Public adjuster
Public Adjuster Contract Template & Example
Last updated 2026-08-14
This is the only document in the library whose title is prescribed by statute. The NAIC model act requires the contract to be headed 'Public Adjuster Contract' — not 'Retainer Agreement', not 'Service Agreement'. Where a state has adopted that provision, a differently titled document is non-compliant before anyone reads a word of it.
That sets the tone for the rest. Ten further terms are mandatory, four specific terms are forbidden, expenses have to be itemized by type with dollar estimates, and the whole thing is executed in duplicate. None of this is convention that a good drafter improves on. It is a checklist, and the value of a template here is that it is complete.
The worked example below is the contract in the Harbour Lane matter, signed after the carrier's initial estimate came in low. It shows the fee provision written the way the model requires and, more usefully, shows one of the forbidden terms being caught and removed from a firm's standard form.
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.
Public Adjuster Contract 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
- Engaging any insured on a first-party property claim, which is the only kind of claim a public adjuster licence reaches.
- Reviewing a firm's standard form against the model act, or against a newly adopted state act.
- An insured has asked what they are signing, and the answer should be a document that can be read.
Worked example
Fictional scenario: the Harbour Lane water loss (claim PC-2026-11482) from the insured's side. Mr D. Okonjo received the carrier's estimate of $18,340 on 31 July 2026 and retained a public adjuster. This is the contract, plus the review that caught a forbidden term in the firm's standard form.
Title and identification of the adjuster
PUBLIC ADJUSTER CONTRACT
- Public adjuster:
- Thea Halvorsen, Merrow Loss Consulting LLC.
- Department of Insurance licence number:
- PA-118427.
- Permanent home state business address:
- 214 Fenwick Street, Suite 3, [City].
- Business phone:
- (555) 0142-8890.
The firm's previous form carried only 'Merrow Loss Consulting LLC' above the signature line. The model requires the legible full name of the individual adjuster signing, as recorded with the Department, and an entity name is not that. Corrected before issue.
The insured, the policy and the loss
- Insured:
- Daniel Okonjo.
- Street address:
- 41 Harbour Lane, [City].
- Insurer:
- [Carrier]. Policy number: HO-4471902.
- Claim number:
- PC-2026-11482.
- Loss:
- water damage to the ground floor of a single-family dwelling, originating from a failed supply line to the upstairs bathroom. Reported to the insurer 14 July 2026, discovered approximately 07:15 that day.
The loss description names the source and the affected area rather than saying 'water damage at the above address'. Mr Okonjo reported a second, unrelated leak at an exterior tap on 2 August. It is expressly not within this contract, and a line records that: 'This contract covers the loss of 14 July 2026 only. It does not cover the exterior tap leak reported 2 August 2026.'
Compensation
Fee: ten percent (10%) of the total amount recovered on the claim, exclusive of any amount already paid by the insurer before the date of this contract.
That exclusion is deliberate. The carrier had issued $6,200 in undisputed payments before Mr Okonjo made contact. Charging a percentage of money already in his hands, obtained without the adjuster's involvement, is the practice that generates most public adjuster complaints. The contract states the excluded figure so there is no arithmetic to argue about later.
- — Independent moisture mapping and drying assessment:
- estimated $450
- — Certified contents inventory support:
- estimated $300
- — Reproduction of policy and claim file documents:
- estimated $60
Reimbursable initial expenses, specified by type with estimates as required:
Any expense beyond these types, or beyond these estimates, requires Mr Okonjo's written approval before it is incurred.
No fee, retainer or deposit has been requested or accepted, and none will be before the claim settles.
Policy-limit provision: if the insurer pays or commits in writing to pay the policy limit within 72 hours of the loss being reported, no percentage commission is payable; compensation is limited to reasonable charges for time spent and expenses incurred. Not engaged here — the loss was reported 14 July and the contract signed 5 August — but the clause is in the form, because a form without it is non-compliant on the file where it would have applied.
Terms that must not appear
Reviewed against the forbidden list on 4 August 2026, before issue. One term failed.
