Introduction and Learning Objectives

Introduction

California has strict rules to ensure insurance claims are handled promptly, fairly, and honestly. These are known as the Fair Claims Settlement Practices Regulations. They protect policyholders from delays or unfair treatment and hold insurers accountable for proper claims handling.

In this chapter, you will learn how claims must be documented, acknowledged, investigated, and resolved.

Learning Objectives

By the end of this chapter, you should be able to:

• Define key claims-related terms such as claimant, notice of legal action, and proof of claim.

• Understand the requirements for documenting claim files.

• Identify the duties of insurers and agents when they receive claim-related communications.

• Apply the standards for prompt, fair, and equitable settlements.