reglab/statecodes huggingface dataset:
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 2 - License Applications › Section 2691.4 - Qualifications and Experience

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Applicants for an insurance adjusters
				  license must possess the qualifications required by Section
				  14025 at the time the application
				  is filed.
(b) One year of
				  experience shall consist of not less than 2,000 hours of actual compensated
				  work performed by each applicant preceding the filing of the application.
				  Applicants shall substantiate claimed years and hours of qualifying experience
				  and the exact details as to the character and nature thereof by written
				  certifications from employers, subject to independent verification by the
				  Commissioner. In the event of inability of applicants to supply such written
				  certifications from employers in whole or in part, applicants may offer written
				  certifications from other than employers to substantiate claimed qualifying
				  experience for consideration by the Commissioner.
Note: Authority cited: Section
						14013
						(a),
						14025,
						Insurance Code. Reference: Section
						14025,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 3 - License Examinations › Section 2691.5 - Complete Application Required

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
An applicant for a license as an insurance adjuster is not
					 eligible for examination or re-examination until the applicant has filed a
					 complete application accompanied by the appropriate fee.
1. Change
					 without regulatory effect amending section filed 7-14-2021 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2021, No. 29). Filing deadline specified in Government
					 Code section
					 11349.3(a)
					 extended 60 calendar days pursuant to Executive Order
					 N-40-20.
Note: Authority cited: Section
						14013,
						Insurance Code. Reference: Section
						14023,
						14027, and
						14097,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 3 - License Examinations › Section 2691.6 - Time and Place of Examination

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Commissioner will give qualifying
				  examinations to insurance adjuster applicants at least once each month in each
				  of the cities in which the Commissioner has an office. The Commissioner may
				  give such examinations at more frequent intervals or in other places throughout
				  the State.
(b) At a reasonable time
				  before an applicant is required to appear for a qualifying examination, the
				  Commissioner will send written notice thereof. Such notice will set forth the
				  time and place of such examination.
1. Change
					 without regulatory effect amending subsection (a) filed 7-14-2021 pursuant to
					 section 100, title 1, California Code of
					 Regulations (Register 2021, No. 29). Filing deadline specified in Government
					 Code section
					 11349.3(a)
					 extended 60 calendar days pursuant to Executive Order
					 N-40-20.
Note: Authority cited: Section
						14013,
						Insurance Code. Reference: Section
						14026,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 3 - License Examinations › Section 2691.7 - Written Examination Required

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Every qualifying examination for an insurance adjuster's
					 license shall be in writing and shall be of sufficient scope to satisfy the
					 Commissioner that the applicant has sufficient knowledge of and is reasonably
					 familiar with the insurance laws of this State and with the provisions, terms
					 and conditions of the insurance contracts for which settlement of claims may be
					 made pursuant to the license sought, and has a general and fair understanding
					 of the obligations and duties of the holder of such license.
Note: Authority cited: Section
						14013,
						Insurance Code. Reference: Section
						14029,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 3 - License Examinations › Section 2691.8 - Failure of Examination

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  If the applicant fails the qualifying examination, the Commissioner shall give
				  written notice of such failure and the applicant may retake such qualifying
				  examination, upon filing the appropriate application and fee therefore and
				  taking such examination within the period prescribed in Section
				  2691.9.
(b) If the applicant fails to appear at the
				  time and place set for the examination the applicant shall be deemed to have
				  failed the examination.
Note: Authority cited: Section
						14013,
						Insurance Code. Reference: Section
						14097,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 3 - License Examinations › Section 2691.9 - Automatic Denial of Application After One Year

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
If an applicant fails to complete the application or fails
					 to take and pass the examination, nor fails to fully qualify for or receive
					 such license within one year after filing the application, the application is
					 automatically denied without prejudice to the filing of a new application for
					 such license. This section shall not apply when the application has been
					 formally denied nor when a Statement of Issues is pending against the license
					 application.
Note: Authority cited: Section
						14013,
						Insurance Code. Reference: Section
						14023,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 4 - Continuation of License Pending Qualification of New Manager › Section 2691.10 - Notice of Separation of Qualifying Person