The firm's standard form read: 'The fee shall be payable in full upon issuance of the first payment by the insurer following execution of this agreement.' That is the second forbidden term — the whole fee taken from the first check rather than as a percentage of each. On this claim it would have meant taking the full anticipated fee out of the first supplemental payment, before the balance of the recovery existed.
Replaced with: 'The fee is payable as ten percent (10%) of each payment issued by the insurer on this claim after the date of this contract, as and when each payment is received.'
The other three were absent: no term collecting fees on money due but unpaid, no requirement that payment issue in the adjuster's name alone, no collection costs or late fees. The form does name the adjuster as co-payee, which the model permits, and that is not the same thing as requiring the check to issue in her name only.
Recorded here because the term had been in the form for two years and had gone out on an unknown number of contracts.
Rescission notice, signatures and execution
NOTICE: You may rescind this contract within three (3) business days after the date you sign it. To rescind, deliver or mail written notice to Merrow Loss Consulting LLC, 214 Fenwick Street, Suite 3, [City], within that period.
- Signed by the public adjuster:
- T. Halvorsen, 5 August 2026.
- Signed by the insured:
- D. Okonjo, 5 August 2026.
Both dates are recorded separately even though they are the same day, because the clock runs from the insured's signature and a single 'Date:' line loses that.
5 August 2026 was a Wednesday, so the three business days are Thursday 6, Friday 7 and Monday 10 August. The right expires at the end of Monday 10 August 2026, not Saturday 8 — which is what a calendar-day reading gives, and which is the error that appears in most secondary summaries of this provision.
Executed in duplicate. Original to Mr Okonjo; original retained by the firm and available for inspection by the commissioner without notice.
Attestation: the public adjuster is fully bonded pursuant to state law.
Section-by-section guide
What each section is for, what a good one contains, and where they typically go wrong.
1.Title and identification of the adjuster
The heading is a required term, not formatting. Then identify the adjuster as the Department of Insurance records identify them: legible full name of the individual signing, permanent home state business address and phone number, and the licence number. 'Legible' is in the model because the recurring failure is a signature block nobody can resolve into a licensed person.
2.The insured, the policy and the loss
Full name, street address, insurer name and policy number — the model allows the policy number to follow 'upon notification' where it is not yet known, which is common when an insured retains help before locating their declarations page. Then a description of the loss and its location. Vagueness here is what later lets a dispute arise about which loss the contract covered, particularly where a second peril follows the first.
3.Services to be provided
A description of what the adjuster will actually do. This is the term most often reduced to a sentence, and it is the one the insured will point at when expectations diverge. Say whether the engagement covers preparing the claim, presenting it, negotiating it, and whether it extends to appraisal or to a supplement after closing. Say what it excludes: legal advice, and anything requiring a licence the adjuster does not hold.
4.Compensation
If compensation is a share of the settlement, the exact percentage is required — not a range and not 'up to'. Reimbursable initial expenses must be specified by type with dollar estimates in the contract, and any additional expense needs the insured's approval first. Two hard limits sit behind this. No fee, retainer, deposit or other thing of value may be required, demanded or accepted before the claim settles. And where the insurer pays or commits in writing to pay policy limits within 72 hours of the loss being reported, no percentage commission is permitted at all — compensation drops to reasonable time and expense, and the insured must be told the recovery might not increase.
5.Terms that must not appear
Four are forbidden outright, and standard forms carry them more often than firms expect. A term allowing the percentage fee to be collected when money is due from the insurer but not paid. A term allowing the whole fee to be taken from the first check rather than as a percentage of each. A term requiring the insurer to issue a check only in the adjuster's name. A term imposing collection costs or late fees. A term precluding the adjuster from pursuing civil remedies is also void. Check the form against this list before the engagement, not after a complaint.
6.Bonding attestation, signatures and execution
Attestation language stating the adjuster is fully bonded pursuant to state law is a required term. Both parties sign, and both signature dates are recorded separately — the model asks for the date the adjuster signed and the date the insured signed as distinct items, because the rescission clock runs from the insured's signature. Execute in duplicate so each party holds an original, and keep the adjuster's original available for inspection by the commissioner without notice.
