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The examiners reviewed files drawn from the category of Closed Claims for the period May 1, 2004, through April 30, 2005, commonly referred to as the "review period". The examiners reviewed 160 claims files. The examiners cited one claim handling violation 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. In one instance, the Company failed to respond to communication within 15 calendar days. The decedent's spouse, whom had assigned the life benefits directly to the funeral service provider, made an inquiry into a potential double payment to the provider. The Company did not respond nor provide an explanation to the inquiry. The Department alleges this act is in violation of CCR §2695.5(b).

Summary of Company Response: This was an isolated incident and not reflective of a pattern and practice of the company. It is the Company procedure to respond timely to all correspondence.

There were no citations alleged or criticisms of insurer practices in this line of business within the scope of this report.

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Last Revised - January 12, 2006
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