California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7.5 - Unfair or Deceptive Acts or Practices in the Business of Insurance › Article 1 - Fair Claims Settlement Practices Regulations › Section 2695.5 - Duties upon Receipt of Communications

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Upon receiving any written or oral
				  inquiry from the Department of Insurance concerning a claim, every licensee
				  shall immediately, but in no event more than twenty-one (21) calendar days of
				  receipt of that inquiry, furnish the Department of Insurance with a complete
				  written response based on the facts as then known by the licensee. A complete
				  written response addresses all issues raised by the Department of Insurance in
				  its inquiry and includes copies of any documentation and claim files requested.
				  This section is not intended to permit delay in responding to inquiries by
				  Department personnel conducting a scheduled examination on the insurer's
				  premises.
(b) Upon receiving any
				  communication from a claimant, regarding a claim, that reasonably suggests that
				  a response is expected, every licensee shall immediately, but in no event more
				  than fifteen (15) calendar days after receipt of that communication, furnish
				  the claimant with a complete response based on the facts as then known by the
				  licensee. This subsection shall not apply to require communication with a
				  claimant subsequent to receipt by the licensee of a notice of legal action by
				  that claimant.
(c) The designation
				  specified in subsection
				  2695.2(c) shall
				  be in writing, signed and dated by the claimant, and shall indicate that the
				  designated person is authorized to handle the claim. All designations shall be
				  transmitted to the insurer and shall be valid from the date of execution until
				  the claim is settled or the designation is revoked. A designation may be
				  revoked by a writing transmitted to the insurer, signed and dated by the
				  claimant, indicating that the designation is to be revoked and the effective
				  date of the revocation.
(d) Upon
				  receiving notice of claim, every licensee or claims agent shall immediately
				  transmit notice of claim to the insurer.
(e) Upon receiving notice of claim, every
				  insurer shall immediately, but in no event more than fifteen (15) calendar days
				  later, do the following unless the notice of claim received is a notice of
				  legal action:
(1) acknowledge receipt of such
				  notice to the claimant unless payment is made within that period of time. If
				  the acknowledgement is not in writing, a notation of acknowledgement shall be
				  made in the insurer's claim file and dated. Failure of an insurance agent or
				  claims agent to promptly transmit notice of claim to the insurer shall be
				  imputed to the insurer except where the subject policy was issued pursuant to
				  the California Automobile Assigned Risk Program.
(2) provide to the claimant necessary forms,
				  instructions, and reasonable assistance, including but not limited to,
				  specifying the information the claimant must provide for proof of
				  claim;
(3) begin any necessary
				  investigation of the claim.