Unfair Claims Settlement Practices
Section 790.03 of the California Insurance Code defines unfair methods of competition and unfair and deceptive acts or practices in the business of insurance. Subsection (h) of 790.03 contains a list of 16 unfair claims settlement practices. It is a violation of 790.03 for an insurance company to knowingly commit any of these acts or perform them often enough that it appears to be a general business practice of the insurer. We discuss these unfair claims settlement practices below. If you believe your insurer has committed one of these acts against you, contact Gianelli & Morris to speak with our skilled and experienced California bad faith insurance law attorneys. We help individual policyholders harmed by such conduct as well as pursue class action litigation on behalf of policyholders when unfair claims settlement practices amount to a general business practice among the company.
Unfair Claims Settlement Practices in California Insurance Code 790.03(h)
(1) Misrepresenting pertinent facts or insurance policy provisions to claimants.
(2) Failing to acknowledge communications from the insured and respond reasonably promptly.
(3) Failing to adopt and implement reasonable standards for the prompt investigation and processing of claims.
(4) Failing to affirm or deny coverage of claims within a reasonable time after proof of loss requirements have been completed and submitted by the insured.
(5) Not attempting in good faith to settle claims promptly and fairly once the issue of liability has become reasonably clear.
(6) Forcing policyholders to file a lawsuit to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered, when the policyholder’s original claim was for a similar amount compared to what was ultimately recovered.
(7) Attempting to settle a claim for less than the amount that a reasonable person would believe he or she was entitled to based on the insurance company’s advertising material.
(8) Attempting to settle claims on the basis of an application that was altered without notice to, or knowledge or consent of, the insured, his or her representative, agent, or broker.
(9) Failing to inform insureds or beneficiaries of the coverage under which a payment was made after the insured or beneficiary requested such information.
(10) Making it known that the company has a practice of appealing arbitration awards in favor of insureds to compel insureds to accept a settlement or compromise less than the amount awarded in arbitration.
(11) Delaying the investigation or payment of claims by requiring an insured or their physician to submit a preliminary claim report and then requiring the subsequent submission of formal proof of loss forms, when both submissions contain substantially the same information.
(12) Failing to settle claims promptly, where liability has become apparent, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
(13) Failing to promptly provide a reasonable explanation of the basis relied on in the insurance policy, in relation to the facts or applicable law, for the denial of a claim or for the offer of a compromise settlement.
(14) Directly advising a claimant not to obtain the services of an attorney.
(15) Misleading a claimant as to the applicable statute of limitations.
(16) Delaying the payment or provision of hospital, medical, or surgical benefits for services provided with respect to acquired immune deficiency syndrome or AIDS-related complex for more than 60 days after the insurer has received a claim for those benefits, where the delay in claim payment is for the purpose of investigating whether the condition preexisted the coverage. This 60-day period does not include any time during which the insurer is awaiting a response for relevant medical information from a healthcare provider.
Contact Gianelli & Morris to Hold Your Insurance Company Accountable to You
If your insurance company has been putting off investigating your claim or delaying payment, if they have been making repeated requests for the same information or documentation, if they denied your claim without giving a reason, if they have been failing to communicate promptly, or if they have committed any unfair claims settlement practice defined in the California Insurance Code, call Gianelli & Morris at 213-489-1600 for a free consultation. We take on insurance companies statewide who delay or deny health and life insurance claims in bad faith, recovering policy benefits and significant compensation for our deserving clients.
