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The examiners reviewed files drawn from the category of Closed Claims for the period December 1, 2004, through November 30, 2005, commonly referred to as the "review period". The examiners reviewed 27 claim 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.
INDIVIDUAL LIFE

1. In one instance, the Company failed to maintain a copy of the certification required by CCR § 2695.6(b)(1),(2) or (3) at the principal place of business. The Company did not certify in writing that their adjusting staff had been trained in accordance with the California Code of Regulations. The Department alleges these acts are in violation of CCR §2695.6(b)(4)

Summary of Company Response: As a result of this exam all the claims handlers will be trained and certified by March 30, 2006. A copy of the certification will be sent to the Department. The certification will take place annually prior to September 1 as required by the Regulations.


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Last Revised - June 08, 2006
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