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The examiners reviewed files drawn from the category of Closed Claims for the period January 1, 2004 through January 1, 2005, commonly referred to as the "review period". The examiners reviewed 240 California Fair Plan claims files. The examiners cited three claims handling violations of the Fair Claims Settlement Practices Regulations and/or California Insurance Code Section 790.03 within the scope of this report. Further details with respect to the files reviewed and alleged violations are provided in the following tables and summaries.

The following is a brief summary of the criticisms that were developed during the course of this examination related to the violations alleged in this report. This report contains only alleged violations of Section 790.03 and Title 10, California Code of Regulations, Section 2695 et al. In response to each criticism, the Company is required to identify remedial or corrective action that has been or will be taken to correct the deficiency. Regardless of the remedial actions taken or proposed by the Company, it is the Company's obligation to ensure that compliance is achieved. There were no recoveries discovered within the scope of this report.

1. The Company failed to properly document the claim file. In three instances, the Company failed to properly document the claim file. The Company failed to document the age and condition of items depreciated on a dwelling claim. The Department alleges these acts are in violation of CCR §2695.3(a).

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Last Revised - July 21, 2005
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