Thanks to the wide variation in state adjuster licensing regulations, carriers, agencies, and TPAs that maintain an adjuster force to review medical and life insurance claims may have their work cut out in maintaining compliance for staff and independent adjusters.
While many of these complaints are relevant to adjusters of all stripes, life and health adjusters, who tend to work as staff or independent adjusters, will face some particular hurdles.
1. Not all states require licenses for adjusters
A few states don’t license adjusters at all. Many more only license public adjusters. If you’re working as an adjuster in a state (or states) that don’t require independent adjusters or staff adjusters (also known as company adjusters) to have a license, then, hey, fantastic, no need to bother with it. Most states, though, do require some kind of licensure for adjusters, although this can be vague and complex because…
2. Most states license independent adjusters and don’t license staff adjusters
Most state DOIs require licenses for independent adjusters, so you’ll need to verify licensing for your external adjuster force, but an internal adjuster that’s examining medical claims against policy coverage may not need a license. Again, this depends on the states your adjusters are processing claims in. But (there’s almost always a but(t) in insurance)…
3. 16 states require staff or company adjusters to maintain a license
There are 16 states that require staff or company adjusters to maintain a license, complete with taking an exam. Now, pleasantly, all 16 states are reciprocal for licenses with each other, but this still presents a bit of a hiccup for your external and internal life or health adjusters depending on their resident state because…
4. States that require staff or independent adjuster licensing might require nonresidents to maintain designated home state (DHS) licenses
A designated home state license, or DHS license, is an adjuster license that essentially establishes a state other than an adjuster’s proper resident state as their “home state” for the purposes of reciprocity. So, if you have life and health staff adjusters from a state that doesn’t have a staff adjuster license available, then you may want to direct your adjusters to one of the 16 states with staff adjuster licenses. There, they can take the state adjuster exam and use it as their DHS, unless…
5. An adjuster’s resident state offers a broader adjuster license that might be used for reciprocity
Georgia and North Carolina, among others, offer general adjuster licenses that aren’t specific to a company adjuster, staff adjuster, or independent adjuster license type. So, historically, staff adjusters from these states have gone to a state like Florida to procure a DHS license. Yet, even after taking the exam and paying the fees to get their DHS in those states, other states that require a staff adjuster license may not accept your adjusters’ DHS licenses if they could be licensed as generic adjusters in their resident state.
So, if you’ve figured out how to navigate which states are reciprocal to your adjusters’ resident or DHS licensing, then fantastic. You’re in the clear. All good on compliance, except that…
6. Some states don’t recognize any adjuster reciprocity
New York, California, and Hawaii are among those that don’t recognize reciprocity for other states’ exams. In turn, other states don’t accept these states’ exams. For independent adjusters in particular, this means that having a resident state license isn’t much help in being able to work in other states’ markets. So, if you’re responsible for life and health adjuster licensing, this would lead you to believe your external adjusters who are residents of nonreciprocal states need to take exams in their resident states and have an exam and DHS in other states, with the catch that…
7. Some states only recognize and prioritize one exam
Some states will only allow you to really report one exam, and give priority to your resident state. For independent adjusters who are residents of New York, Hawaii, or California, that gets dicey – priority for a resident license that isn’t reciprocal sounds nightmarish.
And that’s all not to mention other nuances and variations in adjuster licensing. For instance, some states require a staff adjuster to hold an appointment with a carrier in the state in order for their license to be effective. Renewal dates may be triennial, biennial, or annual, and may be fixed calendar dates or based on the adjuster’s birthday. State idiosyncrasies make adjuster licensing chaotic for even the most organized of offices.
So, what’s an adjuster compliance specialist to do?
4 Ways to Make Compliance Easier
1. Set clear expectations for life and health adjusters about the jurisdictions your business is processing claims in
These variations take a “look before you leap” mentality. Perhaps you’re working only in states that don’t require a license. Or maybe you’re specializing in territories that recognize each others’ reciprocity.
Regardless, giving life and health adjusters a straightforward roadmap will help them make better decisions about where to obtain their license and how far they’ll need to go to maintain compliance over time.
2. Work with tech that synchronizes data with a source of truth
Sometimes the only solution is to reach out to a state department of insurance to get transparency about which independent or staff adjuster licenses are reciprocal, or whether a specific line of authority designation will affect the license. But there are also tech options, like, say, a certain license compliance software that rhymes with BlatantBlink, that integrates with the National Insurance Producer Registry (NIPR) and that can validate an individual’s current adjuster licenses.
By synchronizing data with the industry source of truth, tech like AgentSync’s Manage option can surface valid, up-to-date information to maintain compliance in different jurisdictions.
3. Manage your external and internal adjuster teams from the same space
Instead of switching between systems, languishing in spreadsheet hell, or leaning into the honor system for your independent adjuster contracts, use tech that gives you a complete, 360-degree view of your adjuster compliance. Independent? Staff? Multistate? Get visual, daily insights into their up-to-date compliance health.
4. Use integrations to ensure compliant life and health claims
Most life and health claims adjusting is happening in digital systems, but an adjuster who’s assigned claims outside of their approved jurisdictional territory can cause trouble with internal teams and with state regulators. By integrating compliance software into your policy admin system and claims management solution, you can validate an adjuster’s license data before assigning claims, thereby stopping compliance violations before they happen.
AgentSync can’t make every state and jurisdiction agree to a uniform process for licensing adjusters and maintaining life and health adjuster compliance. But it can make it easier for your team to manage growing internal and external adjuster workforces and stop losing time thanks to manual errors in your claims assignment process. See how today.