Insurance Adjuster Stipulation Form

INSURANCE ADJUSTER STIPULATION FORM

This Insurance Adjuster Stipulation Form is entered into on Effective Date: by and between Insurer Name: and Adjuster Name: . Claim Number: Policy Number: . Date of Loss:

RECITALS

WHEREAS, the Insurer is obligated under the insurance policy identified above to investigate, adjust and, where appropriate, pay amounts for covered loss arising from the Date of Loss; and

WHEREAS, the Adjuster is retained by the Insurer to perform claims adjusting services for the Claim Number described above pursuant to the terms and limitations set forth in this Stipulation; and

WHEREAS, the parties desire to set forth in writing the Adjuster’s authority, duties, reporting requirements, compensation, confidentiality obligations and related terms.

NOW THEREFORE, in consideration of the mutual covenants and agreements contained herein, the parties agree as follows:

1. DEFINITIONS

For purposes of this Stipulation, the following terms shall have the meanings given below: "Claim" means the claim identified by Claim Number; "Policy" means the insurance policy identified by Policy Number; "Adjuster" means the individual or entity named as Adjuster Name; "Insurer" means the named Insurer.

2. SCOPE OF AUTHORITY

The Adjuster is authorized to investigate the Claim, gather and evaluate evidence, obtain inspections, interview relevant persons, approve repairs in accordance with insurer guidelines, and to settle covered claims up to the Limit of Settlement expressly set forth below. Any authority not expressly granted remains reserved to the Insurer.

3. ADJUSTER DUTIES AND PERFORMANCE STANDARDS

The Adjuster shall perform services in a prompt, competent and professional manner consistent with industry standards and applicable law. The Adjuster warrants that work will be performed by persons with appropriate qualifications and licensure where required. The Adjuster shall not unreasonably delay investigation, approval, or payment of covered amounts.

4. REPORTING, RECORDS AND TIMETABLES

The Adjuster shall provide written interim reports and a final written report summarizing findings, work performed, amounts paid or recommended, and all supporting documentation. Reports shall be provided in accordance with the schedule below.

5. COMPENSATION AND EXPENSES

The Insurer shall pay the Adjuster fees as follows: a base fee, and reimbursement for preapproved out-of-pocket expenses incurred in the performance of services. All fees and expenses are subject to the rates and caps set forth below.

6. CONFIDENTIALITY

The Adjuster shall maintain confidential all non-public information obtained in the course of investigating or adjusting the Claim, including claimant medical records, privileged communications, and insurer proprietary materials. Confidential information shall not be disclosed except as required by law or with the Insurer's prior written consent.

7. RELEASE AND NO ADMISSION

Any payment or settlement authorized by the Adjuster pursuant to the authority granted herein does not constitute an admission of liability by the Insurer. The Insurer reserves all defenses arising under the Policy and applicable law.

8. INDEMNIFICATION

The Adjuster shall indemnify and hold harmless the Insurer from and against any claims, liabilities or expenses (including reasonable attorneys' fees) arising from the Adjuster’s negligent acts, errors, or omissions in the performance of services under this Stipulation, except to the extent caused by Insurer bad faith or deliberate misconduct.

9. TERM; TERMINATION

This Stipulation shall commence on the Effective Date and continue until the final report has been delivered and all obligations are satisfied, unless earlier terminated by either party on written notice for material breach, failure to perform, or as otherwise set forth herein. Termination shall not relieve either party of obligations accrued prior to termination.

10. INSURANCE AND LICENSURE

The Adjuster represents and warrants that it maintains all licenses required by applicable law to perform adjusting services and maintains professional liability or errors and omissions insurance in amounts adequate for the scope of services. The Adjuster shall provide certificates of insurance upon request.

11. NOTICES

All notices required or permitted under this Stipulation shall be in writing and delivered to the addresses below by hand, certified mail, or overnight courier and shall be effective upon receipt.

12. AMENDMENT; WAIVER

No amendment, modification or waiver of any provision of this Stipulation shall be effective unless in writing and signed by both parties. The failure of either party to enforce any provision shall not constitute a waiver of future enforcement of that or any other provision.

13. COUNTERPARTS

This Stipulation may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

14. GOVERNING LAW; DISPUTE RESOLUTION

This Stipulation shall be governed by and construed in accordance with the laws of the jurisdiction specified below without regard to conflict of law principles. Any dispute arising out of or relating to this Stipulation shall be submitted to binding arbitration before a neutral arbitrator if the parties cannot resolve the dispute within thirty (30) days after written notice of dispute.

15. ENTIRE AGREEMENT; SEVERABILITY

This Stipulation constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior negotiations and agreements. If any provision is held invalid or unenforceable, such provision shall be modified to the minimum extent necessary to make it enforceable, and the remaining provisions shall continue in full force and effect.

ADDITIONAL PROVISIONS

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