7.Rescission notice on the face of the contract
The insured's right to rescind within three business days must be stated, with the address to which the rescission is sent. Several states prescribe type size or placement for this notice; the model does not, so the state act governs and it is worth checking rather than assuming the model is the ceiling.
Common mistakes
The failure modes that show up most often when this document is reviewed later.
Titling the document anything other than 'Public Adjuster Contract'
The title is one of the eleven required terms. A retainer agreement that is otherwise perfect fails on its heading, and it fails in a way that is obvious to a regulator reading the first line.
Stating the fee as a range, a maximum, or 'up to' a percentage
Where compensation is a share of the settlement, the exact percentage is required. A range is not a percentage, and it leaves the amount to be settled later by whoever is more willing to argue.
Taking the entire fee from the first insurer payment
Expressly forbidden. The fee is a percentage of each payment as it issues. This is the most common non-compliant term in circulating standard forms, and it survives because it only becomes visible when a claim pays in instalments.
Charging a percentage of money the insurer paid before the engagement
Not forbidden by the model in terms, but it is the single largest source of public adjuster complaints, and it is trivially avoided by stating the excluded figure in the contract. A fee is for work done.
Accepting a deposit at signing
No fee, retainer, compensation, deposit or other thing of value may be required, demanded or accepted before the claim settles. This one is unambiguous and it is a licence matter, not a contract dispute.
Listing expenses as a category without dollar estimates
The model requires initial reimbursable expenses to be specified by type WITH dollar estimates. 'Reasonable costs of investigation' is neither a type nor an estimate, and anything beyond the stated estimates needs approval first.
Questions
- Are the 10% and 15% figures the legal cap where I practise?
- Only if your state adopted them. Those are the model's numbers — ten percent for a catastrophic claim settlement, fifteen percent otherwise. Adopted caps vary widely, several states apply a lower cap during a declared emergency, and a few use a sliding scale. Cite your own act's provision in the contract rather than the model's.
- Can I name myself as co-payee on the insurer's payment?
- The model permits the contract to specify it. What it forbids is a term requiring the insurer to issue the check in the adjuster's name alone. Co-payee and sole payee are different provisions and only one of them is allowed.
- The insured wants to sign today and the policy number is not to hand. Can we proceed?
- The model contemplates it — the policy number is required 'if known or upon notification'. Record that it will follow, and supply it when you have it. Do not leave the loss description vague for the same reason, because that one has no equivalent allowance.
- What happens if a required term is missing?
- That depends entirely on your state's act, and the consequences range from an unenforceable contract to a licence sanction. This page describes what the model requires; it does not tell you the effect of non-compliance in your jurisdiction, which is a legal question.
The blank template
Exactly what is in the Word download, so you can see the structure before deciding whether you want it.
Title and identification of the adjuster
The insured, the policy and the loss
Services to be provided
Compensation
Terms that must not appear
- [No fee collectible on money due but unpaid]
- [Fee taken as a percentage of each check, not wholly from the first]
- [No requirement that payment issue in the adjuster's name alone]
- [No collection costs or late fees]
Bonding attestation, signatures and execution
Rescission notice on the face of the contract
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
- NAIC — Public Adjuster Licensing Model Act (Model 228) §15, Contract Between Public Adjuster and Insured
- NAIC — Public Adjuster Licensing Model Act (Model 228) §14, Public Adjuster Fees
- NAIC — Public Adjuster Licensing Model Act (Model 228) §15(I)–(J), rescission
- NAIC — Public Adjuster Licensing Model Act (Model 228) §1, Purpose and Scope
Related templates
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.
Letter of Representation Template & Example (Public Adjuster to Insurer)
The notification letter the model act requires — signed by the insured, authorising the public adjuster to represent their interest. Template, worked example and free Word download.
Public Adjuster Contract Rescission Notice Template & Example
The three-business-day rescission notice: how the window is counted, what has to be returned and when, with a filled-in example and a free Word download.
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.