Short title

This Act may be cited as the

Claims Licensing Advancement for Interstate Matters Act

or the

CLAIM Act

Model licensing act

To promote the policy of robust consumer protection for and more efficient interstate adjusting of property, casualty, disability, or workers’ compensation claims, the Congress hereby urges the National Association of Insurance Commissioners to adopt a model independent claims adjuster licensing Act that— (1)contains basic standards for the integrity, personal qualifications, education, training, and experience required of independent claims adjusters, including continuing education requirements and ethics course requirements; and (2)does not impose any limitation or condition upon any independent claims adjuster to be licensed or otherwise authorized to do business in a State because of his or her status as a non-resident of that State.

Multi-State examination

(a)

Establishment

The Congress hereby urges the NAIC to adopt and administer a multi-State examination for an independent claims adjuster seeking to adjust claims in a jurisdiction other than his or her home State. (b)

Examinee eligibility

The NAIC may require that, as a condition for taking a multi-State examination administered pursuant to this section, the examinee shall— (1)be duly licensed as an independent claims adjuster by his or her home State; (2)meet such integrity, degree, training, and experience requirements as the NAIC considers necessary; and (3)meet any continuing education requirements as established by his or her home State. (c)

Cross-Jurisdiction competency

Any multi-State examination administered pursuant to this section shall require adjusters to demonstrate essential competence with cross-jurisdictional legal and regulatory concepts, and shall include such ethics and other testing as the NAIC deems necessary.

State authorities

Nothing in this Act shall be construed to— (1)require a State that does not have licensing requirements for independent claims adjusters to adopt any such requirements; (2)subject to section 6, limit the right of a State to establish licensing fees or enforce its laws regarding the adjusting of insurance claims, provided that such fee is uniform regardless of the State of residence of the licensee; or (3)affect the jurisdiction and authority of a State insurance regulator to prescribe and enforce its insurance laws, rules, and regulations regulating independent claims adjuster activity in its jurisdiction.

Interstate claims adjusting licensing reforms

(a)

In general

A State is in compliance with the requirements of this subsection, and section 6 shall not apply with respect to such State, if before the expiration of the 4-year period beginning on the date of the enactment of this Act the State has enacted and has in effect— (1)in the case only of a State that requires and issues licenses for independent claims adjusters, laws and regulations governing individuals and entities authorized to operate as independent claims adjusters within the State that are functionally equivalent in meaning and effect to those under any model act developed pursuant to section 2; and (2)laws and regulations governing non-home State individuals and entities operating as independent claims adjusters within that State that provide for the reciprocity required under subsection (c) with other States. (b)

Uniformity requirements

A State that licenses independent claims adjusters shall be deemed to have established the uniformity referred to in subsection (a)(1) if it has enacted and adheres to criteria for the licensing and authorization of adjusters that are functionally equivalent in meaning and effect to those set forth in a model act established pursuant to section 2. (c)

Reciprocity requirements

The laws and regulations of a certain State shall be considered to provide for the reciprocity required under this subsection only if such laws and regulations— (1)do not require licensure of independent claims adjusters; or (2)permit any independent claims adjuster who has a license in another State that is the adjuster’s home State to obtain authorization to engage in the business of adjusting in such certain State as a non-resident to the same extent that such adjuster is permitted to practice in the adjuster’s home State, without satisfying any additional requirements other than, if required under applicable law, to submit— (A)proof of being licensed in good standing in the adjuster’s home State; Provided, That such home State has enacted laws and regulations governing individuals and entities authorized to operate as independent claims adjusters within such home State that are functionally equivalent in meaning and effect to those under any model act developed pursuant to section 2; and (B)payment of any requisite fee to the appropriate authority of the certain State; Provided, That the amount of such fee does not exceed any fee required to be paid by an adjuster whose home State is such certain State. (d)

NAIC determination

(1)

Determination

A State shall be considered to be in compliance with subsection (a) for purposes of this Act if the NAIC determines that, before the expiration of the 4-year period beginning on the date of enactment of this Act, the State is in compliance with the requirements under such subsection. (2)

Continued review

With respect to any State that the NAIC has determined to be in compliance with the requirements of subsection (a), the Congress hereby urges NAIC to continue to review and determine such State’s compliance with the requirements of subsection (a) on an annual basis. If the NAIC determines at any time that a State no longer is in compliance with the requirements of subsection (a), section 6 shall apply with respect to such State. (3)

Judicial review

The appropriate United States District Court shall have exclusive jurisdiction over any challenge arising under this section. The court shall apply the standards set forth in section 706 of title 5, United States Code, in reviewing any such challenge.

