Public adjuster
Letter of Representation Template & Example (Public Adjuster to Insurer)
Last updated 2026-08-14
The model act puts this in one sentence: the public adjuster shall provide the insurer a notification letter, signed by the insured, authorising the public adjuster to represent the insured's interest. The insurer then verifies the adjuster holds a valid licence.
The signature requirement is the part that gets missed. A letter on the adjuster's letterhead announcing the engagement is not what the provision describes — the authority runs from the insured, so the insured signs. A letter the insured has not signed can be, and sometimes is, disregarded.
The worked example is the letter sent on the Harbour Lane claim, including the two things worth adding that the model does not require: what the insurer should do with existing communications, and an express statement that the insured retains the right to be contacted directly.
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.
Letter of Representation 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
- Immediately after the contract is executed and the rescission period has been explained, on every engagement.
- When a carrier continues to correspond only with the insured after an engagement has been notified.
- Re-issuing on a claim that has been reassigned to a new carrier adjuster or moved to a different office.
Worked example
Fictional scenario: the notification letter sent on the Harbour Lane claim on 11 August 2026 — after the rescission period expired on 10 August, which is deliberate and explained below. Claim PC-2026-11482.
Addressing and claim identification
11 August 2026
- cc:
- claims correspondence address on the declarations page
R. Calloway, Claim Representative
[Carrier], Property Claims
[Address]
- Re:
- Notification of public adjuster representation
- Insured:
- Daniel Okonjo
- Policy number:
- HO-4471902
- Claim number:
- PC-2026-11482
- Loss location:
- 41 Harbour Lane, [City]
- Date of loss:
- 14 July 2026
Sent on 11 August rather than 6 August. The contract was signed on 5 August and the insured's right to rescind ran to the end of Monday 10 August. Notifying the carrier of a representation the insured may still cancel creates a letter that has to be withdrawn, and it puts the insured's decision in front of the carrier before he has finished making it. Nothing requires the wait. It is simply the better order.
The authorisation, signed by the insured
I, Daniel Okonjo, the named insured under the above policy, authorise Thea Halvorsen of Merrow Loss Consulting LLC, public adjuster licence number PA-118427, to represent my interest in the above claim.
This authority extends to receiving claim correspondence and documentation, discussing and negotiating the claim with you on my behalf, and attending inspections of the loss location.
- Signed:
- D. Okonjo
- Date:
- 11 August 2026
The letter is signed by Mr Okonjo, not by the adjuster. The authority is his to give, and a letter on the firm's letterhead announcing the engagement would not be the document the act describes. Where an insured is unavailable to sign, the letter waits — it does not go out unsigned with the signature to follow.
Where correspondence should go and what the insured retains
Please direct claim correspondence to:
Merrow Loss Consulting LLC, 214 Fenwick Street, Suite 3, [City]
claims@[firm], (555) 0142-8890
Please continue to copy Mr Okonjo on all correspondence at 41 Harbour Lane and at his email address on file. He has asked to be copied rather than to have correspondence redirected away from him, and that is his preference rather than our default.
Mr Okonjo retains the right to initiate direct communication with you, with his own attorney, and with anyone else regarding the settlement of this claim. This notification does not limit that right and is not intended to.
That paragraph is in every letter this firm sends. It repeats what the pre-contract disclosure told him, and a notification that quietly implied otherwise would contradict a document he has already signed for.
Documents requested
So that the claim can be progressed without repeated requests, please provide:
1. A complete certified copy of the policy in force on 14 July 2026, including all endorsements and the declarations page.
2. Your estimate dated 31 July 2026 in its native format, together with any supporting reports, photographs or moisture readings relied on.
3. A payment history for the claim to date. Our record shows $6,200 paid across two payments; please confirm.
4. Any reservation of rights, coverage position or non-waiver correspondence issued on this claim.
Item 2 asks for the native format rather than a PDF because line-item detail is frequently lost in export, and a line item that cannot be read cannot be discussed. Item 3 states our figure and asks for confirmation rather than asking an open question — it is faster to correct a number than to produce one, and the fee on this claim is calculated on amounts recovered after 5 August, so the pre-contract total needs to be agreed early rather than at settlement.
