In California, the insurance codes have laws established that apply to car insurance companies. Many are designed to punish companies that have engaged in unfair practices. The Department of Insurance is unable to force insurance companies to pay claims that are deserved by claimants. But the individual does have the ability to file a DOI complaint, assuming they are not already represented by an attorney.
The DOI will claim you are not without a remedy since you have an attorney. So this really only applies to people who are trying to battle their case with no outside counsel. In any event, this is good stuff to know. And we recommend that every consumer facing an insurance company peruse through this document to familiarize themselves with the rights, duties, and obligations of both insurers and claimants.
What are Unfair Claims Practices?
First, what the heck is an unfair practice? Well, unfair practices by insurance companies may involve misrepresentation of insurance policy provisions related to coverage and claimants. Insurance companies can be acting in bad faith when they attempt to put off, deny or delay settling a fair claim. So when the objective requirements have been met they cannot escape paying. One example would be when the insurer fails to acknowledge or act within a reasonable amount of time. So upon the communications of the damaged party, when a claim has been filed against an insurance policy. they must act.
Also, it applies if the insurer fails to settle when it is clear that there is compelling evidence they are liable, or offers a paltry amount. If it shocks the conscience and is far from similar case payouts, it may trigger action.
What is the Insurance Code for Unfair Practices?
The California Insurance Codes that apply for unfair practices is Insurance Code 790.03 (h), which is the Unfair Practices Act. This act details various actions by an insurance company. These are actions considered unfair practices against policy holders and claimants. The Department of Insurance is responsible for enforcing the standards insurance companies must practice being within the law.
What are Other Unfair Insurance Practices?
The failure to settle claims promptly, when it has become apparent under the insurance policy coverage there is liability under the ACT, it applies. Also, it comes into play when it influences settlements under portions of the policy coverage. If they fail to promptly to provide a reasonable explanation for the denial of a claim or offer a settlement, they are on the hook. If an insurer or adjuster directly tells a claimant not to involve the services of a lawyer it may also apply.
How Do I File a Complaint with the California Department of Insurance?
Filing a complaint with the California Department of Insurance should not be done prior to contacting the insurance company. You must first attempt to resolve the problems that exist in the claim process. So if this is not successful, the claimant can file a request for assistance. Or a victims may file a complaint form with the Department of Insurance.
Along with this request there should be documentation. Also, if supporting documentation is not included with the complaint or request it could result in a delay. Documents that should be included are the declaration page from your insurance policy, if you are bringing a claim against your own insurance company. Also, any cancelled checks, the denial letter and any other documents that pertain to proving the claim or communications must be sent.
Original documents should not be sent with the complaint or request. And original photos should not accompany either of these documents. After all, they are evidence. And it most likely will not be possible to get them back. Copies are important to send of evidence and photographs to help in the review of the insurance company practices by the Department of Insurance.
When a request or complaint is filed with this agency, a copy of the request is generally provided to the insurance company, broker or agent. But not if the person who files the complaint requests that they do not want a copy forwarded. Attorneys usually suggest that a copy of the request or complaint get forwarded to the insurance company by the plaintiff. Here is a copy of the fill-able PDF complaint form.
The California Department of Insurance can be contacted at:
California Department of Insurance Consumer Communications Bureau
300 South Spring Street, South Tower
Los Angeles, Ca. 90013
They can be contacted between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday at:
1-800-927-HELP (4357) or 213-897-8921.