California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 3 - Form-Required Provisions › Section 2244.5 - Notice and Proof of Claim; Alternative Provisions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Every U. C. D. policy shall contain provisions relative
						to notice and proof of claim which, at the option of the insurer, shall be
						either in the short form set forth under (a) of this section (or in the
						substance thereof) or in all of the forms set forth under (b) of this section
						(or in the substance thereof) in accordance with the instructions for their
						use:
(a) First Alternative Required
					 Provision Relative to Notice and Proof of Claim.
"All__________ provided in this policy shall be paid to
						the employee as they accrue upon receipt of written proof (on the insurer's
						forms or, if such forms are not furnished by the insurer within fifteen days
						after demand therefor, then upon receipt of written proof) covering the
						occurrence, character and extent of the event for which claim is made."
Instructions for Its Use.
This provision may be used, at the option of the insurer,
						in lieu of any one of the following combinations of provisions under (b):
						(b):
(b) (1), (2) and (3)
(b) (1), (2), (3) (4) and (5)
(b) (1), (2), (3), (4), (5) and (6)
In the blank space the word "benefits" or other
						descriptive phrase shall be entered. If this provision is used in combination
						with the provision under (b)(6), there shall be substituted in lieu of the
						words, "to the employee as they accrue" contained in this provision, the words
						"as stated__________" inserting in the blank space the location in the policy
						of the required provision prescribed under (b) (6).
(b) Second Alternative Required Provisions
					 Relative to Notice and Proof of Claim:
(1)
					 "Written notice of injury or of sickness upon which claim is based must be
					 given to the insurer within twenty days after the date of the commencement of
					 the first loss for which benefits arising out of each such injury or sickness
					 are claimed."
(2) "Notice given by
					 or in behalf of the claimant to the insurer at__________ or to any authorized
					 agent of the insurer, with particulars sufficient to identify the insured
					 employee, shall be deemed to be notice to the insurer."
Instructions for Use of Form (b) (2).
In the blank space, the address at which notice may be
						given shall be entered. This provision may be omitted if the insurer has
						conspicuously imprinted on the individual certificate (including supplemental
						certificates) and the statements of coverage the name of the insurer and the
						address of its home and branch offices to which notices may be sent. Otherwise,
						this provision shall be incorporated in the policy if the insurer elects not to
						use the short form of provision relative to notice and proof of claim set forth
						under (a) of this section.
(3) "The
					 insurer, upon receipt of the notice required by this policy , will furnish to
					 the claimant such forms as are usually furnished by it for filing proof of
					 loss. If such forms are not so furnished within fifteen days after the insurer
					 receives such notice, the claimant shall be deemed to have complied with the
					 requirements of this policy as to proof of loss upon submitting, within the
					 time fixed in the policy for filing proofs of loss, written proof covering the
					 occurrence, character and extent of the loss for which claim is made.
(4) "Affirmative proof of loss of time on
					 account of disability for which claim is made must be furnished to the insurer
					 within ninety days after the termination of the period for which claim is
					 made."
(5) "Failure to furnish
					 notice or proof within the time provided in this policy shall not invalidate or
					 reduce any claim if it shall be shown not to have been reasonably possible to
					 furnish such notice or proof and that such notice or proof was furnished as
					 soon as was reasonably possible."
Instructions for Use of Form (b) (5).
If this provision is used in combination with the short
						form of provision under (a), the words "Notice or" shall be
						omitted.
(6) "Upon request
					 of the insured employee and subject to due proof of loss the accrued benefits
					 will be paid to the insured employee each __________during any period for which
					 the insurer is liable, and any balance remaining unpaid at the termination of
					 such period will be paid to the insurer immediately upon receipt of due proof.
Instructions for Use of Form (b) (6).
In the blank space there shall be entered either a period
						of time not greater than one week or a period of time not greater than two
						weeks together with the phrase "or each week, if the claimant so
						requests,."