California Claims Regulation PDF Download

In 1993, after waiting five years after receiving direction from the California Supreme Court, the state of California determined that the insurance industry needed to be regulated to stop insurers from treating the people insured badly and without good faith. It created a set of Regulations called the "California Fair Claims Settlement Practices Regulations" (the "Regulations) that were designed to enforce the mandate created by the California Fair Claims Settlement Practices statute, California Insurance Code Section 790.03 (h). in response to the direction of the California Supreme Court in its decision, Moradi-Shalal v. Fireman's Fund Ins. Companies, 46 Cal. 3d 287 (1988).In so doing the California Department of Insurance (CDOI) issued rules that were designed to micro manage the business of insurance claims and create a method to punish those insurers who failed to comply with the Regulations. Some of the Regulations recited what had always been recognized by the insurance industry as good faith and proper claims handling. Others imposed draconian mandates on what and when to do everything in the claims process.The Regulations also provided a guide to insureds, public insurance adjusters and policyholders' lawyers to assert any violation of the Regulations to be evidence of an insurer's breach of the implied covenant of good faith and fair dealing. The Reason for This BookThis book was designed to assist insurance personnel who do business in the state of California. It will provide advice to: -all insurance claims personnel, -claims professionals, -independent insurance adjusters, -special fraud investigators, -private investigators who work for the insurance industry, -the management in the industry, -the attorneys who serve the industry, -public insurance adjusters, -policyholders and -counsel for policyholders working with insurers doing business in Californiathe information needed to properly, efficiently, and fairly resolve insurance claims. All insurers doing business in California must comply with the requirements of the Regulations or face the ire of, and attempts at financial punishment from, the CDOI. That punishment was found to be questionable and limited because of one courageous insurer who fought the CDOI and succeeded before an administrative law judge who limited the right to punish. That success, as far as I have been able to determine, has not been emulated. For details see Chapter 3.Regardless of difficulties in assessing punishment the state of California requires all who are involved in the claims process - even if only tangentially - to be trained with regard claims handling in compliance with the Regulations and attest to completion of such training under oath. To avoid the required annual training the claims person can submit a sworn document to the insurer or insurers for whom the claims person works that avers that he or she has read and understood the Regulations. Reviewing this book, the Regulations and commentary set forth below should be sufficient to comply with the training requirements of the Regulations.It is necessary that insurance personnel who are engaged in any way in the presentation, processing, or negotiation of insurance claims in California be familiar with the Regulations. Counsel for insurers and policyholders should also be familiar with the Regulations since they establish a minimum standard for claims handling in the state.