Linder v. Insurance Claims Consultants, Inc.

560 S.E.2d 612, 348 S.C. 477, 2002 S.C. LEXIS 32
CourtSupreme Court of South Carolina
DecidedFebruary 25, 2002
Docket25417
StatusPublished
Cited by20 cases

This text of 560 S.E.2d 612 (Linder v. Insurance Claims Consultants, Inc.) is published on Counsel Stack Legal Research, covering Supreme Court of South Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Linder v. Insurance Claims Consultants, Inc., 560 S.E.2d 612, 348 S.C. 477, 2002 S.C. LEXIS 32 (S.C. 2002).

Opinion

WALLER, Justice.

We granted petitioners’ request to hear this declaratory judgment action in our original jurisdiction. Petitioners seek to have the Court declare that the actions of respondents, as public insurance adjusters, constitute the unauthorized practice of law. A lawsuit between these parties is currently pending in circuit court based on respondents’ claim against petitioners for breach of contract. That lawsuit has been stayed pending the Court’s decision in the instant matter.

*482 FACTUAL BACKGROUND

The factual background for this case is both general and specific. We first take a look at the business of public insurance adjusting, in general, and then detail the circumstances surrounding the dispute between the parties.

Public Insurance Adjusting

Insurance adjusting is the business of settling an insurance claim. Black’s Law Dictionary defines an “adjuster” as one “appointed to adjust [i.e., settle] a matter; ... One ... who makes any adjustment or settlement, or who determines the amount of a claim.” Black’s Law Dictionary 27 (6th ed.1991).

First-party public insurance adjusting involves the situation where “an insured hires a public adjuster to assist the insured in filing a claim of loss with its insurer” and is based on contract law. Utah State Bar v. Summerhayes & Hayden, 905 P.2d 867, 868 (Utah 1995). Specifically, a first-party adjuster is retained to:

determin[e] the amount of loss recoverable under the policy. The adjuster documents and measures damages, gathers relevant facts, determines repair or replacement costs, and submits the claim to the insurance company. The adjuster then negotiates with the insurance company, or the insurance company’s adjuster, to obtain the best settlement for the insured.

Id.

In contrast, third-party adjusting involves the situation where a “stranger to the insurance contract” asserts a claim against an insured tortfeasor. Id. “In third-party adjusting, an adjuster represents an injured client in making a claim under a liability insurance contract against an insurance company that insures or indemnifies a third person who is or may be liable for the injury caused to the adjuster’s client.” Id. at 870. Therefore, the third-party adjuster “must determine the extent of the liability, rights, and duties of the parties before attempting to resolve the issue of a settlement amount.” Id. at 868-69.

A first-party adjuster is generally considered to be synonymous with the term “public adjuster.” According to *483 the National Association-of Public Insurance Adjusters (NA-PIA), the term “Public Insurance Adjuster” means a representative of an insured regarding the adjustment of an insurance claim for loss resulting from “fire and its allied lines.” In its amicus brief, NAPIA asserts that the main question a public adjuster is hired to answer is that of “how much?” In that capacity, the public adjuster “documents and measures the damage caused by a property loss to the insured.”

Recently, a new South Carolina statute went into effect regulating public insurance adjusting. See S.C.Code Ann. §§ 38-48-10 through 160 (Supp.2000). Under the statute, “Public Adjusting” is defined as:

investigating, appraising or evaluating, and reporting to an insured in relation to a first party claim arising under insurance contracts, that insure the real or personal property, or both, of the insured. Public adjusting does not include acting in any manner in relation to claims for damages to or arising out of the operation of a motor vehicle. Public adjusting does not include any activities which may constitute the unauthorized practice of law. Nothing in this chapter shall be construed as permitting the unauthorized practice of law.