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
When the manger or person on the basis of whose
					 qualifications a license as an insurance adjuster has been obtained ceases to
					 be connected with the licensee, the licensee shall notify the Commissioner, in
					 writing, within 30 days from such cessation. If the licensee fails to notify
					 the Commissioner within the 30 day period, the license is automatically
					 suspended at the end of such 30 day period and may be reinstated only upon the
					 filing of an application for reinstatement, payment of renewal fees and
					 delinquency fees due, if any, and the qualification of an individual as
					 provided in Insurance Code Sections
					 14025 or
					 14029
					 (b).
Note: Authority cited: Section
						14029
						(c) and
						14030,
						Insurance Code. Reference: Section
						14025,
						14029
						(c),
						14030 and
						14035,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 4 - Continuation of License Pending Qualification of New Manager › Section 2691.11 - Continuation of Business upon Notice

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
If notice is given in accordance with Section
					 2691.10 within 30 days of such
					 cessation, the license shall remain in force, pending the qualification of a
					 manager, for not more than 60 days from the date the previous manager ceased to
					 be connected with the licensee.
Note: Authority cited: Section
						14030,
						Insurance Code. Reference: Section
						14030,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 5 - Information About Employees › Section 2691.12 - List of Employees

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Every applicant for a new or renewal license shall file
					 with such application a list of the full names of all employees who are
					 authorized to negotiate claim settlements, and every licensee shall inform the
					 Commissioner in writing within 30 days from the date of the occurrence of the
					 name of any employee hired or terminated subsequent to the filing of the
					 initial list.
Note: Authority cited: Sections
						14013
						(b) and
						14041,
						Insurance Code. Reference: Section
						14041,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 6 - Branch Office Requirements › Section 2691.13 - Branch Office Under Control of Designated Person

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A branch office shall be under the active management,
					 direction and control of the licensee or the licensee's manager, with a
					 designated person in charge of such branch office. The licensee shall report to
					 the Commissioner the name of each person appointed as branch office manager
					 within 10 days of such appointment.
1. Change
					 without regulatory effect amending section filed 7-14-2021 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2021, No. 29). Filing deadline specified in Government
					 Code section
					 11349.3(a)
					 extended 60 calendar days pursuant to Executive Order
					 N-40-20.
Note: Authority cited: Sections
						14013
						(b) and
						14041 and
						14045,
						Insurance Code. Reference: Sections
						14038
						(h),
						14041 and
						14045,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 6 - Branch Office Requirements › Section 2691.14 - Records

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A copy of all records relating to claims or loss adjusted
					 or investigated and all activities in connection with investigating, adjusting,
					 appraising or otherwise participating in the disposal, settlement, or
					 investigation of any claim under or in connection with a policy of insurance or
					 any other activity set forth in Insurance Code Section
					 14021,
					 shall be maintained at and shall be available for inspection by the Department
					 of Insurance at the location from which the business was conducted or
					 transacted for at least five years from the date such business was conducted or
					 transacted. Personnel and financial records may be maintained at the principal
					 office of the licensee but must be furnished to the Commissioner within ten
					 days of the Commissioner's request for production of such
					 records.
1. Change
					 without regulatory effect amending section filed 7-14-2021 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2021, No. 29). Filing deadline specified in Government
					 Code section
					 11349.3(a)
					 extended 60 calendar days pursuant to Executive Order
					 N-40-20.
Note: Authority cited: Section
						14045,
						Insurance Code. Reference: Section
						14045,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 6 - Branch Office Requirements › Section 2691.15 - Branch Office Must be a Bonafide Place of Business

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A branch office must be a bonafide place of business
					 maintaining reasonable hours for service to customers. A telephone answering
					 service or mail service at any office or location which is not under the active
					 direction, control, charge and management of the licensee or the licensee's
					 manager does not qualify as a branch office.
Note: Authority cited: Section
						14013
						(b), Insurance Code. Reference: Section
						14045,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 6 - Branch Office Requirements › Section 2691.16 - Branch Office Application Required

