Is notarization required for an adjuster change?

Not generally. Adjuster reassignments usually require an authorized signature but not notarization. If the reassignment involves powers that require notarized delegation under specific state law, follow the state requirement or use a RON where allowed.

Can the Adjuster Change Form be signed electronically?

Yes. Electronic signatures meet legal validity under the ESIGN Act (15 U.S.C. ch. 96) and UETA where applicable, provided the signature shows intent, consent, attribution, and the record can be retained and reproduced.

Who has authority to sign the form?

An authorized claims manager, policyholder, or designated representative with delegation rights should sign. Confirm internal delegation policies and retain supporting authorization documents in the claim file.

How do I correct errors after submission?

Prepare a corrected Adjuster Change Form signed by the same authorized party noting the correction and effective date. Attach it to the original file and document why the change was needed for auditability.

Can the reassignment be revoked or canceled?

Yes. A revocation should be documented with a signed form or written instruction from an authorized party, including the effective revocation date and distribution to all previously notified parties.

Where should signed forms be stored?

Keep the signed form in the official claims management system and an archival repository for the retention period. Ensure access controls and retention follow IRS, HIPAA, or state regulator requirements where applicable.

Electronic Signature
Templates
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Adjuster Change Form

Adjuster Change Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

ADJUSTER CHANGE FORM

AN ADJUSTER HAS CHANGED!!

(Use your TAB key to fill out.)

Please check all that apply:

We have assumed the following claims

Past Present Future

List other information needed to identify claims assumed:

Effective Date:

Contact Person

Please check one:

The Primary Adjuster for the Insurer has changed

Insurer's Name: FEIN:

Previous Adjuster:

New Adjuster:

Phone Number:

The Employer's Primary Adjuster (Exception Adjuster) has changed

Employer's Name: FEIN:

Insurer's Name: FEIN:

Previous Adjuster:

New Adjuster:

Phone Number:

Date:

Signed:

Title:

Please PRINT and Sign.

Mail to:

Resolver Section, DMU

Employment Relations Division

PO Box 8011

Helena, MT 59604-8011

Fax to: (406) 444-4140.

Email to: ljeffrey@mt.gov

What the Adjuster Change Form Is and When It’s Used

An Adjuster Change Form documents a request or authorization to transfer responsibility for an insurance claim from one claims adjuster to another. It records claim identifiers, current and new adjuster contact details, the effective date of the reassignment, and a signed authorization from a person with authority to direct claims handling. Organizations use this form to maintain an auditable chain of custody for claim decisions, to route future communications correctly, and to meet recordkeeping and regulatory expectations for claims handling and handling transparency.

Why a Clear Adjuster Change Form Matters

A well-structured Adjuster Change Form reduces processing delays, preserves a clear audit trail, and prevents misdirected communications that can delay payments or investigations. It supports compliance with claims handling rules and provides evidence of authorized delegation when regulatory questions arise.

Who Completes or Receives an Adjuster Change Form

Copies are typically distributed to the originating adjuster, the newly assigned adjuster, the claim file, and any external vendors that require the new point of contact.

Insurance claims staff and adjusters who need to document assignment changes and responsibilities for ongoing investigations or settlements.
Policyholders or authorized representatives who may request a reassignment or need to confirm the person handling their claim.
Third-party administrators, legal counsel, or vendor managers who coordinate assignments across carriers or service providers.

Essential Elements of a Professional Adjuster Change Form

A complete Adjuster Change Form combines identification, assignment details, authorization, timing, and supporting documentation to make reassignment effective and defensible. Design the form to collect all elements consistently and to integrate with claims systems.

Claim Identification

Claim number, policy number, insured name, loss date, and policy line to match the request with the correct file and avoid cross-file errors.

Current Adjuster

Name, company, email, phone, and internal ID for the outgoing adjuster so outstanding tasks can be closed or transferred and historical responsibility is preserved.

New Adjuster

Name, contact details, company affiliation, and effective start date for the incoming adjuster so all future communications route correctly.

Authority & Authorization

Name, title, relationship to the policy (e.g., claims manager, authorized rep), and signature block showing the person authorized to approve reassignments.

Effective Date & Scope

The exact date and any limits on duties being transferred, for example field inspections only or full settlement authority, to avoid role ambiguity.

Attachments & Notes

Supporting documents such as power-of-attorney, vendor assignments, or internal memos that explain the business reason for reassignment.

Step-by-Step: Complete and Process the Adjuster Change Form

Follow these steps to ensure the reassignment is recorded, authorized, and distributed to all affected parties without delaying claim handling.

01

Step 1 — Identify: Confirm claim and policy details before making changes.
02

Step 2 — Populate: Complete all form fields and attach supporting documents.
03

Step 3 — Authorize: Obtain signature from authorized manager or representative.
04

Step 4 — Distribute: Send updated form to file, outgoing adjuster, new adjuster, and vendors.

Where to File or Send the Completed Form

Routing ensures that claims teams, vendors, and policyholders all receive notice of the assignment change and that the claim file reflects the current responsible party.

