California Department of Insurance Regulations
The Department of Insurance has issued regulations that apply to all insurance claims in California. These regulations are lengthy and contain many requirements. The most common, important provisions are the following:
- Every insurance company is required to maintain a file that documents all important events. (10 CCR 2695.30)
- Every insurance company is required to advise the policyholder of all benefits, coverage, time limits, or other provisions that may apply to the claim, to advise the policyholder of when other or additional benefits may be payable, and to cooperate and assist the policyholder in obtaining these benefits. (10 CCR 2695.4(a))
- Every insurance company shall immediately and properly respond to communications from policyholders. 910 CCR 2695.5(b))
- Every insurance company shall maintain appropriate claims manuals. (10 CCR 2695.6)
- In most instances, claims shall be resolved within 40 days unless the insurance company notifies the claimant of the specific reasons (except for suspected fraud) why more time is required. Such notification must be made every 30 days. (10 CCR 2695.7(b))
- A denial of a claim must set forth the specific factual and legal reasons and cite all applicable policy provisions. (10 CCR 2695.7(b)(1))
- No insurer shall attempt to settle a claim by making a settlement offer that is unreasonably low. (10 CCR 2695.7(g))
- In most instances every insurance company shall tender payment of any portion of a claim that is not in dispute within 30 days of acceptance. (10 CCR 2695.7(h))
For more information on the California Insurance Code, please see the official California Legislative Information website .
Knowledge Is Power
Armed with information about what constitutes unfair practices and the regulations under which insurers must operate in California, policyholders have recourse to hold insurers accountable for their actions. The insurance lawyers at Pillsbury & Levinson, LLP, can help. Contact our San Francisco law office to schedule a consultation with an experienced insurance attorney who can review your claim.