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
An application to conduct business from any location other
					 than the principal place of business shall be submitted on a form prescribed by
					 the Commissioner and accompanied by the prescribed fee.
Note: Authority cited: Sections
						14023,
						14024,
						14045,
						Insurance Code. Reference: Sections
						14090,
						14091,
						14093 and
						14094,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 7 - Advertisements › Section 2691.17 - Advertisement Defined

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
				  word "advertisement" as used in Section
				  14044 means:
(1) Any written or printed communication for
				  the purpose of soliciting, describing, or promoting the licensed business of
				  the licensee, including a brochure, letter, pamphlet, newspaper, periodical,
				  publication, or other writing.
(2)
				  A directory listing caused or permitted by the licensee which indicates the
				  licensee's licensed activity.
(3) A
				  radio, television or similar airwaves transmission which solicits or promotes
				  the licensed business of the licensee.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 8 - Substantial Relationship Criteria for Crimes of Wrongful Acts [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Repealer of
				  article 8 (section
				  2691.18) and section filed
				  1-23-2007; operative 2-22-2007 (Register 2007, No. 4).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 9 - Criteria for Evaluating Rehabilitation [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Repealer of
				  article 9 (section
				  2691.19) and section filed
				  1-23-2007; operative 2-22-2007 (Register 2007, No. 4).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 10 - Fees › Section 2691.20 - Change of Classification

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The fee for making a change in a license from one
					 classification to another is the same as for an original license to do business
					 under the new classification.
Note: Authority cited: Sections
						14013(c)
						and
						14097
						(e), Insurance Code. Reference: Sections
						14013 (a)
						(c) and
						14097
						(e), Insurance
						Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 10 - Fees › Section 2691.21 - Renewal Fees

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
				  renewal fee for a license as an insurance adjuster shall be one hundred
				  dollars.
(b) The renewal fee for a
				  branch office certificate shall be twenty dollars.
(c) There shall be no additional fee charged
				  solely by reason of the classification of a license.
Note: Authority cited: Sections
						14097 (d) (1), (2) and
						(e) and
						14013(c),
						Insurance Code. Reference: Sections
						14097 (d) (1), (2) and
						(e) and
						14013
						(c), Insurance
						Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 10 - Fees › Section 2691.22 - Partnership, Corporation or Unincorporated Association

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Before a partnership, corporation or unincorporated
					 association license may be granted, each partner of a partnership, each officer
					 of a corporation, and each member of an unincorporated association, shall file
					 a separate application for such license on the form prescribed by the
					 Commissioner. However, only one officer or partner or manager is required to
					 meet the qualification requirements of Insurance Code Section
					 14025 in
					 order to qualify for a partnership or corporation license. A separate
					 application fee is required for every partner, officer, or member who is a
					 person named to operate or manage the business of the licensee under the
					 requirements of Insurance Code Sections
					 14025 and
					 14029.
Note: Authority cited: Sections
						14013
						(b) and
						14025
						(d), Insurance Code. Reference: Sections
						14029,
						14035 and
						14097,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 10 - Fees › Section 2691.23 - Duplicate Copies of License or Identification Card

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The fee for a duplicate copy of an insurance adjuster's
					 license, branch office certificate, or identification card is ten dollars
					 ($10.00).
1. Editorial
					 correction of printing error (Register 93, No.
					 13).
Note: Authority cited: Section
						14013
						(b), Insurance Code. Reference: Section
						12973.7,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 7 - Insurance Adjusters › Article 10 - Fees › Section 2691.24 - NO Refunds of Fees

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Application fees, renewal fees, branch office fees or any
					 other fees provided for by statute or regulation shall not be refunded whether
					 or not a license is granted or the examination taken, except under the
					 provisions of Insurance Code Section
					 12977.
Note: Authority cited: Sections
						14013 and
						14097,
						Insurance Code; and Section
						158,
						Business and Professions Code. Reference: Sections
						14097 and
						14099,
						Insurance Code.
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 2695.1 - Preamble

