7 of the Most Frequently Asked Questions about Fraud and Fair Claims
It’s not easy wading through the California code of Regulations to make sure you’re doing everything correctly. But we’re here to help! Some of the most common questions we get are around California’s fraud and fair claims rules. So, we collected 7 of our most frequently asked questions about fraud and fair claims to help you determine whether you need certification, what kind of training you need and when:
Q: Who needs fraud and fair claims training?
A: Under California law, all CA Adjusters and Claims Agents must undertake thorough and adequate training regarding the California Fair Claims Settlement Practices Law.
Q: What do Adjusters need to do to be compliant with fraud and fair claims training rules?
A: Compliance with the law requires Adjusters to
1.) Read and understand California Code of Regulations Title 10, Chapter 5
2.) Carry a copy in their claims manual
3.) Abide by clear written instructions regarding claims procedures to be followed to effect proper compliance.
Q: Do I need to display or present a copy of my fraud and fair claims certificate?
A: A copy of your certification shall be maintained at all times at the principal place of business and provided to the commissioner upon request.
Q: How often do I need to renew my certificate?
Q: When is the deadline to renew my certificate each year?
A: Certification must be completed on or before September 1 of each calendar year.
Q: What’s the easiest way to renew my certificate?
A: Affordable Educators offers two EASY, online courses (#183 and #187) that satisfy the requirements for your fraud and fair claims certification AND earn you 12 hours of continuing education credits toward your next license renewal.
Q: When should I take a fraud and fair claims course to make sure I’m compliant
A: We recommend taking one of our two fraud and fair claims courses each year before September 1. This will ensure you are compliant for your fraud and fair claims certification and earn you enough CE credits for your license renewal every two years (24 credits total).
To get started on your CA Fraud and Fair Claims certification training now, visit our California Adjuster Continuing Education page and choose course #183 or #187.
With more than 25 years in the CA insurance containing education business, we’ve come across about just about everything and we’re happy to help you navigate the rules to find the CE you need. Please visit https://affordableeducators.com for more information on all of our continuing education. Or give us a call at 1-800-498-5100.
Pertinent excerpts from CA Fair Claims Settlement Practices Regulations
California Code of Regulations
Title 10, Chapter 5
Section 2695.1. Preamble.
(a) Section 790.03(h) of the California Insurance Code enumerates sixteen claims settlement practices that, when either knowingly committed on a single occasion, or performed with such frequency as to indicate a general business practice, are considered to be unfair claims settlement practices and are, thus, prohibited by this section of the California Insurance Code.
Section 2695.2. Definitions.
(d) “Claims agent” means any person employed or authorized by an insurer, to conduct an investigation of a claim on behalf of an insurer or a person who is licensed by the Commissioner to conduct investigations of claims on behalf of an insurer.
(k) “Investigation” means all activities of an insurer or its claims agent related to the determination of coverage, liabilities, or nature and extent of loss or damage for which benefits are afforded by an insurance policy, obligations or duties under a bond, and other obligations or duties arising from an insurance policy or bond.
Section 2695.6. Training and Certification.
(a) Every insurer shall adopt and communicate to all its claims agents written standards for the prompt investigation and processing of claims, and shall do so within ninety (90) days after the effective date of these regulations or any revisions thereto.
(b) All licensees shall provide thorough and adequate training regarding the regulations to all their claims agents. Licensees shall certify that their claims agents have been trained regarding these regulations and any revisions thereto. However, licensees need not provide such training or certification to duly licensed attorneys.
The full CA Fair Claims Settlement Practices Regulations can be found here: http://www.insurance.ca.gov/01-consumers/130-laws-regs-hearings/05-CCR/fair-claims-regs.cfm
If you have additional questions, please visit https://caladjuster.affordableeducators.com/fair-claims-cart/ or give us a call at 1-800-498-5100.