2017 New Mexico Statutes
Chapter 59A - Insurance Code
Article 13 - Adjusters
Section 59A-13-2 - Definitions.

59A-13-2. Definitions.

A. For the purposes of Chapter 59A, Article 13 NMSA 1978:

(1) "adjuster" means a person that:

(a) investigates, negotiates, settles or adjusts a loss or claim arising under an insurance contract on behalf of an insurer, insured or self-insurer, for a fee, commission or other compensation; however, an adjuster acting on behalf of an insured shall not investigate, negotiate, settle or adjust a claim involving personal injury to the insured; and

(b) advises the insured of the insured's rights to settlement and the insured's rights to settle, arbitrate and litigate the dispute;

(2) "automated claims adjudication system" means a preprogrammed computer system designed for the collection, data entry, calculation and final resolution of portable electronics insurance claims that shall:

(a) only be used by a licensed independent adjuster, licensed agent or supervised individuals operating pursuant to Subsection C of Section 59A-13-3 NMSA 1978;

(b) comply with all claims payment requirements of the Insurance Code [Chapter 59A NMSA 1978]; and

(c) be certified as compliant with the Portable Electronics Insurance Act [59A-60-1 through 59A-60-7 NMSA 1978] by a licensed independent adjuster who is an officer of a licensed business entity pursuant to the Insurance Code;

(3) "business entity" means a corporation, association, partnership, limited liability company, limited liability partnership or other legal entity;

(4) "home state" means the District of Columbia and any state or territory of the United States in which the adjuster's principal place of residence or principal place of business is located. If neither the state in which the adjuster maintains the principal place of residence nor the state in which the adjuster maintains the principal place of business has substantially similar laws governing adjusters, the adjuster may declare another state in which it becomes licensed and acts as an adjuster to be the home state;

(5) "independent adjuster" means an adjuster who is not a staff adjuster or a public adjuster and includes a representative and an employee of an independent adjuster;

(6) "public adjuster" means an adjuster who acts or aids, solely in relation to first-party claims arising under insurance contracts that insure the real or personal property of the insured, on behalf of an insured in negotiating for, or effecting the settlement of, a claim for loss or damage covered by an insurance contract;

(7) "resident adjuster" means an adjuster who resides principally in New Mexico and who conducts business primarily in New Mexico; and

(8) "staff adjuster" means an adjuster individual who is a salaried employee of an insurer or affiliate of the employer insurer, representing and adjusting claims solely under the authority of the employer insurer.

B. Except as otherwise provided, "adjuster" does not include:

(1) an attorney-at-law who adjusts insurance losses or claims from time to time incidental to practice of law and who does not advertise or represent as an adjuster;

(2) a licensed agent or general agent of an authorized insurer or an employee of an agent or general agent who adjusts claims or losses under specific authority from the insurer and solely under policies issued by the insurer;

(3) an agent or employee of a life or health insurer who adjusts claims or losses under the insurer's policies or contracts to administer policies or benefits of that type;

(4) a salaried or part-time claims agent or investigator employed by a self-insured person;

(5) an individual who, for purposes of portable electronics insurance claims, collects claim information from, or furnishes claim information to, insureds or claimants, and who conducts data entry, including entering data into an automated claims adjudication system; provided that the individual is an employee of a licensed independent adjuster or its affiliate where no more than twenty-five such persons are under the supervision of one licensed independent adjuster or licensed agent who is exempt from licensure pursuant to Paragraph (2) of this subsection;

(6) a property damage appraiser or other individual who is employed by an insurer, third-party administrator, independent adjuster or self-insurer who inspects and provides monetary estimates of damages sustained by an insured or third party and does not investigate, negotiate, settle or adjust claims;

(7) a person who is employed solely for the purpose of obtaining facts surrounding a loss or furnishing technical assistance to an adjuster, such as a photographer, estimator, private investigator, engineer or handwriting expert;

(8) a licensed health care provider or employee of a licensed health care provider who prepares or files a health claim on behalf of a patient;

(9) a person who settles subrogation claims between insurers;

(10) a person who is employed to investigate suspected fraudulent insurance claims but does not adjust losses or determine claim payments; or

(11) an employee of an insurer who receives loss reports from insureds and who may advise an insured regarding the claim process or coverage available to the insured but who does not act as an adjuster on the claim.

History: Laws 1984, ch. 127, 230; 1989, ch. 274, 1; 2003, ch. 306, 6; 2007, ch. 282, 8; 2011, ch. 127, 8; 2013, ch. 140, 11; 2017, ch. 76, 1.