Cal. Code Regs. Tit. 10, § 2695.4 - Representation of Policy Provisions and Benefits
(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.
(f) No insurer shall issue checks or drafts
in partial settlement of a loss or claim that contain or are accompanied by
language releasing the insurer, the insured, or the principal on a surety bond
from total liability unless the policy or bond limit has been paid, or there
has been a compromise settlement agreed to by the claimant and the insurer as
to coverage and amount payable under the insurance policy or bond.
(g) No insurer shall require a first party
claimant or beneficiary to submit duplicative proofs of claim where coverage
may exist under more than one policy issued by that insurer.
Notes
2. Amendment of section heading and subsection (a), repealer and new subsection (b), repealer of subsection (f) and subsection relettering filed 1-10-97; operative 5-10-97 (Register 97, No. 2).
3. Amendment filed 4-24-2003; operative 7-23-2003 (Register 2003, No. 17).
4. Change without regulatory effect filed 8-4-2004 depublishing the amendments to the insurance claims handling practices regulations that were approved by OAL 4-24-2003, but were enjoined in Personal Insurance Federation and The Surety Association of America v. John Garamendi, and reinstating replacement regulations that were either (1) in effect prior to OAL's 4-24-2003 approval of the amendments to the regulations or (2) were found by the court to be valid, as amended, all pursuant to a court-approved settlement agreement dated 6-7-2004 (Register 2004, No. 32).
5. Amendment of subsections (b) and (c) filed 6-1-2006; operative 8-30-2006 (Register 2006, No. 22).
Note: Authority cited: Sections 790.10, 12340-12417, inclusive, 12921 and 12926, Insurance Code; and Sections 11152 and 11342.2, Government Code. Reference: Sections 790.03(h)(1), (3) and (4), Insurance Code.
2. Amendment of section heading and subsection (a), repealer and new subsection (b), repealer of subsection (f) and subsection relettering filed 1-10-97; operative 5-10-97 (Register 97, No. 2).
3. Amendment filed 4-24-2003; operative 7-23-2003 (Register 2003, No. 17).
4. Change without regulatory effect filed 8-4-2004 depublishing the amendments to the insurance claims handling practices regulations that were approved by OAL 4-24-2003, but were enjoined in Personal Insurance Federation and The Surety Association of America v. John Garamendi, and reinstating replacement regulations that were either (1) in effect prior to OAL's 4-24-2003 approval of the amendments to the regulations or (2) were found by the court to be valid, as amended, all pursuant to a court-approved settlement agreement dated 6-7-2004 (Register 2004, No. 32).
5. Amendment of subsections (b) and (c) filed 6-1-2006; operative 8-30-2006 (Register 2006, No. 22).
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