Public adjuster
Claim Process Disclosure Template & Example (Public Adjuster)
Last updated 2026-08-14
This is a separate document from the contract, and it is given before the contract is signed. Both halves of that sentence are requirements. A disclosure printed as a clause inside the contract has not been provided separately, and one handed over at signing has not been provided prior to it.
Its content is prescribed rather than left to the drafter. It defines the three kinds of adjuster an insured might encounter, and it states four things the insured needs to know before agreeing to pay anyone a percentage of their own claim — most importantly that they were never obliged to hire a public adjuster at all.
The worked example is the disclosure given to Mr Okonjo the day before he signed, with a note on the one part firms most often soften.
Jurisdiction
Written primarily against US first-party property practice. Claim handling is regulated state by state — acknowledgment and response deadlines, prompt-payment requirements, adjuster licensing and unfair claims practices standards all differ — and the policy actually issued governs the claim. Where a page cites a statute, model act or regulation, confirm what applies in the state where the loss occurred. Outside the US, treat the structure as transferable and the legal references as not.
Claim Process Disclosure template
Free Word download, no email required. Or open it in Professional Drafter — it lands in your template library, ready to draft against.
When to use this document
- Before every public adjuster contract, without exception and without folding it into the contract.
- When an insured asks what a public adjuster is and how they differ from the adjuster the carrier sent.
- Auditing an engagement file, where the absence of a separately dated disclosure is the first thing an examiner looks for.
Worked example
Fictional scenario: the disclosure provided to Mr D. Okonjo on 4 August 2026, the day before the Harbour Lane contract was signed. Same claim, PC-2026-11482.
The three types of adjuster
Property insurance policies require you to present your claim to your insurance company for consideration. Three types of adjuster may be involved in that process.
A COMPANY ADJUSTER is an insurance adjuster employed by an insurance company. They represent the interest of the insurance company and are paid by the insurance company. They will not charge you a fee.
An INDEPENDENT ADJUSTER is an insurance adjuster hired on a contract basis by an insurance company to represent the insurance company's interest in the settlement of the claim. They are paid by your insurance company. They will not charge you a fee.
A PUBLIC ADJUSTER is an insurance adjuster who does not work for any insurance company. They work for you, the insured, to assist in the preparation, presentation and settlement of your claim. You hire them by signing a contract agreeing to pay them a fee or commission based on a percentage of the settlement, or another method of compensation.
On your claim, the adjuster you have dealt with so far — R. Calloway — is a company adjuster. Merrow Loss Consulting is a public adjuster.
You are not required to hire a public adjuster
You are not required to hire a public adjuster to help you meet your obligations under your policy. You have the right to do so if you wish.
This sentence is reproduced as the model act states it. The firm's earlier version read '...although claims of this complexity are often difficult to present without assistance.' That addition is accurate in some cases and it does not belong here: the disclosure exists to tell you that hiring anyone is optional, and a sentence explaining why you should hire someone works against the only job this document has. Removed.
Your right to communicate directly
You have the right to initiate direct communication with your attorney, with your insurance company, with your insurance company's adjuster, with your insurance company's attorney, or with any other person regarding the settlement of your claim.
Retaining us does not remove that right and does not require you to route your communications through us. If you speak with your insurer directly, we ask only that you tell us what was discussed, so that what we present on your behalf does not contradict what you have already said. That is a request, not a condition.
Independence, and who pays our fee
Merrow Loss Consulting LLC is not a representative or employee of your insurance company.
Our fee is your obligation, not your insurer's. It is not paid by the insurance company, it is not added to your claim, and it is not recoverable from your insurer as a separate item. It is deducted from what you recover.
On this claim that means the following, stated in figures so there is no ambiguity: our fee is ten percent of amounts recovered after the date of the contract. Your insurer has already paid $6,200. That $6,200 is excluded from our fee. If the claim recovers a further $12,000, our fee is $1,200 and you receive $10,800 of that further amount.
We have not asked you for, and will not accept, any payment before your claim settles.
Delivery record
- Provided to:
- Daniel Okonjo.
- Date and time:
- 4 August 2026, 14:20.
- Method:
- in person at 41 Harbour Lane, hard copy, with a copy emailed to him at the same time at his request.
