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Section 12921.4 Of Article 1. Generally From California Insurance Code >> Division 3. >> Chapter 2. >> Article 1.
12921.4
. (a) The commissioner shall, upon receipt of a written
complaint with respect to the handling of an insurance claim or other
obligation under a policy by an insurer or production agency, or
alleged misconduct by an insurer or production agency, notify the
complainant of the receipt of the complaint within 10 working days of
receipt. Thereafter, the commissioner shall notify the complainant
of the final action taken on his or her complaint within 30 days of
the final action.
The department shall include, with each notification of final
action, or, at a minimum, with a number of randomly selected
notifications of final action sufficient to assure the validity of
results, a complaint handling evaluation form. This form shall
clearly and concisely seek an evaluation of the department's
performance in handling the complainant's grievance. The areas of
evaluation shall include, but not be limited to: whether the
complaint was handled in a fair and reasonable manner, evaluated
thoroughly and without bias; the time required for resolution of the
complaint; whether the complaint was referred and, if so, whether it
was referred within a satisfactory time; whether the staff involved
in handling the complaint demonstrated an adequate knowledge of the
issues involved in the complaint; whether the complainant was
satisfied with the result of the department's intervention; and
whether the complainant would recommend the department's complaint
handling services to others.
The commissioner shall, if deemed appropriate, notify insurers or
production agencies against whom the complaint is made of the nature
of the complaint, may request appropriate relief for the complainant,
and may meet and confer with the complainant and the insurer in
order to mediate the complaint. This section shall not be construed
to give the commissioner power to adjudicate claims.
(b) The commissioner shall ascertain patterns of complaints by insurer, geographic area, insurance line, type of violation, and any other valid basis the commissioner may deem appropriate for further investigation, and periodically evaluate the complaint patterns to determine additional audit, investigative, or enforcement actions which may be taken by the commissioner, and report on all actions taken with respect to those patterns of complaints in his or her annual report to the Governor pursuant to Section 12922, and to the public. For the purposes of this subdivision, complaints mean those written complaints received by the commissioner under subdivision (a), and written complaints received by the commissioner from any other sources, alleging misconduct or unlawful acts by insurers or production agencies.
(b) The commissioner shall ascertain patterns of complaints by insurer, geographic area, insurance line, type of violation, and any other valid basis the commissioner may deem appropriate for further investigation, and periodically evaluate the complaint patterns to determine additional audit, investigative, or enforcement actions which may be taken by the commissioner, and report on all actions taken with respect to those patterns of complaints in his or her annual report to the Governor pursuant to Section 12922, and to the public. For the purposes of this subdivision, complaints mean those written complaints received by the commissioner under subdivision (a), and written complaints received by the commissioner from any other sources, alleging misconduct or unlawful acts by insurers or production agencies.
