California Code of Regulations
Title 10 - Investment
Chapter 5 - Insurance Commissioner
Subchapter 2 - Policy Forms and Other Documents
Article 6.5 - Unemployment Compensation Disability Policies
Subarticle 3 - Form-Required Provisions
Section 2244.5 - Notice and Proof of Claim; Alternative Provisions

Universal Citation: 10 CA Code of Regs 2244.5

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

Every U. C. D. policy shall contain provisions relative to notice and proof of claim which, at the option of the insurer, shall be either in the short form set forth under (a) of this section (or in the substance thereof) or in all of the forms set forth under (b) of this section (or in the substance thereof) in accordance with the instructions for their use:

(a) First Alternative Required Provision Relative to Notice and Proof of Claim.

"All__________ provided in this policy shall be paid to the employee as they accrue upon receipt of written proof (on the insurer's forms or, if such forms are not furnished by the insurer within fifteen days after demand therefor, then upon receipt of written proof) covering the occurrence, character and extent of the event for which claim is made."

Instructions for Its Use.

This provision may be used, at the option of the insurer, in lieu of any one of the following combinations of provisions under (b): (b):

(b) (1), (2) and (3)

(b) (1), (2), (3) (4) and (5)

(b) (1), (2), (3), (4), (5) and (6)

In the blank space the word "benefits" or other descriptive phrase shall be entered. If this provision is used in combination with the provision under (b)(6), there shall be substituted in lieu of the words, "to the employee as they accrue" contained in this provision, the words "as stated__________" inserting in the blank space the location in the policy of the required provision prescribed under (b) (6).

(b) Second Alternative Required Provisions Relative to Notice and Proof of Claim:

(1) "Written notice of injury or of sickness upon which claim is based must be given to the insurer within twenty days after the date of the commencement of the first loss for which benefits arising out of each such injury or sickness are claimed."

(2) "Notice given by or in behalf of the claimant to the insurer at__________ or to any authorized agent of the insurer, with particulars sufficient to identify the insured employee, shall be deemed to be notice to the insurer."

Instructions for Use of Form (b) (2).

In the blank space, the address at which notice may be given shall be entered. This provision may be omitted if the insurer has conspicuously imprinted on the individual certificate (including supplemental certificates) and the statements of coverage the name of the insurer and the address of its home and branch offices to which notices may be sent. Otherwise, this provision shall be incorporated in the policy if the insurer elects not to use the short form of provision relative to notice and proof of claim set forth under (a) of this section.

(3) "The insurer, upon receipt of the notice required by this policy, will furnish to the claimant such forms as are usually furnished by it for filing proof of loss. If such forms are not so furnished within fifteen days after the insurer receives such notice, the claimant shall be deemed to have complied with the requirements of this policy as to proof of loss upon submitting, within the time fixed in the policy for filing proofs of loss, written proof covering the occurrence, character and extent of the loss for which claim is made.

(4) "Affirmative proof of loss of time on account of disability for which claim is made must be furnished to the insurer within ninety days after the termination of the period for which claim is made."

(5) "Failure to furnish notice or proof within the time provided in this policy shall not invalidate or reduce any claim if it shall be shown not to have been reasonably possible to furnish such notice or proof and that such notice or proof was furnished as soon as was reasonably possible."

Instructions for Use of Form (b) (5).

If this provision is used in combination with the short form of provision under (a), the words "Notice or" shall be omitted.

(6) "Upon request of the insured employee and subject to due proof of loss the accrued benefits will be paid to the insured employee each __________during any period for which the insurer is liable, and any balance remaining unpaid at the termination of such period will be paid to the insurer immediately upon receipt of due proof.

Instructions for Use of Form (b) (6).

In the blank space there shall be entered either a period of time not greater than one week or a period of time not greater than two weeks together with the phrase "or each week, if the claimant so requests,."

Disclaimer: These regulations may not be the most recent version. California may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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