Authority for interstate claims adjusting

(a)

Authority

In the case of any State that requires and issues licenses for independent claims adjusters but is not in compliance with section 5(a), after the expiration of the 4-year period beginning on the date of the enactment of this Act, an independent claims adjuster and the adjuster’s employer may ascertain, determine, negotiate, or settle a claim in such State, but only if the adjuster meets the following requirements: (1)The independent claims adjuster holds a valid such license in his or her home State. (2)If the NAIC has established and administers a multi-State examination pursuant to section 3, the adjuster has passed such examination. (b)

Prohibition of additional State requirements

An independent claims adjuster authorized under subsection (a) to investigate, evaluate, negotiate the resolution of a claim in a State that is not in compliance with section 5 shall not be subject to any additional licensure or other requirements from such State in order to adjust claims and otherwise act as an independent claims adjuster in such State.

Accelerating claims adjusting of losses caused by natural or other disasters

(a)

Authority to adjust

An independent claims adjuster meeting the requirements of subsection (b) may adjust claims for losses related to any natural or other disaster, occurring in any jurisdiction, that has been designated by the President as a major disaster pursuant to section 401 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5170) notwithstanding the licensure requirements of the State in which the disaster area for the major disaster is located and notwithstanding the requirements under section 6 of this Act for interstate claims licensing. (b)

Adjuster requirements

The requirements under this subsection with respect to an independent claims adjuster are as follows: (1)

State license

The adjuster holds a valid license as an independent claims adjuster in his or her home State (whether actual or designated, pursuant to section 8(a)(1)). (2)

Multi-state examination

If the NAIC has adopted and administers a multi-State examination pursuant to section 3, the adjuster has passed such an examination.

Definitions

For purposes of this Act, the following definitions shall apply: (1)

Home State

(A)

Actual

The term home State means, with respect to an independent claims adjuster, the State in which the adjuster maintains his, her, or its principal place of residence or business and is licensed as an independent claims adjuster. (B)

Designated

If the State in which an independent claims adjuster maintains his or her principal place of residence or business does not issue an independent claims adjuster license for the line or lines of authority sought, such term means any other State in which the independent claims adjuster is so licensed and that is designated by such adjuster as his or her home State. (2)

Independent claims adjuster

The term independent claims adjuster means an individual, other than a public adjuster, who undertakes on behalf of insurers or self-insurers to investigate, evaluate, and negotiate the resolution of the amount of a property, casualty, disability, or workers’ compensation claim, loss, or damage on behalf of an insurance policy or insurer or as a third-party on behalf of a self-insurer. Such term includes company or staff adjusters, who are individuals, other than a public adjuster, employed by property casualty insurers and undertake to investigate, evaluate, and negotiate the resolution of a property, casualty, disability, or workers’ compensation claim, loss, or damage on behalf of an insurance policy or insurer. (3)

Naic

The term NAIC means the National Association of Insurance Commissioners. (4)

Public adjuster

The term public adjuster means any person who, for compensation or any other thing of value, on behalf of the insured acts, aids, advertises, or solicits business to ascertain, determine, negotiate, or settle the amount of a claim, loss, or damage, solely in relation to first party claims arising under contracts that insure the real or personal property of the insured. (5)

State

The term State means the States of the United States, the District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, Guam, the Virgin Islands, American Samoa, and any other territory or possession of the United States. (6)

State law

The term State law includes all laws, decisions, rules, regulations, or other State action of any State having the effect of law; and a law of the United States applicable only to the District of Columbia shall be treated as a State law rather than as a law of the United States.