California Claim Regulations

What Every California Policyholder Should Know

When living in California, it’s best to keep yourself protected just in case something unfortunate happens. Although it’s not necessarily common to keep a titanium shield with you at all times, there is another similar alternative.

Obtaining insurance entitles you to insured protection should you ever run into any mishap (car accidents, a sudden flood, a massive earthquake, etc.). If ever you were to run into such damaging events or collisions, having insurance will help protect your values, interests, and properties by allowing you to compensate for the loss.

Although this may seem great, it’s also best not to completely entrust the insurer. Some insurance companies are known to practice “bad faith” or ” simply fail to insure their customer when they clearly deserved the compensation. In these cases, some would say that insurance companies don’t always fulfill their initial duty. In this case, it’s best to understand the process of filing your claim, and how such determines if you can be compensated.


Below, are the California Guidelines that every insurer must follow when proceeding with a claim:

  • Acknowledge receipt of notice of claim to the claimant ” within 15 calendar days after receipt of a notice of the claim [Cal. Code Regs. Tit. 10, § 2695.5(e)(1)]
  • Create an appropriate response to all communications from the claimant regarding a claim that urgently seeks a response ” within 15 calendar days following receipt of communication
    [Cal. Code Regs. Tit. 10, § 2695.5(b)]
  • Provide all necessary claim forms, instructions, and reasonable assistance to the claimant ” within 15 calendar days after receipt of a notice of the claim [Cal. Code Regs. Tit. 10, § 2695.5(e)(2)]
  • Begin any investigation of the claim ” within 15 calendar days after receipt of a notice of the claim [Cal. Code Regs. Tit. 10, § 2695.5(e)(3)]
  • Advise the claimant of the acceptance or denial of their claim in whole or part; if rejected,
    (a) for 1st party claimant must list all factual and legal bases with explanation of any statute or law if applicable within insurer’s knowledge; (b) for 3rd party claimant the denial or rejection of liability must be in writing ” within 40 calendar days after receipt of proof of claim. This can be increased to 80 days or suspended completely if carrier has reasonable basis supported by specific information for belief that claim is false or fraudulent. [Cal. Code Regs. Tit. 10, § 2695.7(b)(1) Cal. Code Regs. Tit. 10, § 2695.7(k)]
  • Provide additional form of written notification that entails the investigation remains incomplete and the reasons why ” within 40 calendar days from the first notification and no more than every 30 calendar days thereafter until the investigation is complete [Cal. Code Regs. Tit. 10, § 2695.7(c)(1)]
  • Pay a portion of the claim not in dispute ” immediately but no later than within 30 calendar days [Cal. Code Regs. Tit. 10, § 2695.7(h)]
  • Provide a written notification to the claimant not represented by an attorney of any statute of limitation or other time limit upon which the carrier might rely to deny a claim. Notice must clearly state the time that might be expiring and its effect upon the claim. ” compliance required no less than 60 calendar days before the date on which the time limit might expire. If notice of the claim is received by the carrier within the sixty days prior to expiration, the notice of expiration must be given immediately.

Cautious Claimants

The guidelines above are a great example to display that California has more laws to protect insurance policyholders than any other state in the nation (probably due to our high rate of car accidents). The given guidelines are meant to outline the actions insurers can and cannot do. In other words, these “code provisions,” “case laws,” and “statutes” can be more formally identified as “regulations.” Regardless, these laws are established by the state’s Department of Insurance to help protect wary policyholders.

Why would a policyholder ever have the need to feel wary? Maybe for the same reason that California has the most insurance laws than any other state in the nation ” to avoid any practice of bad faith, acts of falseness, or to avoid any lack of care and consideration.

Although the claims process seems to be filled with longevity, it shouldn’t be difficult or stressful when dealing with your assigned adjuster. Even though the adjusters are mainly held responsible for handling your claim, it’s still your job as a policyholder to update the adjuster on any information, evidence, health concerns, and any other useful elements that may change while the claim is being processed. This helps secure your claim and has all the important details to help you redeem your compensation.

If you are a worried claimant, you can rest assured that you are entitled to every document from your adjuster regarding your claim. It’s best to keep every single document close at hand, just in case there should ever be problems with your claim in the future. It’s also required that every adjuster send an automated response or accommodate you, the claimant, whenever you have a concern or question.

Rule of Thumb

Growing up, our parents taught us values and lessons to abide by and implement them to our daily lives. One of the lessons you may remember is the golden rule; treat others how you’d want to be treated. The same applies for accommodating your claim with your adjuster. If your adjuster has claimed to be unwilling to compensate a rightful amount, or even no amount at all, you are entitled to a clear and concise reasoning as to why. If the allegations from your insurer seem rather questionable, ask for proof. It’s a law in California that your insurer must explain to you in length why you weren’t properly compensated for your loss. In this event, ask the adjuster to outline your policy and point out where on the policy it states you are not entitled the proper amount. If the adjuster gives some sort of inadequate reasoning, ask the adjuster to provide you with a copy of the law that supports their reasoning. If you don’t have an attorney or any legal representation, it’s best to act as your own, or simply retain with one for better support.

Compensating Successfully

In the event that your insurance has failed to compensate you or you don’t want to go about the claim process alone, retaining with an attorney can help benefit you greatly. Having a legal representative on your side may help you not only compensate, but receive a larger compensation than you would if you filed alone. An attorney has studied the law in depth and is current on the ever-changing world of rules, regulations, and laws. If you are concerned and strongly believe you deserve more, you may not be in the wrong at all. Consult with one of our experienced claims attorneys today to learn more.

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