Is an electronic signature valid?

Yes. Electronic signatures are generally valid under the federal ESIGN Act (15 U.S.C. §7001) and state UETA acts, provided intent, consent, attribution, and record retention requirements are met.

Do I need a notary or witnesses?

It depends on state law and the addendum’s content. Some states or lenders may require notarization or witnesses for certain instruments; confirm local requirements before execution.

Can the public adjuster sign releases?

Only if the addendum explicitly grants that authority. Absent clear written authority, the adjuster should not sign releases that extinguish policyholder rights.

How to fix a missing signature?

If a signature is missing, have the party sign a correction or amendment; maintain an audit trail of the amendment and date of change for evidentiary purposes.

Is remote notarization acceptable?

Many states permit Remote Online Notarization (RON) with identity proofing and audio-video recording requirements; check state notary rules and RON status before relying on it.

What if the adjuster’s license is expired?

An expired license may limit enforceability and violate state insurance regulations. Renew promptly and consider seeking legal advice if an expired-license situation affects past signings.

Electronic Signature
Templates
Insurance
Insurance Public Adjuster Addendum

Insurance Public Adjuster Addendum

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

INSURANCE PUBLIC ADJUSTER ADDENDUM

This Insurance Public Adjuster Addendum amends and supplements the engagement between the Insured and the Public Adjuster. Client Name: ; Public Adjuster Firm: ; Effective Date: .

1. Insured and Contact Information

Insured Name Insured Address

Date of Birth

Phone

Email

2. Policy Information

Insurer: Policy Number: Policy Type:

Coverage Amount

Deductible

Premium

Policy Period From: To:

3. Scope of Services

The Public Adjuster will provide the following services as authorized by the Insured. Select all services to be provided and initial any additional terms in the space provided.

Services (check applicable): Inspect loss location and prepare damage report Prepare and present claim to Insurer Negotiate settlement on behalf of the Insured Retain experts, contractors, and consultants as necessary Attend inspections, examinations under oath, and meetings Handle subrogation coordination with third parties

Additional Scope or Limitations

4. Fee, Costs, and Payment

Fee Structure (select applicable method and provide amounts). The Insured authorizes fees and costs as set forth below and acknowledges that fees are earned upon recovery or settlement.

Contingency Fee

Contingency Percentage: Maximum Fee Cap (if any):

Flat Fee

Flat Fee Amount:

Costs Advanced by Adjuster (recoverable)

The Insured authorizes the Public Adjuster to deduct agreed fees, costs, and disbursements from claim proceeds prior to disbursement. The Public Adjuster will provide an itemized statement of fees and costs at the time of settlement.

5. Assignment, Authorization and Release

The Insured hereby authorizes the Public Adjuster to act as the Insured's representative with respect to the claim and grants the following limited authorities:

Access and obtain copies of policy, claim file, adjuster notes, estimates, photographs, and related records from the Insurer and third parties.
Prepare, sign, and submit proof of loss, supplements, and other claim documentation on behalf of the Insured consistent with the engagement.
Negotiate and accept settlements subject to the Insured's final approval when required by law or policy.

Assignment of Proceeds (if applicable)

6. Coverage Selections and Limits

Select the coverages subject to this engagement and provide applicable policy limits where known.

Property Damage

Limit:

Business Interruption

Limit:

Contents / Personal Property

Limit:

Liability

Limit:

7. Exclusions and Acknowledgements

The Public Adjuster will not provide legal representation in litigation, defend criminal matters, or assume obligations not expressly stated herein. The following exclusions apply to this engagement:

Coverage disputes that require litigation unless separately retained for such services.
Pre-existing conditions or losses not timely reported to the Insurer unless expressly agreed in writing.
Matters outside the enumerated scope without written amendment.

Insured acknowledges and accepts the exclusions and limits set forth above.

8. Claims Documentation

Date of Loss

Description of Loss Estimated Damage Amount Documentation Checklist Photographs of damage Contractor or repair estimates Receipts for repairs or replaced property Police, fire, or incident reports (if applicable)

9. Confidentiality and Records

The Public Adjuster will maintain confidentiality of Insured information except as necessary to pursue the claim. The Insured authorizes release of claim and policy information to the Public Adjuster and consents to limited sharing with experts and contractors engaged to pursue recovery.

10. Term, Termination, and Revocation

This Addendum shall remain in effect until the claim is finally resolved or the engagement is terminated by either party with written notice. Termination does not relieve the Insured of obligations to pay fees that were earned prior to termination as set forth in this Addendum.

