“Bad faith” in insurance claims handling refers to an insurer’s unreasonable and unfounded refusal to pay a claim covered by the policy. In New Hampshire, while there isn’t a specific statute defining bad faith, it’s generally understood through case law and the implied covenant of good faith and fair dealing inherent in every contract, including insurance policies. Examples of adjuster actions that could constitute bad faith include: unreasonably delaying claim investigation, misrepresenting policy provisions to avoid coverage, failing to properly investigate a claim, offering a settlement substantially less than the claim’s value without reasonable justification, and denying a claim without conducting a reasonable investigation. These actions may violate New Hampshire Insurance Regulation Ins 302.03, which outlines unfair claim settlement practices. Case law, such as Lawton v. Great Southwest Fire Insurance Company, provides precedent for holding insurers accountable for acting in bad faith. The burden of proof rests on the claimant to demonstrate the insurer’s actions were unreasonable and without a fair basis.

New Hampshire licensed insurance adjusters are required to complete continuing education (CE) to maintain their licenses. According to New Hampshire statutes and regulations, specifically RSA 402-C:22 and Ins 305.01, adjusters must complete a certain number of CE credit hours biennially. The specific number of hours can vary, but it is typically around 24 credit hours every two years. These hours must be completed in courses approved by the New Hampshire Insurance Department. Qualifying courses generally cover topics related to insurance law, ethics, policy updates, and claims handling best practices. Failure to meet the CE requirements can result in license suspension or revocation. Adjusters are responsible for tracking their CE credits and providing proof of completion to the Insurance Department upon request. The Department may also conduct audits to ensure compliance with CE requirements.

Subrogation is a legal right held by an insurer to pursue a third party who caused a loss to the insured, after the insurer has paid the insured’s claim. In property insurance, if a loss is caused by the negligence of another party, the insurer, after paying the claim, can “step into the shoes” of the insured and seek recovery from the responsible party. For example, if a fire in a neighbor’s property spreads and damages the insured’s home, the insurer pays the homeowner’s claim and then pursues the negligent neighbor (or their insurer) to recover the amount paid. The adjuster’s responsibilities in pursuing subrogation include: identifying potential subrogation opportunities during the claim investigation, preserving evidence related to the loss, notifying the potentially responsible party of the insurer’s subrogation interest, and negotiating with the responsible party or their insurer to recover the claim payment. New Hampshire law recognizes the right of subrogation, and adjusters must be familiar with the legal requirements for pursuing these claims effectively. Failure to properly pursue subrogation can result in a loss of potential recovery for the insurer.

New Hampshire allows insurance companies to utilize independent contractors for claims adjusting, but these individuals are subject to specific licensing and regulatory requirements. According to New Hampshire statutes, specifically RSA 402-C, independent adjusters must hold a valid New Hampshire adjuster’s license. This license requires passing an examination, meeting certain educational or experience requirements, and undergoing a background check. Insurance companies using independent adjusters are responsible for ensuring that these individuals are properly licensed and qualified to handle claims. While the independent adjuster operates independently, the insurance company retains ultimate responsibility for the proper handling of claims. The insurance company must provide adequate training and supervision to ensure that independent adjusters comply with all applicable laws and regulations. Failure to properly license or supervise independent adjusters can result in penalties for the insurance company.

“Betterment” refers to a situation where a repair or replacement improves the value or condition of a property beyond its pre-loss state. In New Hampshire, insurance policies typically do not cover betterment. The principle is that the insured should be indemnified for their loss, but not receive a windfall gain. For example, if an older roof is damaged and needs replacement, the insurer may only pay for the cost of a roof of similar age and condition, deducting for depreciation. If the insured chooses to install a more durable or upgraded roof, the difference in cost is considered betterment and is the responsibility of the insured. An adjuster handling a betterment situation should clearly explain the concept to the insured, document the pre-loss condition of the property, and obtain estimates for both the cost of restoring the property to its pre-loss condition and the cost of the upgraded repair or replacement. The adjuster should then pay only for the portion of the repair that restores the property to its original condition, excluding the betterment portion. Clear communication and documentation are crucial in managing betterment situations to avoid disputes with the insured.

