California Insurance Claim Deadlines
California's Fair Claims Settlement Practices Regulations impose strict timelines on insurers. These are not suggestions - they are legally binding requirements under California law. If your insurer misses these deadlines, it may constitute bad faith.
| Action Required | Deadline | Legal Citation |
|---|---|---|
| Acknowledge receipt of claim | 15 days | Cal. Code Regs. tit. 10, § 2695.5(e) |
| Begin investigation | 15 days | Cal. Code Regs. tit. 10, § 2695.7(b) |
| Accept or deny claim | 40 days | Cal. Code Regs. tit. 10, § 2695.7(b) |
| Pay undisputed amounts | 30 days | Cal. Code Regs. tit. 10, § 2695.7(h) |
| Respond to policyholder communications | 15 days | Cal. Code Regs. tit. 10, § 2695.5(b) |
Under Cal. Code Regs. tit. 10, § 2695.7(b), insurers must accept or deny your claim
within 40 calendar days of receiving proof of claim. They can request one 30-day extension if they
explain why in writing - but only if the delay is beyond their control.
If your insurer is "still investigating" after 40 days without a valid extension, document this violation. It strengthens any future bad faith claim.
What If the Insurer Needs More Time?
California law allows insurers to request extensions, but they must meet specific requirements:
- Written notice required: The insurer must explain in writing why more time is needed
- Reason must be valid: The delay must be for reasons beyond the insurer's control
- 30-day maximum: Extensions are limited to 30 additional days per request
- Continued communication: The insurer must update you every 30 days during extended investigations
California Fair Claims Settlement Practices
The California Fair Claims Settlement Practices Regulations (Cal. Code Regs. tit. 10, § 2695.1-2695.17) are your primary weapon against insurer misconduct. These regulations apply to all types of insurance and create specific duties that insurers must follow.
What Insurers Must Do
- Thorough investigation: Insurers must conduct a complete investigation before denying any claim
- Plain language: All communications must be in clear, understandable language
- Written explanations: Denials must include specific reasons and reference to policy provisions
- Proof of loss assistance: Insurers must provide necessary forms and help policyholders document claims
- Fair settlement offers: Settlement amounts must be reasonable based on the claim's value
Under Cal. Code Regs. tit. 10, § 2695.7(g), insurers cannot make settlement offers
so low that they force you to file a lawsuit to get fair compensation. If an insurer's first offer
is dramatically lower than your claim's actual value, document this as potential bad faith.
What Insurers Cannot Do
- Misrepresent policy terms: Insurers cannot lie about what your policy covers
- Delay tactics: Unreasonable delays in investigation or payment are prohibited
- Demand unnecessary documentation: Insurers can only request documents reasonably related to your claim
- Threaten or intimidate: Scare tactics to discourage claims are illegal
- Deny without investigation: Every claim must be properly investigated before denial
Key California Insurance Code Sections
Beyond the regulations, California's Insurance Code contains important protections. Here are the sections most relevant to your insurance claim:
Cal. Insurance Code § 790.03 - Unfair Practices
This is the foundation of California insurance consumer protection. It prohibits insurers from:
- Making false statements about policy coverage
- Failing to acknowledge communications promptly
- Not attempting fair claim settlements when liability is clear
- Compelling policyholders to sue to recover amounts due
- Not providing a reasonable explanation for claim denials
Cal. Insurance Code § 785 - Time Limits
Sets the statute of limitations for insurance contract claims. In California, you generally have:
- 4 years for breach of written insurance contract
- 2 years for bad faith tort claims
Your claim deadline depends on whether you're suing for breach of contract (4 years) or bad faith tort (2 years). The clock typically starts when the insurer denies your claim or when you knew or should have known about the denial. Don't wait - consult an attorney if you're approaching these limits.
Cal. Insurance Code § 2071 - Fire Insurance
Specific protections for fire insurance claims, including:
- Standard policy language requirements
- Proof of loss procedures
- 12-month deadline from loss to file suit (can be extended by negotiations)
California fire insurance policies contain a standard suit limitation clause requiring you to file
suit within 12 months of the loss. However, under Cal. Insurance Code § 2071, this
period is tolled (paused) while the insurer is investigating your claim. Document all communications
to preserve your right to sue.
Filing a California Department of Insurance Complaint
The California Department of Insurance (CDI) regulates all insurance companies operating in California. If your insurer violates California law, you can file a complaint.
When to File a CDI Complaint
- Insurer missed the 40-day investigation deadline
- Insurer won't return your calls or emails
- Claim was denied without proper investigation
- Denial letter doesn't explain the specific reasons
- Settlement offer is unreasonably low
- Insurer is engaging in delay tactics
How to File
- Gather documentation: Collect all correspondence, your policy, denial letters, and claim records
- Go online: Visit insurance.ca.gov
- Complete the form: Provide detailed information about your complaint
- Submit evidence: Upload supporting documents
- Track your case: CDI will assign a case number and investigate
While CDI cannot award you money damages, a CDI complaint can pressure the insurer to resolve your claim fairly. CDI complaints also create a paper trail that can support a future lawsuit. The CDI can fine insurers up to $10,000 per violation and revoke licenses for pattern violations.
California-Specific Rules by Claim Type
Auto Insurance Claims
- Minimum coverage required: 15/30/5 (liability), but most Californians should carry more
- Total loss threshold: When repair costs exceed the vehicle's actual cash value
- Rental car coverage: Must be offered but not required in California
- Diminished value: California allows third-party diminished value claims
Homeowners Insurance Claims
- Wildfire claims: Special protections under AB 2756 for disaster areas
- Additional Living Expenses: Insurers must pay ALE while your home is uninhabitable
- Personal property: Insurers must help create inventory and cannot demand original receipts for everything
- Code upgrade coverage: Required to be offered in California
California has enacted special protections for wildfire victims. Under Cal. Insurance Code
§ 675.1, insurers must provide policyholders with a detailed explanation of coverages
and cannot cancel policies in high-risk areas within certain timeframes after a declared disaster.
Health Insurance Claims
- Independent Medical Review: California's IMR process lets you appeal denials to an independent reviewer
- Timely access: Insurers must ensure you can get appointments within specific timeframes
- Balance billing protections: AB 72 protects against surprise bills from out-of-network providers at in-network facilities
Need Help With Your California Claim?
I help California policyholders fight back against unfair claim denials. Whether you need a demand letter, help with a CDI complaint, or representation in a bad faith case, I can help.