Notice Period for Termination (days)

11. Dispute Resolution

Parties agree to attempt good-faith negotiation of disputes. If unresolved, disputes shall be resolved by binding arbitration unless the parties agree otherwise. The arbitration shall be conducted in the county of the Insured's principal residence unless otherwise agreed in writing.

Insured agrees to arbitration as primary dispute resolution method Applicable Jurisdiction for Arbitration

12. Indemnification and Liability

The Public Adjuster shall perform services with reasonable care and skill. The Insured agrees to indemnify and hold harmless the Public Adjuster from third-party claims arising from services provided in good faith, except to the extent such claims arise from gross negligence or willful misconduct by the Public Adjuster.

13. Representations and Warranties

The Insured represents that the information provided herein and in any claim submissions is true, complete, and accurate to the best of the Insured's knowledge. The Insured will promptly notify the Public Adjuster of changes in material facts or new information relevant to the claim.

14. Beneficiary Designation for Recovery Proceeds

If proceeds are to be directed to a third party or held for payment of obligations, provide beneficiary details below. If none, enter "None".

Beneficiary Name

Relationship

Percentage of Recovery

15. Certification and Acknowledgment

By signing below, the Insured certifies that they have read and understand this Addendum, that they authorize the Public Adjuster to act as described, and that all information provided is true and complete. The Insured acknowledges receipt of a copy of this Addendum.

Applicant Name:

By:

Date:

What the Insurance Public Adjuster Addendum Is

An Insurance Public Adjuster Addendum is a contract attachment that documents the scope, authority, and compensation terms when a policyholder engages a public adjuster to represent a claim. It clarifies the adjuster’s duties, time limits, commission or fee formulas, dispute resolution, and any limits on settlement authority, and it is appended to the underlying insurance claim submission or representation agreement to avoid ambiguity during claims handling.

Why a Clear Addendum Matters for Claims

A well-drafted addendum reduces disputes by documenting authority, payment terms, and deadlines. It protects the policyholder and adjuster by creating a written record of expectations that insurers and third parties can review.

Who Typically Completes This Addendum

Parties and professionals involved should complete or review the addendum prior to any substantive claim action.

Policyholders and insureds who engage a licensed public adjuster to file or negotiate claims on their behalf.
Licensed public adjusters who need to document limited or full authority to settle, negotiate, or sign releases.
Insurance company representatives or third-party administrators reviewing documentation of representation and fee arrangements.

Each signer should confirm licensing, identity, and statutory disclosure obligations before executing the addendum.

Signers and Their Roles

Policyholder / Named Insured

The individual or entity named on the insurance policy. Must confirm identity, sign to delegate specified claim authority, and acknowledge fee arrangements and any conflict disclosures.

Public Adjuster

A licensed claims representative acting for the insured. Should state license number, scope of representation, commission or fee terms, and sign to accept the assignment and related obligations.

Step-by-Step: Completing and Executing the Addendum

Follow these steps in order to prepare a clear, enforceable addendum that integrates with the existing claim file.

01

Prepare Document: Attach to the claim or representation agreement.
02

Verify Identities: Confirm policyholder and adjuster IDs.
03

Define Authority: Specify negotiation and settlement powers.
04

Sign and Date: All parties sign and date the addendum.

Digital Workflow Settings for Online Completion

Configure the online form to capture required fields, signer authentication, and an auditable completion record.

Field	Configuration
Required Fields	Make name, license, and fee fields required.
Authentication	Use email or SMS code for signer verification.
Attachments	Allow photos of damage and policy pages.
Audit Trail	Capture IP, timestamp, and signer events.

Typical Submission and Routing Flow

A concise routing flow ensures each party receives the right view and signed copy at each stage of the claim lifecycle.

Upload: Sender uploads the addendum to the claim file.
Assign Fields: Place signature, date, and required fields.
Send to Signers: Notify policyholder and adjuster by email/SMS.
Archive: Store signed copy in claim records.

Platform and Integration Considerations

Ensure the signing platform supports audit trails, secure storage, and integrations your organization uses.

Integrations: Salesforce, NetSuite, Google Workspace
File Formats: PDF, DOCX, HTML
Authentication: Email, SMS, or advanced options

Where PHI or sensitive data is present, confirm HIPAA BAA and encryption standards with your vendor and documentation.

