Is notarization always required?

Not always. Notarization depends on state law and whether the agreement grants powers that require acknowledgment. Check state requirements or include a notary block when in doubt to strengthen evidentiary value.

Can this agreement be signed electronically?

Yes, electronic signatures are legally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states, provided the parties consent and the platform preserves an audit trail and the record can be reproduced.

What licensing info must the adjuster provide?

Include the adjuster's full name, state license number, and issuing state as required by many state insurance departments; failure to disclose may create regulator issues.

How should fees be stated?

Specify exact fee percentages, flat fees, or hourly rates and any caps mandated by state law; avoid vague wording that invites disputes or regulator scrutiny.

Can the adjuster receive settlement funds directly?

Only if expressly authorized in writing and permitted by state law and the insurer's procedures; include clear instructions on payment routing and accounting to avoid misappropriation risks.

How long should I keep signed agreements?

Retain the agreement and supporting claim records for at least three years after filing and longer if subject to HIPAA (6 years) or possible litigation; follow IRS and state retention guidelines.

Electronic Signature
Templates
Insurance
Insurance Public Adjuster Agreement

Insurance Public Adjuster Agreement

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

Insurance Public Adjuster Agreement

Parties and Identification

Client Name:

Client Address Date of Birth

Policy Information

Insurer / Carrier Name Policy Number

Policy Type: Homeowners Commercial Property Flood Wind/Hail Other

Coverage Limit / Coverage Amount Deductible Premium (most recent)

Policy Period Start: End:

Scope of Engagement

The Client hereby retains Public Adjuster to act as the Client’s representative with respect to the claim arising from loss under the above policy(ies) (the Claim). The Public Adjuster shall: inspect damage; prepare claim documentation and inventories; present claims and negotiate with the insurer on Client's behalf; attend inspections and meetings; and provide periodic written status updates. The authority granted is limited to matters related to the Claim unless otherwise agreed in writing.

Specific Services to be Performed (check all that apply)

Property inspection and scope of loss
Prepare and submit proof of loss and supporting documentation
Negotiate settlement with insurer
Obtain repair and replacement estimates
File appeal or demand for reconsideration

Fees, Expenses and Payment

Contingent Fee: Client agrees to pay Public Adjuster a contingent fee of of the gross recovery recovered from the insurer on account of the Claim, payable from proceeds of any settlement, award or recovery.

Minimum or Cap (if applicable):

Expenses: Client shall reimburse reasonable, documented out-of-pocket expenses advanced by Public Adjuster for the prosecution of the Claim (e.g., appraisal, estimates, travel, filing fees). Reimbursement shall occur from claim proceeds at the time of settlement unless otherwise agreed in writing.

Payment Allocation Instructions (if recovery payable to multiple payees)

Client Authorizations and Releases

Client authorizes Public Adjuster to act on Client's behalf for the purposes of investigating, preparing, negotiating and settling the Claim, including the authority to obtain policy, claim, adjuster, contractor and repair records from third parties. Client authorizes insurer(s) and third parties to release claim and policy information to Public Adjuster.

Client releases and indemnifies Public Adjuster from liability for any act or omission performed in good faith consistent with this Agreement. Client acknowledges Public Adjuster does not guarantee a particular recovery amount or outcome.

Client Obligations

Client shall: (a) provide truthful, complete and timely information and documentation; (b) promptly forward all insurer correspondence to Public Adjuster; (c) not independently settle or release the Claim without prior written notice to Public Adjuster where Public Adjuster’s fee is claimed; and (d) cooperate in good faith with reasonable requests by Public Adjuster.

Exclusions and Limitations

Public Adjuster shall not: provide legal advice, represent Client in court, assume liability for pre-existing conditions unrelated to the Claim, or guarantee repair performance by contractors. Services do not include professional engineering or structural certifications unless expressly agreed in writing.

Known Exclusions (check if applicable)

Suspected fraud or material misrepresentation
Pre-existing damage not related to the Claim
Perils not covered by policy

Claim-specific Information

Date of Loss Brief Description of Loss Estimated Damage / Preliminary Estimate Documentation Checklist (check provided)

Photographs of damage
Contractor or repair estimates
Receipts for temporary repairs
Copy of current policy

Beneficiary / Payee Designation for Disbursement

If settlement proceeds are to be disbursed to multiple parties, specify names, relationship to Client, and percentage allocation.

