024
The following forms are hereby approved for use as specified
				  in this Part:
(a) Form 1.
PUBLIC ADJUSTER
COMPENSATION AGREEMENT
[Name and Address of Public Adjuster]
_________________________
Name of sublicensee
Date of initial contact: __________________ Time of initial
				  contact: ___________________
(Number) disclosure statements are attached hereto.
NOTICE TO INSURED
1.
				The Adjuster may not receive any compensation unless the Adjuster discloses the
				compensation to you.
2. The
				Adjuster may not charge you any fees that total more than 12.5% of the recovery
				for services rendered by the Adjuster, except that the Adjuster may charge a
				fee of up to 20% on a supplemental claim if the aggregate fee charged is less
				than or equal to 12.5% of the full claim payment. A supplemental claim is a
				claim made to an insurer in a situation in which you did not retain a public
				adjuster when you made an initial claim, the insurer made a payment to you, and
				then you retained a public adjuster to prove the amount of the loss and extent
				of the loss and not the cause of the loss.
A.
				The limit on the total fees that may be charged includes services rendered by
				an outside expert or consultant retained or employed by the Adjuster that
				directly relate to the adjusting function of the Adjuster.
B. The limit on total fees also includes any
				referral of an individual or entity for services, work, or repairs relating to
				any insurance claim for which the Adjuster represents or represented you or has
				negotiated or effected a settlement.
C. If the Adjuster refers you to an
				individual or entity, including after you sign this compensation agreement,
				then the Adjuster must obtain an acknowledged disclosure statement from you at
				the time of the referral.
D. YOU
				ARE NOT REQUIRED TO USE ANY INDIVIDUAL OR ENTITY TO WHOM OR WHICH THE ADJUSTER
				REFERS YOU.
3. The
				Adjuster must compute the fee based upon any monies paid by the insurer for any
				insurance claim for which the public adjuster represents or represented you or
				has negotiated or effected a settlement, after you have retained the Adjuster's
				services.
4. The fee to be charged
				under this compensation agreement may be negotiated between the parties for
				less than 12.5%, or with regard to a supplemental claim, for less than 20%. You
				should discuss the amount of the fee with the Adjuster before signing any
				compensation agreement. You must initial the amount upon which you have
				agreed.
5. This compensation
				agreement is valid only if both this agreement and the attached notice of
				cancellation are written in the same language as that principally used in the
				oral negotiations and presentation.
6. You may cancel this compensation agreement
				at any time prior to midnight of the third business day after you signed this
				compensation agreement. Please read the attached "Notice of Cancellation" form
				for an explanation of this right.
_____________________ _______________________
Signature of Public Adjuster Signature of Named
				  Insured(s)
or Licensed Representative Thereof
Date: _________________ Time:
				  _________________