The California Fair Claims Settlement Practices Act imposes multiple deadlines to respond and report to insureds during a claim adjustment. Knowing and understanding an insurer’s reporting duties and deadlines can speed up the adjustment and payment of a claim. Although a failure to meet a deadline by a day or two may not, in and of itself, constitute bad faith, failing to respond to an insured or repeated failure to meet deadlines is evidence of an insurer’s poor conduct and may be evidence of bad faith.
Insurers’ reporting duties are scattered throughout the California Fair Claims Settlement Practices Act. They can therefore be difficult to follow and keep track of when advocating on an insured’s behalf. If an insurer has not met a deadline, it is a best practice always to send a written communication confirming and setting forth all facts that identify the insurer’s failure to comply with its reporting obligations under California law.
The major deadlines are set forth below and can be summarized as follows:
- An insurer has 15 days to acknowledge it received notice of a claim. The insurer should also provide any necessary forms and instructions for the claim, should offer reasonable assistance to the insured and begin its investigation. Cal. Ins. Code § 2695.5(e).
- An insurer has 40 days to accept or deny a claim in whole or in part. If an insurer is unable to accept or deny a claim, it should provide a written explanation of why it cannot come to a claim decision and describe what additional information it needs. Cal. Ins. Code § 2695.7(b). Always immediately inform an insurer in writing if it has not complied with this deadline.
- If an insurer needs additional time, i.e., more than 40 days, to investigate a claim, it must provide written notice explaining the reasons why more time is needed. The insurer is further required to provide a written update on the status of the claim investigation every 30 days until the claim investigation is complete. Cal. Ins. Code § 2695.7(c). Whenever you receive a status letter stating more time is needed for an insurer to accept or deny coverage, immediately calendar a reminder for 35 days to see if an insurer has provided a 30-day status letter. Promptly notify the insurer if it has not complied with this request.
- An insurer has 15 days to respond to every communication from an insured that reasonably suggests a response is necessary. The insurer is required to provide as complete a response as possible. Cal. Ins. Code § 2695.5(b).
- An insurer must provide written notice of any statute of limitation or other time period requirement an insurer may rely on to deny to a claim no less than 60 days before that date. Cal. Ins. Code § 2695.7(f).
- And last, but certainly not least, an insurer has 30 days to tender payment after an agreement for claim payment is reached, and any necessary release is executed. Cal. Ins. Code § 2695.7(h).
Knowing and monitoring all of these dates will enhance your representation of insureds and build your credibility with carriers.