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Adjuster Experience Survey
*
Indicates required field
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Date of Birth
*
Email
*
Phone Number
*
Can you receive text communications on your mobile phone?
*
Yes
No
Select your mobile carrier:
*
None
Alltel
AT&T
Bell Mobility (Canada)
Cellular South
Cincinnati Bell
Fido (Canada)
I Wireless
Manitoba Telecom Systems (Canada)
Metro PCS
Microcell (Canada)
NBTel (Canada)
PageMart (Canada)
PageNet (Canada)
Rogers
Sprint
Telus
T-Mobile
US Cellular
Verizon Wireless
Emergency Contact Person
*
First
Last
Emergency Contact Phone
*
Xactimate:
What version of Xactimate do you use?
*
Xactimate 25 or earlier
Xactimate 27.3
Xactimate 27.5
Xactimate 28
What's Xactimate?
Xactnet Address
*
Is your Xactimate subscription current?
*
Yes
No
Property Experience
Catastrophe
Are you currently available for domestic deployment?
*
Yes
No
Do you have commercial Cat experience?
*
Yes
No
How many commercial property Cat claims have you worked in the past 5 years?
*
International
Do you have a current passport?
*
Yes
No
Are you an experienced international adjuster interested in receiving international claims?
*
Yes
No
Are you interested in working claims internationally, but have no experience?
*
Yes
No
Are you currently available to deploy internationally?
*
Yes
No
Do you understand that the minimum length for international deployment is typically 6 to 8 weeks?
*
Yes
No
Do you have the ability to support yourself in a foreign and debilitated environment for an extended period of time?
*
Yes
No
Please select all languages that you speak fluently:
*
Mandarin
English
Spanish
Portugese
Russian
Arabic
French
German
Japanese
Other
Flood
Do you have experience working flood claims for NFIP?
*
Yes
No
Do you have your NFIP Small Commercial Certification?
*
Yes
No
Do you have your NFIP Large Commercial Certification?
*
Yes
No
Do you have experience as an NFIP Team Lead?
*
Yes
No
Do you have flood management or examiner experience?
*
Yes
No
Do you have your NFIP Residential Certification?
*
Yes
No
Residential Flood Experience:
How many residential flood losses have you worked in the past five years?
*
How many of those losses were in excess of $50k?
*
How many of those losses were in excess of $100k?
*
Commercial Flood Experience:
How many commercial flood losses have you worked in the past five years?
*
How many of those losses were in excess of $50k?
*
How many of those losses were in excess of $100k?
*
RCBAP Experience:
How many RCBAP flood losses have you worked?
*
Please describe the loss size range for your RCBAP experience (ex. $150k - $250k):
*
Were you the lead adjuster on these losses?
*
Yes
No
What is your NFIP Certification Number (FCN):
*
Earthquake
Do you have any experience working earthquake losses?
*
Yes
No
Does your earthquake experience include international losses?
*
Yes
No
Are you currently a CEA Certified Adjuster?
*
Yes
No
What year did you receive your CEA certification?
*
How many commercial earthquake losses have you worked?
*
How many residential earthquake losses have you worked?
*
Please answer yes or no concerning your experience with the following:
Mudslides
*
Yes
No
Sinkholes
*
Yes
No
Landslides
*
Yes
No
Volcanic Eruption
*
Yes
No
Tsunamis
*
Yes
No
Wild Fires
*
Yes
No
Fuel Spills
*
Yes
No
Oil Spills
*
Yes
No
Toxic Waste
*
Yes
No
Vibration
*
Yes
No
Farms
*
Yes
No
Crops
*
Yes
No
Livestock
*
Yes
No
Machinery
*
Yes
No
Business Interruption
*
Yes
No
Casualty Experience
Commercial General Liability
Do you have experience with investigating simple slip and fall claims?
*
Yes
No
Do you have experience taking scripted and ad-lib recorded statements?
*
Yes
No
Approximately how many CGL files have you worked in the past 5 years?
*
Check all that relate to your CGL experience:
*
Suspicious/Accidental Death
Bodily Injury
Suicide
Construction Defect
Builder's Risk
Professional Liability
Litigation
Legal Liability
None
Have you ever attended a mediation?
*
Yes
No
Were you given settlement authority for purposes of mediation?
*
Yes
No
What were the dollar limits of your authority?
*
Transportation Losses
Do you have experience working cargo losses?
*
Yes
No
Do you have experience with quick response cargo losses (24/7 on call)?
*
Yes
No
Approximately how many cargo losses have you worked in the last 5 years?
*
Check all that apply to your transportation loss experience:
*
Accident Reconstruction
Scene Investigations
Scene Diagrams
Hazmat
FDA or EPA Claims
Heavy Equipment Estimation
Auto Appraisal
None
Are you interested in being on-call for 24/7 trucking and cargo loss inspections?
*
Yes
No
Do you understand that these losses may involve calls after hours, through the night and holidays?
*
Yes
No
Professional Designations, Licensure and Referrals
Select all the professional designations that you currently hold:
*
AIC
CPCU
CLCS
HCI-R
HCI-C
HCI-W
SCLA
None
Referrals:
Know any good adjusters? Or perhaps a carrier contact that could benefit from Quick Cat's expertise in the industry? Let us know about them below:
Name
*
First
Last
Email
*
Title/Company
*
Name
*
First
Last
Email
*
Title/Company
*
Select the states where you hold an active P&C or All-Lines Adjuster's License:
*
Alabama
Alaska
Arizona
Arkansas
California
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Indiana
Kentucky
Louisiana
Maine
Massachusetts
Michigan
Minnesota
Mississippi
Montana
Nevada
New Hampshire
New Mexico
New York
North Carolina
Oklahoma
Oregon
Rhode Island
South Carolina
Texas
Utah
Vermont
Washington
West Virginia
Wyoming
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