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Section
				  790.03(h)
				  of the California Insurance Code enumerates sixteen claims settlement practices
				  that, when either knowingly committed on a single occasion, or performed with
				  such frequency as to indicate a general business practice, are considered to be
				  unfair claims settlement practices and are, thus, prohibited by this section of
				  the California Insurance Code. The Insurance Commissioner has promulgated these
				  regulations in order to accomplish the following objectives:
(1) To delineate certain minimum standards
				  for the settlement of claims which, when violated knowingly on a single
				  occasion or performed with such frequency as to indicate a general business
				  practice shall constitute an unfair claims settlement practice within the
				  meaning of Insurance Code Section
				  790.03(h);
(2) To promote the good faith, prompt,
				  efficient and equitable settlement of claims on a cost effective
				  basis;
(3) To discourage and
				  monitor the presentation to insurers of false or fraudulent claims;
				  and,
(4) To encourage the prompt
				  and thorough investigation of suspected fraudulent claims and ensure the prompt
				  and comprehensive reporting of suspected fraudulent claims as required by
				  Insurance Code Section
				  1872.4.
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 2695.2 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
As used in these regulations:
(a) "Beneficiary" means:
(1) for the purpose of life and disability
				  claims, the party or parties entitled to receive the proceeds or benefits
				  occurring under the policy in lieu of the insured; or,
(2) for the purpose of surety claims, a
				  person who is within the class of persons intended to benefit from the
				  bond;
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 2695.3 - File and Record Documentation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Every licensee's claim files shall be
				  subject to examination by the Commissioner or by the Commissioner's duly
				  appointed designees. These files shall contain all documents, notes and work
				  papers (including copies of all correspondence) which reasonably pertain to
				  each claim in such detail that pertinent events and the dates of the events can
				  be reconstructed and the licensee's actions pertaining to the claim can be
				  determined;
(b) To assist in such
				  examination all insurers shall:
(1) maintain
				  claim data that are accessible, legible and retrievable for examination so that
				  an insurer shall be able to provide the claim number, line of coverage, date of
				  loss and date of payment of the claim, date of acceptance, denial or date
				  closed without payment. This data must be available for all open and closed
				  files for the current year and the four preceding years;
(2) record in the file the date the licensee
				  received, date(s) the licensee processed and date the licensee transmitted or
				  mailed every material and relevant document in the file; and
(3) maintain hard copy files or maintain
				  claim files that are accessible, legible and capable of duplication to hard
				  copy; files shall be maintained for the current year and the preceding four
				  years.
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 2695.4 - Representation of Policy Provisions and Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Every insurer shall disclose to a first
				  party claimant or beneficiary, all benefits, coverage, time limits or other
				  provisions of any insurance policy issued by that insurer that may apply to the
				  claim presented by the claimant. When additional benefits might reasonably be
				  payable under an insured's policy upon receipt of additional proofs of claim,
				  the insurer shall immediately communicate this fact to the insured and
				  cooperate with and assist the insured in determining the extent of the
				  insurer's additional liability.
(b)
				  No insurer shall misrepresent or conceal benefits, coverages, time limits or
				  other provisions of the bond which may apply to the claim presented under a
				  surety bond.
(c) No insurer shall
				  deny a claim on the basis of the claimant's failure to exhibit property, unless
				  there is documentation in the file (1) of reasonable demand by the insurer, and
				  unfounded refusal by the claimant, to exhibit property, or (2) of the breach of
				  any policy provision providing for the exhibition of property.
(d) Except where a time limit is specified in
				  the policy, no insurer shall require a first party claimant under a policy to
				  give notification of a claim or proof of claim within a specified
				  time.
(e) No insurer shall:
(1) request that a claimant sign a release
				  that extends beyond the subject matter which gave rise to the claim payment
				  unless, prior to execution of the release, the legal effect of the release is
				  disclosed and fully explained by the insurer to the claimant in writing. For
				  purposes of this subsection, an insurer shall not be required to provide the
				  above explanation or disclosure to a claimant who is represented by an attorney
				  at the time the release is presented for signature;
(2) be precluded from including in any
				  release a provision requiring the claimant to waive the provisions of
				  California Civil Code Section
				  1542 provided
				  that, prior to execution of the release, the legal effect of the release is
				  disclosed and fully explained by the insurer to the claimant in writing. For
				  purposes of this subsection, an insurer shall not be required to provide the
				  above explanation or disclosure to a claimant who is represented by an attorney
				  at the time the release is presented for signature.
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 2695.6 - Training and Certification

