ll Claims Personnel Must be Trained by September 1, 2021 on Fair Claims Regulations

Published: July 27, 2021, 3:03 p.m.

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A Video Explaining the Need tor Training of the Fair Claims Settlement  Practices Regulations   

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https://zalma.com/blog

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In 1993, after waiting five years after receiving direction from the  California Supreme Court, the state of California determined that the  insurance industry needed to be regulated to stop insurers from treating  the people insured badly and without good faith. It created a set of  Regulations called the \\u201cCalifornia Fair Claims Settlement Practices  Regulations\\u201d (the \\u201cRegulations) that were designed to enforce the  mandate created by the California Fair Claims Settlement Practices  statute, California Insurance Code Section 790.03 (h).  

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in response to  the direction of the California Supreme Court in its decision,  Moradi-Shalal v. Fireman\\u2019s Fund Ins. Companies, 46 Cal. 3d 287 (1988).  In so doing the California Department of Insurance (CDOI) issued rules  that were designed to micro manage the business of insurance claims and  create a method to punish those insurers who failed to comply with the  Regulations. Some of the Regulations recited what had always been  recognized by the insurance industry as good faith and proper claims  handling. 

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Others imposed draconian mandates on what and when to do  everything in the claims process.  The Regulations also provided a guide to insureds, public insurance  adjusters and policyholders\\u2019 lawyers to assert any violation of the  Regulations to be evidence of an insurer\\u2019s breach of the implied  covenant of good faith and fair dealing.

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All insurers doing business in California must comply with the  requirements of the Regulations or face the ire of, and attempts at  financial punishment from, the CDOI. That punishment was found to be  questionable and limited because of one courageous insurer who fought  the CDOI and succeeded before an administrative law judge who limited  the right to punish. That success, as far as I have been able to  determine, has not been emulated.

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Regardless of difficulties in assessing punishment the state of  California requires all who are involved in the claims process \\u2014 even if  only tangentially \\u2014 to be trained with regard claims handling in  compliance with the Regulations and attest to completion of such  training under oath. To avoid the required annual training the claims  person can submit a sworn document to the insurer or insurers for whom  the claims person works that avers that he or she has read and  understood the Regulations.

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