Beneficiary Name Relationship to Client Percentage of Proceeds

Term, Termination and Post-Termination Rights

This Agreement shall commence on the date of Client signature and continue until final disposition of the Claim, unless earlier terminated by either party with seven (7) days written notice. Termination shall not affect obligations to pay fees and expenses earned prior to termination. Client agrees that Public Adjuster’s fee applies to any recovery obtained after termination that arises from the Claim if substantially resulting from services provided under this Agreement.

Dispute Resolution; Governing Law

Any dispute arising out of this Agreement shall be submitted to binding arbitration in the county of the insured property under the rules mutually agreed upon at the time of dispute. This Agreement shall be governed by the substantive law of the state where the insured property is located.

Miscellaneous Provisions

Entire Agreement: This Agreement contains the entire understanding of the parties regarding the Claim and supersedes prior negotiations. Amendment: Any amendment must be in writing and signed by both parties. Assignment: Client may not assign this Agreement without written consent of Public Adjuster.

Acknowledgment and Certification

By signing below, Client certifies that the information provided in this Agreement is true and accurate to the best of Client’s knowledge, authorizes Public Adjuster to proceed as described, and acknowledges receipt of a copy of this Agreement.

Insured (Client) — Print Name:

By:

Date:

Public Adjuster — Print Name:

By:

Date:

What the Insurance Public Adjuster Agreement Is and when it applies

An Insurance Public Adjuster Agreement is a written contract that appoints a licensed public adjuster to represent a policyholder in preparing, filing, and negotiating an insurance claim. It defines the scope of services — inspection, damage estimation, documentation, and claim negotiation — plus fees, term, and client obligations. The agreement establishes authority to communicate with the insurer and may grant limited rights to sign claim documents on the policyholder's behalf. Use this agreement when a policyholder engages a public adjuster to ensure roles, compensation, and legal compliance are clear.

Why a clear agreement matters for claims and compliance

A written Insurance Public Adjuster Agreement protects the policyholder and adjuster by defining duties, fees, timelines, and dispute resolution, reducing misunderstandings and evidencing consent for insurer interactions.

Who typically completes or signs this agreement

Parties should confirm the adjuster holds the required state license and that the signed agreement matches any state-required disclosure or fee limits.

Policyholders and homeowners engaging a public adjuster to document and negotiate an insurance claim, including residential and commercial property owners.
Licensed public adjusters and their firms who must collect client authorization and disclose fee terms under state adjuster statutes.
Insurance attorneys or advocates assisting clients with complex or denied claims where specialized negotiation authority is required.

Typical signer profiles and responsibilities

Policyholder

The individual or entity that owns the insurance policy. Responsible for approving the adjuster's authority, providing documentation, and signing the agreement; retains final decision on settlement acceptance.

Public Adjuster

A state-licensed professional who inspects damage, prepares the claim, negotiates with the insurer, and may execute claim-related documents if authorized. Must comply with state adjuster statutes and disclosure rules.

Core provisions to include in a professional agreement

A complete Insurance Public Adjuster Agreement addresses scope, fees, duration, authority, disclosures, and dispute resolution to align expectations and meet regulatory requirements.

Scope of Services

Specify duties such as inspection, estimating loss, preparing proof of loss, submitting documentation, and negotiating with the insurer; identify exclusions and deliverables.

Fee Structure

State the compensation method (percentage of recovery, flat fee, hourly), timing of payment, and any caps required by state law to avoid regulatory issues.

Authority Granted

Describe whether the adjuster may sign settlement documents, receive payments, or act as attorney-in-fact; limit powers to what the client authorizes.

Term and Termination

Define when the agreement begins and ends, grounds for early termination, notice requirements, and obligations on termination such as final accounting.

State Disclosures

Include license number, required statutory disclosures, contingency fee caps, and consumer-rights language mandated by the state's insurance regulator.

Dispute Resolution

Specify governing law, arbitration or court forum, and any notice periods for disputes; identify the state whose law will interpret the agreement.

Step-by-step: completing the agreement

Follow these four steps to prepare and execute a compliant agreement.

01

Gather documents: Collect policy, IDs, and damage evidence before drafting.
02

Draft terms: Specify scope, fee, and termination in clear language.
03

Disclosures: Add state-required notices and license details.
04

Sign and notarize: Execute with required signatures and notarization if applicable.

Configuring a digital workflow for this agreement

Use a consistent electronic workflow to collect signatures, attach supporting evidence, and preserve an audit trail for regulatory compliance.