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Every insurer shall adopt and communicate
				  to all its claims agents written standards for the prompt investigation and
				  processing of claims, and shall do so within ninety (90) days after the
				  effective date of these regulations or any revisions thereto.
(b) All licensees shall provide thorough and
				  adequate training regarding the regulations to all their claims agents.
				  Licensees shall certify that their claims agents have been trained regarding
				  these regulations and any revisions thereto. However, licensees need not
				  provide such training or certification to duly licensed attorneys.
A licensee shall demonstrate compliance with this
					 subsection by the following methods:
(1) where the licensee is an individual, the
				  licensee shall annually certify in writing under penalty of perjury that the
				  licensee has read and understands the regulations and any and all amendments
				  thereto;
(2) where the licensee is
				  an entity, the annual written certification shall be executed, under penalty of
				  perjury, by a principal of the entity as follows:
(A) that the licensee's claims adjusting
				  manual contains a copy of these regulations and all amendments thereto;
				  and,
(B) that clear written
				  instructions regarding the procedures to be followed to effect proper
				  compliance with this subchapter were provided to all its claims
				  agents;
(3) where the
				  licensee retains insurance adjusters as defined in California Insurance Code
				  Section
				  14021, the
				  licensee must provide training to the insurance adjusters regarding these
				  regulations and annually certify, in a declaration executed under penalty of
				  perjury, that such training is provided. Alternately, the insurance adjuster
				  may annually certify in writing, under penalty of perjury, that the insurance
				  adjuster has read and understands these regulations and all amendments thereto
				  or has successfully completed a training seminar which explains these
				  regulations;
(4) a copy of the
				  certification required by subsections
				  2695.6(b)(1), (2) or
				  (3) shall be maintained at all times at the
				  principal place of business of the licensee, to be provided to the Commissioner
				  only upon request.
(5) the annual
				  certification required by this subsection shall be completed on or before
				  September 1 of each calendar year.
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 2695.8 - Additional Standards Applicable to Automobile Insurance

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) This section enumerates standards which
				  apply to adjustment and settlement of automobile insurance claims.
(1) the words "automobile" and "vehicle" are
				  used synonymously.
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 2695.81 - The Standardized Auto Body Repair Labor Rate Survey

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Insurance Commissioner has promulgated Section
					 2695.81 of these regulations in
					 order to (1) establish a standardized labor rate survey that the Commissioner
					 recommends insurers use as a basis to settle or pay automobile repair insurance
					 claims in a fair and equitable manner, if the insurer elects to use a survey;
					 and (2) ensure and enforce the good faith, prompt, fair and equitable
					 settlement of automobile insurance claims pursuant to Insurance Code section
					 790.03.
(a) Nothing in this section shall be
				  construed to require the insurer to pay for repair costs associated with prior
				  or unrelated damages to the claimant's vehicle, to the degree an insurer is not
				  required to pay for these costs under the insurance policy or any applicable
				  law.
(b) Nothing in this section
				  shall be construed to prohibit an insurer from paying a labor rate lower than
				  the prevailing auto body rate, if the auto body repair shop, chosen by the
				  claimant to perform repairs, charges a labor rate lower than the prevailing
				  auto body rate.
(c) A survey that
				  complies with the standards and requirements set forth in subdivision (d) of
				  this Section
				  2695.81 (hereinafter, a
				  "Standardized Labor Rate Survey"), that complies with Section
				  2698.91, and that is used pursuant
				  to subdivision (e) of this section, shall result in a rebuttable presumption by
				  the Commissioner that the insurer has attempted in good faith to effectuate a
				  fair and equitable:
(1) labor rate component
				  of a claim settlement, or
(2)
				  adjustment of the labor rate component of a written estimate provided by a
				  claimant pursuant to subdivision (f)(3) of Section
				  2695.8.
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 2695.9 - Additional Standards Applicable to First Party Residential and Commercial Property Insurance Policies