When a claim involves a disputed cause of loss in New Hampshire, the adjuster must conduct a thorough and impartial investigation. This includes gathering all relevant information, such as policy documents, witness statements, expert opinions, and police reports. The adjuster should carefully analyze the policy language to determine whether the claimed cause of loss is covered. If the investigation reveals conflicting evidence, the adjuster should seek clarification and additional information to resolve the ambiguity. If, after a reasonable investigation, the adjuster determines that the cause of loss is not covered, the claim should be denied in writing, with a clear explanation of the reasons for the denial and the specific policy provisions relied upon. If the insured disagrees with the denial, they have several legal options, including mediation, arbitration, or filing a lawsuit against the insurer. New Hampshire law provides insureds with the right to pursue legal action to challenge claim denials. The adjuster should document all steps taken in the investigation and maintain clear communication with the insured throughout the process.

The New Hampshire Consumer Protection Act, specifically RSA 358-A, prohibits unfair methods of competition and unfair or deceptive acts or practices in the conduct of any trade or commerce. This includes insurance claims handling. While the Act doesn’t specifically list insurance practices, it provides a broad framework for prohibiting deceptive or unfair conduct. Examples of practices that could violate the Act include: misrepresenting the terms of an insurance policy, failing to disclose material facts about coverage, making false or misleading statements about the claim process, and engaging in coercive or intimidating tactics to pressure claimants into accepting settlements. An adjuster who violates the Consumer Protection Act could face several consequences, including: civil penalties, such as fines and damages; cease and desist orders from the Attorney General; and potential disciplinary action from the New Hampshire Insurance Department, including suspension or revocation of their adjuster’s license. The Act provides consumers with a private right of action to sue for damages resulting from violations. Therefore, adjusters must adhere to ethical and transparent claims handling practices to avoid violating the Act.

“Bad faith” in insurance claims handling refers to an insurer’s unreasonable and unfounded refusal to pay a claim covered by the policy. In New Hampshire, while there isn’t a specific statute defining bad faith, the concept is recognized under common law. Actions that could constitute bad faith include: unreasonably delaying claim processing, denying a claim without proper investigation, misrepresenting policy provisions, failing to communicate with the insured, or offering a settlement substantially less than the claim’s value. The legal ramifications for bad faith can be significant. An insurer found to have acted in bad faith may be liable for compensatory damages, including the policy benefits wrongfully withheld, as well as consequential damages resulting from the breach of contract. While punitive damages are generally disfavored, they may be awarded in egregious cases where the insurer’s conduct is particularly malicious or egregious. The New Hampshire Supreme Court has addressed bad faith claims in numerous cases, shaping the understanding of insurer obligations. Adjusters, as representatives of the insurer, can also face professional consequences for participating in bad faith practices, potentially including license suspension or revocation under the authority of the New Hampshire Insurance Department.

Subrogation is the legal right of an insurer to pursue a third party who caused a loss to the insured, allowing the insurer to recover the amount it paid out on the claim. In New Hampshire, the adjuster’s responsibilities in protecting subrogation rights begin immediately upon receiving notice of a potential claim. This includes identifying potential third-party liability, preserving evidence, and notifying all potentially liable parties of the insurer’s subrogation interest. The adjuster must also avoid actions that could prejudice the insurer’s subrogation rights, such as releasing the responsible party from liability without the insurer’s consent. New Hampshire follows general subrogation principles, requiring the insurer to stand in the shoes of the insured and pursue the claim based on the insured’s rights against the third party. The “made whole” doctrine may apply, meaning the insured must be fully compensated for their loss before the insurer can recover its subrogation interest. The adjuster must be familiar with relevant statutes of limitations for pursuing claims against third parties to ensure the insurer’s subrogation rights are not lost.