Claims File: Upload the signed form to the official claim record in your claims management system.
Outgoing Adjuster: Send a copy to the prior adjuster for task closure and notes transfer.
Incoming Adjuster: Deliver a copy to the new adjuster to begin handling duties.
External Vendors: Notify vendors and contractors that need the new contact for inspections or payments.

How to Configure an Online Adjuster Change Workflow

Set up an online workflow to capture the data consistently, trigger approvals, and notify stakeholders automatically.

Field Mapping	Map form fields to your claims system identifiers for automated linking.
Authentication	Require business email or SSO authentication for signers to ensure attribution.
Approval Flow	Add an approval step for claims managers before final assignment.
Notifications	Configure email or system alerts to all parties upon completion.
Retention	Route a certified PDF copy to your records retention location.

Digital Signing and File Format Recommendations

Use secure e-signature and storage systems that preserve an audit trail and produce tamper-evident signed documents.

File Formats: PDF, DOCX supported for upload and signed export.
Authentication Options: Email link, SMS code, or SSO for signer verification.
Integrations: Connectors to Salesforce, NetSuite, Microsoft 365, and Box.

Store the signed PDF in your claims system or an approved document repository to ensure discoverability, auditability, and retention compliance.

Typical Timelines and Processing Expectations

Time requirements vary by carrier and internal SLA; using a standardized form and e-signature usually shortens processing time and improves traceability.

Policyholder Notice:

Notify the policyholder immediately upon adjuster reassignment.

Internal Assignment SLA:

Complete reassignment and file update within 5 business days.

Vendor Notification:

Inform external vendors within 2 business days of assignment change.

Effective Date:

Use the specified effective date; do not backdate without written justification.

Record Availability:

Signed form should be accessible in the claim file within 24 hours.

Common Mistakes to Avoid When Preparing the Form

Entering an incorrect claim number, which can attach the change to the wrong file and require manual remediation.
Leaving the authorization or signature block unsigned, which renders the reassignment unauthorized under company policy.
Failing to update vendor or billing contact details, causing missed inspections, payment delays, or duplicate work.
Using ambiguous scope language such as 'handle as needed' instead of specifying duties and limits for the new adjuster.

Risks and Potential Consequences of an Incorrect Form

Delayed Payment: Claim payments may be postponed.

Regulatory Scrutiny: State regulators may investigate mishandled assignments.

Liability Gaps: Critical tasks may be unaddressed.

Invalid Authorization: Unauthorized reassignments can be challenged.

Vendor Disputes: Vendors may refuse work without clear contact.

Data Integrity: Mismatched records increase audit risk.

eSignature Vendor Pricing and Capability Snapshot

Common eSignature vendors and entry-level pricing models. signNow is listed first per comparative convention; feature availability and plan terms vary by vendor and plan.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 env./user/yr	Varies	Varies	Varies

Security and Compliance for Signed Adjuster Change Forms

Encryption in Transit: TLS 1.2 / 1.3

Encryption at Rest: AES-256

Audit and Controls: SOC 2 Type II

Healthcare Compliance: HIPAA (BAA required)

Signature Laws: ESIGN and UETA compliance

Regulated Records: 21 CFR Part 11 support available

Real-world Examples of Digital Document Adoption

Organizations across sectors use e-signature workflows to speed processing and maintain compliance for routine administrative documents.

Optica Ventures (COO Brian Fitzgibbons)

Optica uses online signatures for participant-facing forms to reduce friction.

The interface is simple and easy-to-use.
The team reported easier client completion and fewer processing errors after moving forms online, improving turnaround without adding administrative staff.

Martin Properties (Founder Tim Martin)

Martin Properties adopted digital signatures for property and claims administration.

Mobile and offline signing worked well.
The company processed documents entirely online while maintaining compliance and security, enabling faster property claim resolutions across multiple offices.

Frequently Asked Questions About Adjuster Change Forms

Answers to common questions about authority, e-signing, notarization, corrections, revocation, and storage for Adjuster Change Forms.

Need help? Contact support

Is notarization required for an adjuster change?
Not generally. Adjuster reassignments usually require an authorized signature but not notarization. If the reassignment involves powers that require notarized delegation under specific state law, follow the state requirement or use a RON where allowed.
Can the Adjuster Change Form be signed electronically?
Yes. Electronic signatures meet legal validity under the ESIGN Act (15 U.S.C. ch. 96) and UETA where applicable, provided the signature shows intent, consent, attribution, and the record can be retained and reproduced.
Who has authority to sign the form?
An authorized claims manager, policyholder, or designated representative with delegation rights should sign. Confirm internal delegation policies and retain supporting authorization documents in the claim file.
How do I correct errors after submission?
Prepare a corrected Adjuster Change Form signed by the same authorized party noting the correction and effective date. Attach it to the original file and document why the change was needed for auditability.
Can the reassignment be revoked or canceled?
Yes. A revocation should be documented with a signed form or written instruction from an authorized party, including the effective revocation date and distribution to all previously notified parties.
Where should signed forms be stored?
Keep the signed form in the official claims management system and an archival repository for the retention period. Ensure access controls and retention follow IRS, HIPAA, or state regulator requirements where applicable.

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