What Are My Rights As A Policyholder?

As an insurance policyholder in California, you have clearly defined rights under the Insurance Code, California law, and the Fair Claims Settlement Practices Act.

YOU HAVE THE RIGHT:

To Be Treated Fairly. Policyholders have the right to be treated in good faith, meaning the the insurance company must communicate all information about the claim; must give the policyholder's interest at least as much as the company's own interest; engage in a prompt, reasonable and diligent investigation; and do nothing to impair the rights of the policyholder under the policy.

To Information. You have a right to ask your insurer to explain to you "all benefits, coverage, time limits or other provisions of any insurance policy that insurer may apply to the claim presented by the claimant."

To A Fast Response. "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 [insurer]." The insurer shall also "acknowledge receipt of such notice to the claimant unless payment is made within that period of time."

To All Claim Forms Needed. Within 15 days after receiving a communication from the policyholder, "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."

To An immediate Claim Investigation. Within 15 days after receiving a communication from the policyholder, the insurer must "begin any necessary investigation of the claim."

To A Fair Claim Investigation. "Every insurer shall conduct and diligently pursue a thorough, fair and objective investigation and shall not persist in seeking information not reasonably required for or material to the resolution of a claim dispute."

To A Fair Claim Payment.  "No insurer shall attempt to settle a claim by making a settlement offer that is unreasonably low."

To A Fast Claim Payment. After accepting liability for a claim, an insurer "shall immediately, but in no event more than thirty (30) calendar days later, tender payment or otherwise take action to perform its claim obligation."

To Information About Additional Benefits. "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."

To The Truth. "No insurer shall misrepresent or conceal benefits, coverages, time limits or other provisions of the bond which may apply to the claim presented[.]"

To Complain To The California Department of Insurance Without Reprimand. "No insurer shall require that a claimant withdraw, rescind or refrain from submitting any complaint to the California Department of Insurance regarding the handling of a claim or any other matter complained of as a condition precedent to the settlement of any claim."

To Non-Discrimination. "No insurer shall discriminate in its claims settlement practices based upon the claimant's age, race, gender, income, religion, language, sexual orientation, ancestry, national origin, or physical disability, or upon the territory of the property or person insured."

To A Full Explanation Why A Claim Is Denied. "Where an insurer denies or rejects a first party claim, in whole or in part, it shall do so in writing and shall provide to the claimant a statement listing all bases for such rejection or denial and the factual and legal bases for each reason given for such rejection or denial which is then within the insurer's knowledge. Where an insurer's denial of a first party claim, in whole or in part, is based on a specific statute, applicable law or policy provision, condition or exclusion, the written denial shall include reference thereto and provide an explanation of the application of the statute, applicable law or provision, condition or exclusion to the claim. Every insurer that denies or rejects a third party claim, in whole or in part, or disputes liability or damages shall do so in writing."

To Updates On Your Claim Status. "If more time is required .. to determine whether a claim should be accepted and/or denied in whole or in part, every insurer shall provide the claimant...with written notice of the need for additional time. This written notice shall specify any additional information the insurer requires in order to make a determination and state any continuing reasons for the insurer's inability to make a determination. Thereafter, the written notice shall be provided every thirty (30) calendar days until a determination is made or notice of legal action is served. If the determination cannot be made until some future event occurs, then the insurer shall comply with this continuing notice requirement by advising the claimant of the situation and providing an estimate as to when the determination can be made."