Core Components of a Professional Addendum

A complete addendum is concise but explicit: it identifies parties, defines authority, sets compensation, records limits, and prescribes dispute handling and record retention.

Parties Identified

Full legal names, policy number, and contact details for the insured and public adjuster to avoid future identity or authority disputes.

Authority Scope

A clear description of the adjuster’s powers (inspect, evaluate, negotiate, sign releases) with explicit exclusions or monetary limits stated.

Compensation Terms

Detailed fee or commission formula, payment timing, whether fees are calculated on gross or net recoveries, and how expenses are handled.

Licensing & Disclosures

State adjuster license numbers and any statutorily required disclosures about conflicts, referrals, or contingency arrangements.

Term & Termination

Effective date, expiration, automatic termination conditions, and procedures to revoke authority or substitute representatives.

Dispute Resolution

Governing law, venue, mediation/arbitration clauses, and whether attorney fees are recoverable in disputes over the addendum.

Security and Compliance Checklist

Encryption: TLS 1.2/1.3 in transit

Data at Rest: AES-256 encryption

Audit Trail: IP, timestamp, and event log

HIPAA: BAA required for PHI

ESIGN / UETA: Meets ESIGN and UETA standards

Access Control: Role-based signer permissions

Key Risks if the Addendum Is Incorrect

Invalid Authority: Adjuster lacks legal power

Commission Disputes: Disagreements on fee basis

Regulatory Fines: State licensing violations

Claim Delays: Insurer rejects or pauses processing

Evidence Gaps: Missing signatures or dates

Confidentiality Breach: Improper PHI handling

Common Preparation Errors to Avoid

Using informal language about authority instead of precise, contract-style limits and powers for the adjuster.
Failing to include the adjuster’s license number or issuing state, a typical request from insurers during verification.
Leaving fee calculations vague (e.g., 'reasonable percentage') instead of stating a specific percentage or fee schedule.
Not attaching required policy pages, proof of loss, or supporting damage documentation when submitting the addendum.

Time-Sensitive Dates to Track with an Addendum

Monitor execution, submission to insurer, payment milestones, and any statutory or policy notice windows applicable to the underlying claim.

Execution Date:

Date when all parties sign; use MM/DD/YYYY format

Submission to Insurer:

Submit addendum with claim documentation promptly to avoid processing delays

Fee Payment Window:

Specify when commission is payable (e.g., on settlement or within X days)

Revocation Period:

If allowed, state how long a party may revoke authority

Record Retention Start:

Retention clock begins on execution or final settlement date

Key Milestones from Signing to Settlement

Track these numbered milestones to keep the claim moving and ensure obligations tied to the addendum are fulfilled.

01

1. Sign and Date

All parties execute the addendum and note the effective date.

02

2. Submit to Insurer

Upload signed addendum to the insurer and attach supporting claim materials.

03

3. Insurer Acknowledgement

Insurer confirms receipt and validates representation or requests clarification.

04

4. Settlement or Dispute

Negotiate settlement under the documented authority or initiate dispute resolution per the addendum.

Representative eSignature Pricing and Capabilities

Below is a concise vendor comparison of core pricing and capability dimensions relevant when digitally executing addenda. signNow is listed first per platform comparison conventions.

	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 by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Common Questions About the Insurance Public Adjuster Addendum

Answers below address enforceability, electronic signing, notarization, and how to correct the most frequent execution errors.

Need help? Contact support

Is an electronic signature valid?
Yes. Electronic signatures are generally valid under the federal ESIGN Act (15 U.S.C. §7001) and state UETA acts, provided intent, consent, attribution, and record retention requirements are met.
Do I need a notary or witnesses?
It depends on state law and the addendum’s content. Some states or lenders may require notarization or witnesses for certain instruments; confirm local requirements before execution.
Can the public adjuster sign releases?
Only if the addendum explicitly grants that authority. Absent clear written authority, the adjuster should not sign releases that extinguish policyholder rights.
How to fix a missing signature?
If a signature is missing, have the party sign a correction or amendment; maintain an audit trail of the amendment and date of change for evidentiary purposes.
Is remote notarization acceptable?
Many states permit Remote Online Notarization (RON) with identity proofing and audio-video recording requirements; check state notary rules and RON status before relying on it.
What if the adjuster’s license is expired?
An expired license may limit enforceability and violate state insurance regulations. Renew promptly and consider seeking legal advice if an expired-license situation affects past signings.

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