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) When a residential or commercial property
				  insurance policy provides for the adjustment and settlement of first party
				  losses based on replacement cost, the following standards apply:
(1) When a loss requires repair or
				  replacement of an item or part, any consequential physical damage incurred in
				  making the repair or replacement not otherwise excluded by the policy shall be
				  included in the loss. The insured shall not have to pay for depreciation nor
				  any other cost except for the applicable deductible.
(2) When a loss requires replacement of items
				  and the replaced items do not match in quality, color or size, the insurer
				  shall replace all items in the damaged area so as to conform to a reasonably
				  uniform appearance.
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 2695.10 - Additional Standards Applicable to Surety Insurance

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) No insurer shall base or vary its claims
				  settlement practices, or its standard of scrutiny and review, upon the
				  claimant's age, gender, income, religion, language, sexual orientation,
				  ancestry, national origin, or physical disability, or upon the territory of the
				  property or person insured.
(b) As
				  soon as possible, but in no event later than forty (40) calendar days after
				  receipt by the insurer of proof of claim, and provided the claim is not in
				  litigation or arbitration, the insurer shall accept or deny the claim, in whole
				  or in part, and affirm or deny liability. Every insurer that denies or rejects
				  a claim in whole or in part, or disputes liability or damages, shall provide to
				  the claimant a written statement listing all bases for such rejection or
				  denial, and the factual and legal bases for each reason given for each
				  rejection or denial, which are within the insurer's knowledge. If an insurer's
				  denial of a claim in whole or in part is based on a specific statute or
				  specific bond provisions, the denial shall include reference thereto and
				  provide an explanation of the application of the statute or bond provision to
				  the claim. Written notification pursuant to this subsection shall also include
				  a notification that the claimant may have the matter reviewed by the California
				  Department of Insurance and shall provide the address and telephone number of
				  the unit of the Department which reviews complaints regarding claims practices.
(1) A principal's absence, non-cooperation,
				  or failure to meet the bonded obligation shall not excuse unreasonable delay by
				  the insurer in determining whether a claim should be accepted or
				  denied.
(2) While an insurer may
				  consider all information provided by a principal, absent reasonable factual
				  and/or legal bases for denying a claim, no insurer shall deny a claim based
				  solely upon a principal's protest of a claim or denial of liability for a
				  claim.
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 2695.11 - Additional Standards Applicable to Life and Disability Insurance Claims

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) No insurer
				  shall seek reimbursement of an overpayment or withhold any portion of any
				  benefit payable as a result of a claim on the basis that the sum withheld or
				  reimbursement sought is an adjustment or correction for an overpayment made
				  under the same policy unless:
(1) the
				  insurer's files contain clear, documented evidence of an overpayment and
				  written authorization from the insured or assignee, if applicable, permitting
				  the reimbursement or withholding procedure, or
(2) the insurer's files contain clear,
				  documented evidence pursuant to section
				  2695.3 of all of the following:
(A) The overpayment was erroneous under the
				  provisions of the policy.
(B) The
				  error which resulted in the payment is not a mistake of the law.
(C) The insurer notifies the insured within
				  six (6) months of the date of the error, except that in instances of error
				  prompted by representations or nondisclosure of claimants or third parties, the
				  insurer notifies the insured within fifteen (15) calendar days after the date
				  of discovery of such error. For the purpose of this subsection, the date of the
				  error shall be the day on which the draft for benefits is issued.
(D) Such notice states clearly the cause of
				  the error and states the amount of the overpayment.
(E) The procedure set forth above in
				  (a)(2)(A) through (D) above may not be used if the overpayment is the subject
				  of a reasonable dispute as to facts.
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 2695.12 - Penalties