We will provide our scope and estimate within fourteen days of receiving items 1 and 2.
Section-by-section guide
What each section is for, what a good one contains, and where they typically go wrong.
1.Addressing and claim identification
Address it to the claim handler by name where one is known, and copy the carrier's general claims address. Identify the policy number, the claim number, the insured, the loss location and the date of loss. A notification that arrives without the claim number gets attached to the wrong file or to no file, and the delay is invisible until someone asks why nothing has moved.
2.The authorisation, signed by the insured
The operative sentence authorises the adjuster to represent the insured's interest in the claim, and the insured signs it. Say what the authority covers: receiving claim correspondence and documentation, discussing and negotiating the claim, and attending inspections. Note the licence number in the same block, since the insurer is expected to verify it.
3.Where correspondence should go
Not a statutory requirement and the most practically useful part of the letter. State the address, email and phone for claim correspondence. Then decide explicitly whether the insurer should continue to copy the insured — and say so either way, because a carrier left to guess will usually keep writing to the insured alone, and the insured will forward things late or not at all.
4.What the insured retains
Reaffirm that the insured keeps the right to communicate directly with the insurer. This costs nothing and it forecloses the argument that the engagement was used to insert a barrier between the carrier and its own policyholder. It also matches what the pre-contract disclosure already told the insured, and a letter that contradicted it would be a problem.
5.Documents requested
Ask for what is needed to work the claim: a complete certified copy of the policy including all endorsements and declarations, the carrier's estimate and any supporting reports, the payment history to date, and any reservation of rights or coverage correspondence. Ask once, in the notification, rather than in five separate emails over three weeks.
Common mistakes
The failure modes that show up most often when this document is reviewed later.
Sending the letter on the adjuster's signature alone
The model requires the notification to be signed by the insured. The authority originates with the insured, and a carrier that disregards an unsigned letter is entitled to.
Sending it during the rescission period
Nothing forbids it, and it creates a representation the insured can still cancel, which then has to be unwound with the carrier. Waiting costs three business days and removes the problem entirely.
Omitting the claim number
The letter attaches to the wrong file or to none. The failure is silent — nothing bounces — and it surfaces weeks later as an unexplained lack of response.
Leaving it ambiguous whether the insured should still be copied
A carrier that has to guess usually stops writing to the insured. The insured then learns about their own claim second-hand, which is both a service failure and, if the engagement later sours, an accusation waiting to be made.
Requesting documents piecemeal over the following weeks
Each request restarts a handling cycle at the carrier. One itemised request in the notification is answered once; five separate emails are answered five times, slowly.
Questions
- Does the insurer have to deal with the public adjuster once notified?
- The model says the insurer shall verify the adjuster holds a valid licence; how the carrier then handles communications is governed by its own obligations to its insured and by state law. What the notification reliably achieves is that the carrier cannot say it was unaware of the representation.
- Should the letter go by post or email?
- Whatever produces a record. What matters more is that it reaches the claim file — copy the general claims address as well as the handler, because handlers change and a letter sent only to a departed adjuster's inbox is a letter nobody read.
- Do I need to re-notify if the carrier reassigns the claim?
- Not as a legal matter, but do it. A new handler working from a file summary frequently does not register an existing representation, and re-sending the notification costs nothing compared with discovering the problem after a decision has been made without you.
The blank template
Exactly what is in the Word download, so you can see the structure before deciding whether you want it.
Addressing and claim identification
The authorisation, signed by the insured
Where correspondence should go
What the insured retains
Documents requested
- [Certified complete policy including endorsements and declarations]
- [Carrier estimate and supporting reports]
- [Payment history to date]
- [Any reservation of rights or coverage correspondence]
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
Public Adjuster Contract Template & Example
A public adjuster contract template with the eleven terms the NAIC model act requires, the four it forbids, and a filled-in example. Free Word download, no signup.
Claim Process Disclosure Template & Example (Public Adjuster)
The separate pre-contract disclosure the NAIC model act requires, with the three adjuster definitions and four statements it prescribes, plus a filled-in example.
Itemized Statement of Recoveries & Compensation Template
The two itemized statements the model act requires in every public adjuster file — the insured's recoveries and all compensation received from any source — with a worked example.
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.