The correct answer is B. An independent adjuster's claim decision must be based on the policy, facts, evidence, applicable law, and authority received from the insurer, not merely on the insured's preference that a third-party claim be rejected. An insured's assertion that a claim is meritless is relevant information, but it does not substitute for an objective investigation.
New York Regulation 64 establishes prompt and fair claims-handling standards. DFS states that insurers should assist in claim processing, obtain verification where reasonably necessary, clearly communicate positions on disputed matters, and respond promptly to interested parties. DFS also identifies unfair claims settlement practices as prohibited conduct.
Accordingly, the adjuster may inform the insurer of the insured's position, making A permissible. The adjuster can also decline to follow an unsupported instruction to deny the claim, so C is permissible. Contacting the claimant to investigate the circumstances is an appropriate fact-development step, making D permissible.
What the adjuster cannot properly do is deny liability simply because the insured wants a denial. Such action would bypass the required investigation and professional evaluation.
The Series 17-70 outline specifically tests the adjuster's role, duties and responsibilities, claim investigation, liability-loss investigation procedures, verification, and settlement procedures.