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) In determining
				  whether to assess penalties and if so the appropriate amount to be assessed,
				  the Commissioner shall consider admissible evidence on the following:
(1) the existence of extraordinary
				  circumstances;
(2) whether the
				  licensee has a good faith and reasonable basis to believe that the claim or
				  claims are fraudulent or otherwise in violation of applicable law and the
				  licensee has complied with the provisions of Section
				  1872.4 of
				  the California Insurance Code;
(3)
				  the complexity of the claims involved;
(4) gross exaggeration of the value of the
				  property or severity of the injury, or amount of damages incurred;
(5) substantial mischaracterization of the
				  circumstances surrounding the loss or the alleged default of the
				  principal;
(6) secreting of
				  property which has been claimed as lost or destroyed.
(7) the relative number of claims where the
				  noncomplying act(s) are found to exist, the total number of claims handled by
				  the licensee and the total number of claims reviewed by the Department during
				  the relevant time period;
(8)
				  whether the licensee has taken remedial measures with respect to the
				  noncomplying act(s);
(9) the
				  existence or nonexistence of previous violations by the licensee;
(10) the degree of harm occasioned by the
				  noncompliance;
(11) whether, under
				  the totality of circumstances, the licensee made a good faith attempt to comply
				  with the provisions of this subchapter;
(12) the frequency of occurrence and/or
				  severity of the detriment to the public caused by the violation of a particular
				  subsection of this subchapter;
(13)
				  whether the licensee's management was aware of facts that apprised or should
				  have apprised the licensee of the act(s) and the licensee failed to take any
				  remedial measures; and
(14) the
				  licensee's reasonable mistakes or opinions as to valuation of property, losses
				  or damages.
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 2695.13 - Severability

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
If any provision or clause of this rule or the application
					 thereof to any person or situation is held invalid, such invalidity shall not
					 affect any other provision or application of this rule which can be given
					 effect without the invalid provision or application, and to this end the
					 provisions of this rule are declared to be severable.
1. New
					 section filed 12-15-92; operative 1-14-93 (Register 92, No. 52).
2.
					 Editorial correction of Authority cite (Register 95, No. 42).
3.
					 Repealer of former section
					 2695.13 and renumbering of former
					 section 2695.16 to new section
					 2695.13 filed 1-10-97; operative
					 5-10-97 (Register 97, No. 2).
Note: Authority cited: Sections
						790.10,
						12340-12417, inclusive, 12921 and
						12926, Insurance Code; and Sections
						11342.2
						and
						11152,
						Government Code. Reference: Section
						790.03(h),
						Insurance Code.
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 2695.14 - Compliance Date