- Contract signed:
- 5 August 2026, 11:05 — the following day.
A day's gap is not required by the model, which asks only that the disclosure be provided prior to signing. It is our practice because 'prior to' and 'twenty minutes earlier in the same meeting' are both compliant and only one of them gives the insured a chance to read it. Where an insured wants to sign in the same visit we record both times and note that the gap was at their election.
Section-by-section guide
What each section is for, what a good one contains, and where they typically go wrong.
1.The three types of adjuster
The model prescribes the substance of all three definitions. A company adjuster is an employee of the insurer, represents the insurer's interest, is paid by the insurer, and will not charge the insured a fee. An independent adjuster is hired on contract by the insurer to represent the insurer's interest in settling the claim, is paid by the insurer, and will not charge the insured a fee. A public adjuster does not work for any insurer, works for the insured, and is hired by the insured signing a contract agreeing to pay a fee or commission. Keep the 'will not charge you a fee' language on the first two — it is the comparison that makes the disclosure meaningful.
2.The insured is not required to hire anyone
Stated plainly: the insured is not required to hire a public adjuster to meet their obligations under the policy, but has the right to do so. This is the sentence that most reworded disclosures weaken, usually by adding a clause about complexity or about claims being denied without help. Adding to it changes it.
3.The insured's right to communicate directly
The insured keeps the right to initiate direct communication with their own attorney, the insurer, the insurer's adjuster, the insurer's attorney, or anyone else about the settlement of their claim. Retaining a public adjuster does not route the insured's own voice through the adjuster, and a disclosure that implies otherwise is misdescribing the engagement.
4.Independence from the insurer, and who pays
Two statements that work together. The public adjuster is not a representative or employee of the insurer. And the fee is the obligation of the insured, not the insurer. Insureds routinely assume the second is untrue — that the fee comes out of the carrier's side somehow — and the disclosure exists partly to correct that before money is committed.
5.Delivery record
Not required by the model in terms, but the requirement is that the disclosure was provided prior to signing, and an undated disclosure cannot demonstrate that. Record what was given, to whom, on what date, and how. If the contract is signed the same day, record the times.
Common mistakes
The failure modes that show up most often when this document is reviewed later.
Printing the disclosure as a section of the contract
The model requires a separate disclosure document. A clause inside the contract is not separate, and it also cannot have been provided prior to the contract being signed.
Providing it at the signing meeting and treating that as 'prior'
Technically compliant if it precedes signature, and it defeats the point. An insured reading a disclosure with a pen in their hand is not being informed, and the file will look exactly like what it is.
Softening the 'not required to hire' statement
Adding a clause about complexity or about claims going wrong without help converts a neutral disclosure into a sales document. It is the one statement most likely to be compared word-for-word against the statute.
Omitting that the fee is the insured's obligation
Insureds frequently assume the fee comes from the carrier's side. Leaving it implicit is how a fee dispute starts, and the statement is prescribed precisely because the assumption is so common.
Dropping 'they will not charge you a fee' from the company and independent adjuster definitions
That line is what makes the three definitions a comparison rather than a glossary. Without it the insured cannot see what they are choosing between.
Questions
- Does the disclosure have to use the model's exact words?
- The model prescribes what it must state rather than a script, and states vary in how prescriptive their adopted version is. Reproducing the substance closely is the safe course, and it is also the more honest one — the parts firms reword are almost always the parts that are least flattering.
- Can it be delivered by email?
- Nothing in the model requires paper. What matters is that it is separate, that it precedes signature, and that you can show both. Email is easier to evidence than a hard copy handed across a table.
- The insured says they do not want to read it. Do I still have to give it?
- Yes. The obligation is to provide it, and it does not turn on whether the insured engages with it. Record the delivery and proceed.
The blank template
Exactly what is in the Word download, so you can see the structure before deciding whether you want it.
The three types of adjuster
The insured is not required to hire anyone
The insured's right to communicate directly
Independence from the insurer, and who pays
Delivery record
Download this template
Free Word download, no email required. Or open it in Professional Drafter — it lands in your template library, ready to draft against.
Sources
Related templates
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This page is a documentation aid, not legal advice and not a coverage opinion. Claim-handling requirements vary by state and by policy wording, and a template cannot tell you what your file requires. The worked example describes a fictional loss.