California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 9.7 - Workers' Compensation Insurance Procedural Requirements and Standards Applicable to Employers, Insurers, and Rating Organizations in the Initiation of and Response to Requests for Review, Requests for Policyholder Information, and Requests for Reconsideration Provided in Insurance Code Sections 11737(f), 11752.6(c), 11753.1(a) and 11753.1(b), and, Rules of Practice and Procedure for Appeals to the Insurance Commissioner Pursuant to Insurance Code Sections 11737(f), 11752.6(c), 11753.1(a), 11753.1(b) and 11753.1 › Section 2509.45 - Decision on Complaint and Request for Action; Time for Reconsideration; Notice of Appeal Rights

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Within sixty (60) days after the insurer or rating organization serves the
				  applicant with a notice granting review of the Complaint and Request for
				  Action, the insurer or rating organization shall serve the applicant with a
				  written decision upon the Complaint and Request for Action. The decision shall
				  provide the insurer's or rating organization's evaluation of the Complaint and
				  Request for Action and contain a recitation of the pertinent facts and a
				  determination of the issues presented which grants or rejects in whole or in
				  part the Complaint and Request for Action. The decision shall include a
				  specific statement of the basis for the action taken. If an acknowledgment and
				  notice have not been served pursuant to Section
				  2509.44, above, the decision shall
				  include the statements required in the acknowledgment and notice. If the
				  insurer or rating organization fails to grant or reject the Complaint and
				  Request for Action within sixty (60) days after the notice granting review was
				  served, the applicant may proceed in the same manner as if the Complaint and
				  Request for Action had been rejected.
(b) An employer, insurer, or other aggrieved
				  person may request reconsideration of a decision of an insurer or the
				  designated rating organization served pursuant to subsection (a) of this
				  section. The request for reconsideration shall be in writing and shall be
				  served within thirty (30) days of service of the decision. The insurer or
				  rating organization shall serve a decision on reconsideration within thirty
				  (30) days of service of the request for reconsideration.
(c) A decision which grants a Request for
				  Policyholder Information, or rejects the request in part, shall be accompanied
				  by such portions of the policyholder information requested that the rating
				  organization has agreed to make available and for which payment has been
				  received.
(d) If review of the
				  Complaint and Request for Action is rejected or the Complaint and Request for
				  Action is rejected, the decision shall include a statement in substantially the
				  following form, in bold:
You have only 30 days from the date this decision was
					 served on you to appeal the decision to the California Insurance Commissioner.
					 See Title 10, California Code of Regulations, section
					 2509.46.
Address your appeal to:
ADMINISTRATIVE HEARING BUREAU
CALIFORNIA DEPARTMENT OF INSURANCE
1901 HARRISON STREET, 3RD FLOOR MAILROOM
OAKLAND, CA 94612
(415) 538-4102
1. New
					 section filed 2-22-99 as an emergency; operative 2-22-99 (Register 99, No. 9).
					 A Certificate of Compliance must be transmitted to OAL by 6-18-99 or emergency
					 language will be repealed by operation of law on the following
					 day.
2. New section refiled 6-18-99 as an emergency; operative
					 6-18-99 (Register 99, No. 25). A Certificate of Compliance must be transmitted
					 to OAL by 10-18-99 or emergency language will be repealed by operation of law
					 on the following day.
3. New section refiled 10-18-99 as an
					 emergency; operative 10-19-99 (Register 99, No. 43). A Certificate of
					 Compliance must be transmitted to OAL by 2-16-2000 or emergency language will
					 be repealed by operation of law on the following day.
4. Repealed by
					 operation of Government Code section
					 11346.1(g)
					 (Register 2000, No. 6).
5. New section filed 2-10-2000; operative
					 3-11-2000 (Register 2000, No. 6).
6. Change without regulatory
					 effect amending subsection (d) and amending NOTE filed 1-2-2003 pursuant to
					 section 100, title 1, California Code of
					 Regulations (Register 2003, No. 1).
7. Change without regulatory
					 effect amending NOTE filed 6-3-2003 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2003, No. 23).
8. Change without regulatory
					 effect amending subsection (d) filed 8-27-2020 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2020, No. 35).
Note: Authority cited: Section
						11400.20,
						Government Code; and Section
						11753.1,
						Insurance Code. Reference: Section
						11415.10,
						Government Code; and Sections
						11734,
						11737(f),
						11750,
						11752.6(c),
						11753.1(a)
						and
						11753.1(b),
						Insurance Code.