Cal. Code Regs. Tit. 10, § 2695.5 - Duties upon Receipt of Communications
(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.
(f) An insurer may not require that the
notice of claim under a policy be provided in writing unless such requirement
is specified in the insurance policy or an endorsement thereto.
Notes
2. Amendment of section heading and section filed 1-10-97; operative 5-10-97 (Register 97, No. 2).
3. Amendment of subsections (d) and (e), repealer of subsection (e)(4) and amendment of NOTE filed 4-24-2003; operative 7-23-2003 (Register 2003, No. 17).
Note: Authority cited: Sections 790.04, 790.10, 12340-12417, inclusive, 12921, 12926, Insurance Code; and Sections 11342.2 and 11152, Government Code. Reference: Sections 790.03(h)(2) and (3), Insurance Code.
2. Amendment of section heading and section filed 1-10-97; operative 5-10-97 (Register 97, No. 2).
3. Amendment of subsections (d) and (e), repealer of subsection (e)(4) and amendment of Note filed 4-24-2003; operative 7-23-2003 (Register 2003, No. 17).
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