South Carolina § 38-47-10 - Licenses required for adjusters; exemptions; automated claims adjudication system; denied claims.

§ 38-47-10. Licenses required for adjusters; exemptions; automated claims adjudication system; denied claims.

(A) An individual commonly called an adjuster, adjusting losses for an insurer licensed to do business in this State, must be licensed by the director or his designee. These individuals shall apply for a license on a form prescribed by the director or his designee. The director or his designee shall satisfy himself that each applicant for an adjuster's license is an individual of good moral character, has sufficient knowledge of the insurance business and his duties as an adjuster, has not violated the insurance laws of the State, and is a fit and proper individual for the position. No license may be issued to a nonresident adjuster who resides in a state refusing to license South Carolina adjusters.

(B) The following individuals are exempt from licensure as an adjuster:

(1) A producer licensed under Chapter 43 is not required to comply with this section.

(2) An individual who, for portable electronics insurance, collects claim information from, or furnishes claim information to, insureds or claimants and who conducts data entry, including entering data into an automated claims adjudication system, provided that no more than twenty-five such persons are under the supervision of a licensed adjuster or a licensed producer who is otherwise exempt from licensure pursuant to item (1).

(C) For purposes of this section, "automated claims adjudication system" means a preprogrammed computer system designed for the collection, data entry, calculation, and final resolution of portable electronics insurance claims that:

(1) only may be used by a licensed adjuster, licensed producer, or supervised individuals operating pursuant to this paragraph;

(2) must comply with all claims payment requirements of the insurance code; and

(3) must be certified as compliant with this section by a licensed independent adjuster who is an officer of the entity or an affiliate of the entity that employs an individual operating pursuant to this section.

(D) If the insured's claim is denied and the insured contests the denial, an individual licensed under this section must review the denial with the insured.

HISTORY: Former 1976 Code SECTION 38-47-10 [1947 (45) 322; 1952 Code SECTION 37-201; 1962 Code SECTION 37-201] recodified as SECTION 38-45-10 by 1987 Act No. 155, SECTION 1; Former 1976 Code SECTION 38-49-10 [1947 (45) 322; 1952 Code SECTION 37-221; 1962 Code SECTION 37-221] recodified as SECTION 38-47-10 by 1987 Act No. 155, SECTION 1; 1993 Act No. 181, SECTION 681; 2012 Act No. 281, SECTION 1, eff June 26, 2012.