The state of California requires that insurers communicate standards for the prompt handling of claims to all individuals that may be in contact with our customers and could receive notice of a claim.
On an annual basis, the company’s Chief Compliance Officer must certify compliance with the California Fair Claims Settlement Practices regulations. Although you do not process claims, you play a very important role in supporting the Claims area to meet the standards set by California. This communication is intended to serve as a reminder of the California requirements, which state:
Upon receiving notice of claim (written or oral) or any communication from a claimant that reasonably suggests that a response is expected, every producer or customer service associate shall immediately transmit notice of claim to the insurer.
Since you are part of an area that is sometimes on the critical path of ensuring the timely handling of claims, and to ensure you are generally aware of California’s requirements yourself, we have summarized for you the standards that our Claims area must comply with:
Upon receiving notice of claim, every insurer shall immediately, but in no event more than fifteen (15) calendar days later, do the following unless the notice of claim received is a notice of legal action:
- Acknowledge receipt of such notice to the claimant unless payment is made within that period of time. If the acknowledgement is not in writing, a notation of acknowledgement shall be made in the insurer’s claim file and dated
- 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
- Begin any necessary investigation of the claim
The actual California Fair Claims Settlement Practices regulations are posted on SPA under the Training and Compliance Tab and then Other Compliance Resources. Please familiarize yourself with these requirements.
Thank you in advance for your efforts to help us comply with these regulatory requirements. If you have questions, please contact Sales Support at (877) 617-5589 or firstname.lastname@example.org.