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Any
				  amendments to these regulations shall be complied with within ninety (90)
				  calendar days after they are filed with the Secretary of State.
(b) Prior to the compliance date of these
				  regulations, licensees shall, pursuant to Section
				  2695.6, adopt and communicate to
				  their claims agents standards for the prompt investigation and processing of
				  claims, and provide training and instruction on these regulations.
(c) These regulations shall apply to any
				  claims handling that takes place on or after the compliance date set forth
				  under subsection
				  2695.14(a).
1. New
					 section filed 6-1-2006; operative 8-30-2006 (Register 2006, No. 22). For prior
					 history, see Register 2004, No. 32.
Note: Authority cited: Sections
						790.10,
						12921 and
						12926,
						Insurance Code; and Section
						11343.4,
						Government Code. Reference: Section
						790.03(h),
						Insurance Code.
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 2695.15 - Penalties. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 12-15-92; operative 1-14-93 (Register 92, No. 52).
2.
					 Repealer filed 1-10-97; operative 5-10-97 (Register 97, No.
					 2).
Note: Authority cited: Sections
						790.035,
						790.07,
						790.08,
						790.09,
						790.10,
						1872.4,
						12340-12417, inclusive, 12921,
						1065, 704, 780-784, 1011, 11690, 12926 and 12928.6, Insurance Code; and
						Sections
						11342.2
						and
						11152,
						Government Code. Reference: Sections
						790.03(h),
						790.035(a),
						790.04,
						790.05,
						790.06,
						790.08 and
						790.10,
						Insurance Code.
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 2695.16 - Severability. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 12-15-92; operative 1-14-93 (Register 92, No. 52).
2.
					 Renumbering of former section
					 2695.16 to new section
					 2695.13 filed 1-10-97; operative
					 5-10-97 (Register 97, No. 2).
Note: Authority cited: Sections
						790.10,
						12340-12417, inclusive, 12921 and
						12926, Insurance Code; and Sections
						11342.2
						and
						11152,
						Government Code. Reference: Section
						790.03(h),
						Insurance Code.
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 2695.17 - Effective Date. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 12-15-92; operative 1-14-93 (Register 92, No. 52).
2.
					 Renumbering and amendment of former section
					 2695.17 to new section
					 2695.14 filed 1-10-97; operative
					 5-10-97 (Register 97, No. 2).
3. Editorial correction repealing
					 inadvertently retained text of renumbered section (Register 99, No.
					 50).
Note: Authority cited: Sections
						790.10,
						11346.2,
						12340-12417, inclusive, 12921 and
						12926, Insurance Code; and Sections
						11342.2
						and
						11152,
						Government Code. Reference: Section
						790.03(h),
						Insurance Code.
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 1.3 - Valuation of Homes › Section 2695.180 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
As used in this article and in California Insurance Code
					 section
					 1749.85 the
					 following terms have the following meanings:
(a) "Homeowners' insurance policy" shall have
				  the same meaning as a "policy of residential property insurance" as defined in
				  subdivision (a) of Insurance Code section
				  10104. A
				  "homeowners' insurance policy" does not include:
(A) a tenant's policy;
(B) a policy covering an individually owned
				  mobilehome and its contents;
(C) a
				  policy covering an individually owned manufactured home and its
				  contents;
(D) a renter's policy;
				  or
(E) a policy insuring an
				  individually owned condominium unit that does not provide dwelling structure
				  coverage.
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 1.3 - Valuation of Homes › Section 2695.181 - Standards for Real Estate Appraisers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Subdivision (d) of Insurance Code 1749.85 provides that if
					 the Department of Insurance, by adopting a regulation, establishes standards
					 for the calculation of estimates of replacement value of a structure by
					 appraisers, then on and after the effective date of the regulation a real
					 estate appraiser's estimate of replacement cost shall be calculated in
					 accordance with the regulation. A real estate appraiser, whether or not a
					 licensee, shall not estimate the replacement cost of a structure for use in
					 connection with a homeowner's insurance policy unless the estimate of
					 replacement cost complies with the provisions of subdivisions (a) through (e)
					 of Section
					 2695.183. Appropriate licensure by
					 the Department of Insurance is required in order to lawfully explain levels of
					 coverage under a homeowners' insurance policy.
1. New
					 section filed 12-29-2010; operative 6-27-2011 pursuant to Government Code
					 section
					 11343.4(b)
					 (Register 2010, No. 53).
Note: Authority cited: Sections
						35,
						790.10,
						1631,
						1633,
						1749.7,
						1749.85 and
						2051.5,
						Insurance Code. Reference: Sections
						35,
						790.03,
						1631,
						1625,
						1625.5,
						1633,
						1749.85,
						2051.5,
						10087 and
						10104,
						Insurance Code.
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 1.3 - Valuation of Homes › Section 2695.182 - Documentation of Person Making Estimate

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) In the event an estimate of replacement
				  cost is provided or communicated by a licensee to an applicant or insured in
				  connection with an application for or renewal of a homeowners' insurance policy
				  that provides coverage on a replacement cost basis, the licensee shall document
				  and maintain in the applicant's or insured's file the following information:
(1) The status of the person preparing the
				  estimate of replacement value, as the insurer underwriter or actuary or other
				  person identified by the insurer, a broker-agent, a contractor, an architect, a
				  real estate appraiser, or other person or entity permitted to make such an
				  estimate by Insurance Code section
				  1749.85;
(2) The name, job title, address, telephone
				  number, and license number, if applicable, of the person preparing the estimate
				  of replacement value;
(3) The
				  source from which or method by which the estimate of replacement cost was
				  prepared, to include any replacement cost calculator, contractor's estimate,
				  architectural report, real estate appraisal, or other source or method;
				  and
(4) A copy of any reports,
				  inspection reports, contractor's estimates, or other documents used to prepare
				  the estimate of replacement value.