§ 38 — 48—10(2) (emphasis added). Thus, South Carolina restricts public adjusting to first-party claims involving only real or personal property. 1

Facts of the Underlying Lawsuit

Petitioners (“the Linders”) suffered property loss due to a fire at their home in February 1996. While their claim was being adjusted by the insurance company, the Linders had many concerns about how the repairs to their home were being handled. One of the repairmen recommended respondent Insurance Claims Consultants, Inc. (“ICC”) to Mrs. *484 Linder. Mrs. Linder called ICC and met with respondent Gerald Moore. 2

In that initial meeting with Moore, the Linders discussed the fact that the insurance company had rejected their claim for the full value of Mr. Linder’s gun collection. According to Mrs. Linder, Moore advised them the guns should be covered under their policy. Moore indicated that he advised the Linders to read their insurance policy and that he and Mr. Linder read the policy together. Respondent Jeffrey Raines states in an affidavit that they “were successful in obtaining payment for Mr. Linder’s guns which was originally and erroneously denied by the company.”

The Linders entered into a contract with ICC and agreed to pay ICC 10% of the total amount adjusted or otherwise recovered. In addition, they executed a “Notice” to their insurance company which indicated that ICC had been hired for the preparation of their claim and that ICC should be contacted for “any further information and negotiations” concerning their claim. After executing the contract with ICC, the Linders released the lawyer they had retained a couple of weeks before contacting ICC.

ICC communicated directly with the insurance company’s adjuster both orally and in writing, as well as with the insurance company’s attorney. The majority of the communications reflect that the adjusters concentrated on cost-related issues, such as completing the contents inventory and the sworn statement of proof of loss, as well as discussions on the extent and amount of repairs. Indeed, Raines stated that ICC spent over 300 man hours preparing the detailed inventory of the damaged household contents. According to Raines, ICC was able to obtain an almost $12,000 increase in what the insurance company originally agreed to cover. The Linders approved the claim, but the insurance company delayed payment. Raines stated that he then recommended to Mrs. Linder that she get an attorney. When the attorney settled the claim, the Linders executed a release of all claims.

On a “fact sheet” given to Mrs. Linder by Moore, ICC describes itself as a “professional Loss Consulting Firm” *485 which represents a client’s “best interest” while handling a property damage claim. The fact sheet states that ICC will provide, inter alia:

Free access — add to your briefcase to read the full text and ask questions with AI

Related

U.S. Bank National Association v. Frances L. Mack
Supreme Court of South Carolina, 2025
Ex Parte Patrick Booker v. State of South Carolina
Supreme Court of South Carolina, 2024
Westbrook v. Murkin Group
Supreme Court of South Carolina, 2020
Boone v. Quicken Loans, Inc.
803 S.E.2d 707 (Supreme Court of South Carolina, 2017)
Rogers Townsend & Thomas, PC v. Peck
797 S.E.2d 396 (Supreme Court of South Carolina, 2017)
H & H of Johnston, LLC v. Old Republic National Title Insurance
748 S.E.2d 72 (Court of Appeals of South Carolina, 2013)
Wells Fargo v. Watkins
Court of Appeals of South Carolina, 2013
Wachovia Bank, N.A. v. Coffey
698 S.E.2d 244 (Court of Appeals of South Carolina, 2010)
Dema v. Tenet Physician Services-Hilton Head, Inc.
678 S.E.2d 430 (Supreme Court of South Carolina, 2009)
Dema v. TENET PHYSICIAN SERVICES-HILTON
678 S.E.2d 430 (Supreme Court of South Carolina, 2009)
Roberts v. LaConey
650 S.E.2d 474 (Supreme Court of South Carolina, 2007)
Franklin v. Chavis
640 S.E.2d 873 (Supreme Court of South Carolina, 2007)
Hambrick v. GMAC Mortgage Corp.
634 S.E.2d 5 (Court of Appeals of South Carolina, 2006)
Brown v. Citifinancial, Inc.
414 F. Supp. 2d 561 (D. South Carolina, 2006)
Roof Doctor, Inc. V. Birchwood Holdings, Ltd.
622 S.E.2d 746 (Court of Appeals of South Carolina, 2005)
Adkins v. South Carolina Department of Corrections
602 S.E.2d 51 (Supreme Court of South Carolina, 2004)
Housing Authority v. Key
572 S.E.2d 284 (Supreme Court of South Carolina, 2002)

Cite This Page — Counsel Stack

Bluebook (online)
560 S.E.2d 612, 348 S.C. 477, 2002 S.C. LEXIS 32, Counsel Stack Legal Research, https://law.counselstack.com/opinion/linder-v-insurance-claims-consultants-inc-sc-2002.