Failing to Communicate With the Insured
Insurance policyholders in California rely on their insurers for timely communication regarding claims and policy benefits. Unfortunately, some insurers fail to maintain adequate communication, which can leave policyholders in stressful and precarious situations. When insurers fail to communicate with their insureds, they may be engaging in an unfair practice prohibited by California law.
If your insurer is failing to communicate with you as required by law, they may be acting in a bad faith attempt to unreasonably delay or deny your claim. Contact Gianelli & Morris to share your concerns with a knowledgeable and experienced California insurance bad faith lawyer who stands up to the biggest insurers and makes sure they process claims as required by law.
California Insurance Code 790.03(h)(2)
California’s insurance industry is governed by strict laws that prohibit insurers from engaging in unfair practices. California Insurance Code 790.03(h) outlines various unfair methods of competition and unfair or deceptive acts in the business of insurance, many of which protect policyholders from bad faith practices.
One specific subsection, 790.03(h)(2), directly addresses an insurer’s duty to communicate with its insured. Under this statute, it is considered an unfair practice for an insurer to fail “to acknowledge and act reasonably promptly upon communications with respect to claims arising under insurance policies.” In other words, insurers must respond in a timely manner when policyholders submit claims or make inquiries about their policy benefits.
Delaying or ignoring communication with the insured can result in significant harm to the policyholder, including financial hardship, stress, and delayed medical care. This failure not only breaches the trust between the insurer and the insured but also violates the insurer’s legal obligations under California law.
What Constitutes “Failure to Communicate”?
Insurers are expected to respond promptly to any communications related to claims, whether initiated by the policyholder or a representative. Failing to communicate can include:
- Not responding to phone calls, emails, or written correspondence from the insured.
- Not acknowledging receipt of claims.
- Failing to provide updates on claim status or required documentation.
- Delaying responses without a valid reason.
If an insurer’s lack of communication rises to the level of a pattern or practice, it may constitute a violation of California Insurance Code 790.03(h)(2), opening the door for legal action.
Required Time Frames for Insurer Responses Under California Health and Safety Code
In addition to the Insurance Code statutes like 790.03(h)(2), insurers providing health insurance in California are also subject to rules found in the California Health and Safety Code. Sections 1368 and 1368.01, for example, establish specific time frames within which insurers must communicate with policyholders regarding claims and grievances.
Section 1368: Time Frame for Insurer Responses to Grievances
California Health and Safety Code Section 1368 outlines the procedures and timelines for health insurers to respond to grievances, including complaints related to claims denials, delays, or other issues with benefits. Under this code, health insurers are required to:
- Acknowledge receipt of a grievance within five calendar days of receiving it.
- Provide a written response to the grievance within 30 calendar days of receipt.
In some urgent circumstances, where the health of the insured is at risk, the law requires expedited responses. Insurers may be required to address grievances much sooner in cases involving imminent or serious threats to the health of the policyholder.
Section 1368.01: Expedited Grievance Resolution
For urgent health matters, California Health and Safety Code Section 1368.01 establishes even stricter deadlines. Specifically, when an insured files a grievance related to the denial, delay, or modification of a treatment that poses an imminent threat to their health, the insurer must resolve the grievance within 72 hours of receipt.
These provisions are designed to ensure that policyholders receive timely information and access to care when they need it most. Failing to comply with these response timelines can result in severe consequences for insurers, including regulatory penalties and potential bad faith lawsuits.
The Impact of Delayed Communication on Policyholders
When insurers fail to communicate or respond in a timely manner, it creates a multitude of problems for policyholders. For health insurance policyholders, delays can mean postponed medical treatments, mounting bills, or a worsening health condition. For life insurance policyholders, it may result in families waiting for months to receive the policy benefits they need for funeral costs or financial support.
Delays in communication or claims processing also cause significant stress and uncertainty. Policyholders may be left wondering if their claims are being handled properly, whether additional documentation is needed, or if their coverage is in jeopardy.
Legal Recourse for Policyholders Victimized by Communication Failures
When an insurance company fails to communicate with its insured or otherwise violates the timelines required by law, the policyholder may have grounds for a bad faith insurance claim. Bad faith claims allow policyholders to seek compensation beyond just the value of their original claim. In some cases, insurers who act in bad faith can be held liable for emotional distress, attorney’s fees, and even punitive damages, depending on the severity of the misconduct.
At Gianelli & Morris, we understand the frustration and hardship that can result from an insurer’s failure to communicate. Our legal team is dedicated to helping policyholders throughout California who have been victimized by bad faith insurance practices. We fight aggressively to hold insurers accountable and secure the benefits our clients are entitled to under their policies.
Contact Gianelli & Morris for Help With Insurance Claim Denials in California
California law places stringent requirements on insurers to ensure they communicate promptly and efficiently with policyholders. Failing to do so is not just an inconvenience—it’s a violation of the law. Under California Insurance Code 790.03(h)(2) and Health and Safety Code Sections 1368 and 1368.01, insurers are obligated to acknowledge and respond to claims and grievances in a timely manner. When they fail to uphold these duties, policyholders have legal recourse to protect their rights and recover compensation for bad faith insurance practices.
If your insurance company is failing to communicate with you or is delaying your claim, contact Gianelli & Morris at 213-489-1600 for a free, initial consultation. We will review your case and help you determine the best course of action.