Licensed insurance adjusters in New Hampshire are required to complete continuing education (CE) courses to maintain their licenses. The specific number of CE hours required and the frequency of the requirement (typically biennial) are determined by the New Hampshire Insurance Department. These CE courses must cover topics relevant to insurance adjusting, such as ethics, insurance law, and claim handling practices. Failure to meet the CE requirements can result in disciplinary actions, including license suspension or revocation. The New Hampshire Insurance Department monitors compliance through various methods, including requiring adjusters to report completed CE credits electronically and conducting audits of CE records. Adjusters are responsible for maintaining accurate records of their completed CE courses and providing documentation to the Department upon request. The Department publishes guidelines and updates regarding CE requirements on its official website.

Insurance adjusters in New Hampshire have a significant ethical responsibility to act with honesty, integrity, and fairness in all their dealings. They owe specific ethical duties to the insured, the insurer, and the public. To the insured, the adjuster has a duty to conduct a thorough and impartial investigation of the claim, to communicate clearly and promptly, and to treat the insured with respect and courtesy. To the insurer, the adjuster has a duty to protect the insurer’s financial interests by accurately assessing the claim, negotiating settlements fairly, and preventing fraud. To the public, the adjuster has a duty to uphold the integrity of the insurance industry and to comply with all applicable laws and regulations. Conflicts can arise when the interests of the insured and the insurer diverge. For example, an adjuster might be pressured by the insurer to deny a valid claim to save money, conflicting with the adjuster’s duty to fairly compensate the insured. In such situations, the adjuster must prioritize ethical conduct and comply with the law, even if it means facing disapproval from the insurer. Maintaining transparency and documenting all actions are crucial for demonstrating ethical behavior.

Handling a total loss vehicle claim in New Hampshire requires a careful assessment of the vehicle’s actual cash value (ACV). The adjuster must determine the ACV by considering factors such as the vehicle’s age, mileage, condition (prior to the loss), and comparable sales of similar vehicles in the local market. The adjuster should use reliable sources, such as the NADA Used Car Guide or other industry-recognized valuation services, to support the ACV determination. Documentation is crucial to justify the ACV offered to the insured. This includes detailed photographs of the vehicle, repair estimates (if any), documentation of comparable sales, and the valuation report used to determine the ACV. The adjuster must also provide the insured with a clear explanation of how the ACV was calculated and offer the insured the opportunity to provide additional information or documentation that might affect the valuation. If the insured disputes the ACV, the adjuster should engage in good-faith negotiations to reach a fair settlement.

The New Hampshire Insurance Department plays a crucial role in regulating insurance adjusters to protect consumers and ensure the integrity of the insurance industry. The Department is responsible for licensing insurance adjusters, setting standards for qualifications and competence. It also has the power to investigate complaints against adjusters, conduct disciplinary hearings, and impose sanctions, including license suspension or revocation, for violations of insurance laws and regulations. The Department’s enforcement powers extend to investigating allegations of fraud, misrepresentation, and other unethical or illegal conduct by adjusters. It also provides consumer protection by offering resources and assistance to individuals who have disputes with insurance companies or adjusters. The Department publishes information on its website about insurance laws, regulations, and consumer rights, and it operates a consumer hotline to address inquiries and complaints.

When investigating a potential insurance fraud claim in New Hampshire, an adjuster must proceed cautiously and systematically. The initial step is to gather all relevant information and documentation related to the claim, including the policy, claim forms, police reports, and medical records. The adjuster should look for red flags that might indicate fraud, such as inconsistencies in the information provided, suspicious circumstances surrounding the loss, or a history of prior claims. If fraud is suspected, the adjuster should conduct a thorough investigation, which may involve interviewing witnesses, obtaining expert opinions, and conducting surveillance. It’s crucial to maintain confidentiality and avoid making accusations of fraud without sufficient evidence. Legally, the adjuster must comply with all applicable laws and regulations regarding privacy and data protection. Ethically, the adjuster must act with fairness and impartiality, avoiding bias or prejudice. Resources available to assist adjusters in identifying and reporting fraudulent activity include the New Hampshire Insurance Department, the National Insurance Crime Bureau (NICB), and specialized fraud investigation units within insurance companies. Any suspected fraud should be reported to the appropriate authorities for further investigation and prosecution.