California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 4.5 - General Provisions › Article 9 - Forms › Section 2623.5 - Request for Award of Compensation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Name
Address
Telephone Number of Petitioner or Attorney
BEFORE THE INSURANCE COMMISSIONER OF THE STATE OF
					 CALIFORNIA
In the Matter of
)
)
Insurance
							 Company,
)
Case No.
)
Applicant
							 (or
)
REQUEST FOR AWARD
Respondent).
)
OF
							 COMPENSATION
)
____________________ hereby requests an award of
					 compensation in the amount of ____________________ for its contribution in this
					 proceeding. In the support of its request, ____________________ alleges:
I
On ____________________ (date) ____________________, (name
					 of petitioner) was found eligible by the Insurance Commissioner to seek an
					 award of compensation in Departmental proceedings.
II
On ____________________ (date), ____________________, (name
					 of petitioner) filed a Notice of Intent to Seek Compensation in this
					 matter.
III
___________________________
On
____________________
(date)
____________________
, the Commissioner issued a preliminary determination
					 finding that
___________________________
___________________________
(and)
(if applicable)
On ____________________ (date) ____________________,
					 Petitioner was given an interim award of ____________________ and
					 ____________________ in this proceeding.
IV
A final decision by the Insurance Commissioner was issued
					 in this proceeding on ____________________. This request is timely because it
					 is submitted within 30 days of that day.
V
___________________________
__________
substantially contributed to the Insurance Commissioner's
					 final decision in that
___________________________
VI
A detailed description of the services and expenditures of
					 ____________________ in this proceeding are attached and made a part of this
					 Petition and are summarized as follows:
reasonable advocacy fees of:
___________________________
___________________________
reasonable witness fees of:
___________________________
___________________________
other reasonable expenses of:
___________________________
___________________________
VII
___________________________
The amounts set forth in paragraph VI above are reasonable
					 because
___________________________III
On ____________________ (date) ____________________, the
					 Commissioner issued a preliminary determination finding that
___________________________
___________________________
VIII
_________________________'s presentation did not materially
					 duplicate the contribution or presentation of any other party to the proceeding
					 in that ____________________.
IX(If applicable)
Petitioner certifies that it has filed a request for
					 attorney fees under the appropriate statutes in Civil Court (attach a
					 copy).
WHEREFORE, ____________________ respectfully requests an
					 award of compensation in the amount of ____________________ in this
					 proceeding.
DATED:
Respectfully Submitted,
____________________
Signature
1. New
					 section filed 2-1-93; operative 2-1-93 (Register 93, No.
					 6).
Note: Authority cited: Sections
						1861.10,
						12921 and
						12926,
						Insurance Code. Reference: Section
						1861.10(a),
						Insurance Code; and CalFarm Insurance Company, et al. v. George Deukmejian, et
						al., 48 Cal.3d 805 (1989).