Field	Configuration
Signer authentication	Email + SMS code or ID verification for high-assurance signers
Conditional fields	Show fee/authorization fields only when specific options are selected
Template reuse	Store approved templates to ensure consistent disclosures across clients
Integrations	Connect to document storage and CRM for audit logging

Typical e-signing flow when using an electronic platform

An electronic signing platform streamlines document delivery, signer authentication, and evidence capture for the agreement.

Upload document: Sender uploads the agreement PDF or DOCX.
Place fields: Add signature, date, and conditional fields.
Send to signer: Generate secure email/SMS link for the client.
Capture audit trail: Platform records timestamps, IP, and actions.

Technical considerations for secure eSubmission

Ensure the provider offers required compliance features such as tamper-evident PDFs and records retention to satisfy ESIGN/UETA and state regulator expectations.

File formats: PDF and DOCX support
Authentication: Email, SMS, or ID verification
Integrations: Connectors for CRM and storage

Common mistakes to avoid when preparing the agreement

Failing to include the adjuster's state license number and required statutory disclosures can render the contract noncompliant with regulator rules.
Using vague fee language such as 'reasonable percent' without numeric detail invites disputes and may violate state contingency fee limits.
Granting overly broad authority to sign on the policyholder's behalf without explicit limits can expose the client to unwanted settlements.
Neglecting to attach necessary documents—policy declarations, proof of loss, photos—delays claim submission and weakens negotiating position.

Penalties and legal risks of an incorrect or missing agreement

Regulatory fines: Civil penalties by state insurance regulators

Contract disputes: Fee or authority disagreements may lead to litigation

Claim denial: Insurer challenges to standing or authority

Tax consequences: Incorrect reporting could trigger backup withholding

Professional discipline: License suspension or revocation

Document rejection: Insurer may refuse unsigned or improperly executed claims

Timing considerations and typical deadlines

Be mindful of insurer notice requirements, policy-specific deadlines, and statute of limitations that affect claim eligibility and recovery.

Immediate notice:

Notify insurer per policy periods (often within days of loss)

Proof of loss:

Submit when requested; policies set specific timelines

Statute of limitations:

State law governs; often 1–6 years for contract claims

Tax reporting:

Report fee income correctly for the year received

I-9 and employment:

If employing staff, retain I-9 per federal rules

Real-world examples of how the agreement is used

These condensed examples show common scenarios where a public adjuster agreement clarifies roles and outcomes.

Residential Wind Damage

A homeowner hires a licensed adjuster to document hurricane damage and file a claim

Adjuster compiles estimates and negotiates with the insurer
The agreement specifies a 10% contingency fee, requires license disclosure, and limits adjuster signing authority to claim forms.

Commercial Roof Loss

A small business engages an adjuster for roof and inventory loss after a storm

Adjuster coordinates with contractor estimates and insurer adjusters
Agreement attaches project schedule, authorizes access to the site, and requires invoices for any advance payments.

Comparing eSignature vendors for signing and storing this agreement

Basic vendor capabilities and starting prices for common eSignature providers; signNow is listed first per provider comparison rules.

	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, no card	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

Frequently asked questions about completing and using this agreement

Answers to routine questions about execution, notarization, authority, and electronic signing for the Insurance Public Adjuster Agreement.

Need help? Contact support

Is notarization always required?
Not always. Notarization depends on state law and whether the agreement grants powers that require acknowledgment. Check state requirements or include a notary block when in doubt to strengthen evidentiary value.
Can this agreement be signed electronically?
Yes, electronic signatures are legally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states, provided the parties consent and the platform preserves an audit trail and the record can be reproduced.
What licensing info must the adjuster provide?
Include the adjuster's full name, state license number, and issuing state as required by many state insurance departments; failure to disclose may create regulator issues.
How should fees be stated?
Specify exact fee percentages, flat fees, or hourly rates and any caps mandated by state law; avoid vague wording that invites disputes or regulator scrutiny.
Can the adjuster receive settlement funds directly?
Only if expressly authorized in writing and permitted by state law and the insurer's procedures; include clear instructions on payment routing and accounting to avoid misappropriation risks.
How long should I keep signed agreements?
Retain the agreement and supporting claim records for at least three years after filing and longer if subject to HIPAA (6 years) or possible litigation; follow IRS and state retention guidelines.

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