West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-25 - Insurance Adjusters › Section 114-25-3 - License Requirements

Current through Register Vol. XLI, No. 28, July 12, 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.