California Code of Regulations
Title 10 - Investment
Chapter 5 - Insurance Commissioner
Subchapter 3 - Insurers
Article 9.7 - Workers' Compensation Insurance Procedural Requirements and Standards Applicable to Employers, Insurers, and Rating Organizations in the Initiation of and Response to Requests for Review, Requests for Policyholder Information, and Requests for Reconsideration Provided in Insurance Code Sections 11737(f), 11752.6(c), 11753.1(a) and 11753.1(b), and, Rules of Practice and Procedure for Appeals to the Insurance Commissioner Pursuant to Insurance Code Sections 11737(f), 11752.6(c), 11753.1(a), 11753.1(b) and 11753.1
Section 2509.45 - Decision on Complaint and Request for Action; Time for Reconsideration; Notice of Appeal Rights
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) Within sixty (60) days after the insurer or rating organization serves the applicant with a notice granting review of the Complaint and Request for Action, the insurer or rating organization shall serve the applicant with a written decision upon the Complaint and Request for Action. The decision shall provide the insurer's or rating organization's evaluation of the Complaint and Request for Action and contain a recitation of the pertinent facts and a determination of the issues presented which grants or rejects in whole or in part the Complaint and Request for Action. The decision shall include a specific statement of the basis for the action taken. If an acknowledgment and notice have not been served pursuant to Section 2509.44, above, the decision shall include the statements required in the acknowledgment and notice. If the insurer or rating organization fails to grant or reject the Complaint and Request for Action within sixty (60) days after the notice granting review was served, the applicant may proceed in the same manner as if the Complaint and Request for Action had been rejected.
(b) An employer, insurer, or other aggrieved person may request reconsideration of a decision of an insurer or the designated rating organization served pursuant to subsection (a) of this section. The request for reconsideration shall be in writing and shall be served within thirty (30) days of service of the decision. The insurer or rating organization shall serve a decision on reconsideration within thirty (30) days of service of the request for reconsideration.
(c) A decision which grants a Request for Policyholder Information, or rejects the request in part, shall be accompanied by such portions of the policyholder information requested that the rating organization has agreed to make available and for which payment has been received.
(d) If review of the Complaint and Request for Action is rejected or the Complaint and Request for Action is rejected, the decision shall include a statement in substantially the following form, in bold:
You have only 30 days from the date this decision was served on you to appeal the decision to the California Insurance Commissioner. See Title 10, California Code of Regulations, section 2509.46.
Address your appeal to:
ADMINISTRATIVE HEARING BUREAU
CALIFORNIA DEPARTMENT OF INSURANCE
1901 HARRISON STREET, 3RD FLOOR MAILROOM
OAKLAND, CA 94612
(415) 538-4102
1. New section
filed 2-22-99 as an emergency; operative 2-22-99 (Register 99, No. 9). A Certificate
of Compliance must be transmitted to OAL by 6-18-99 or emergency language will be
repealed by operation of law on the following day.
2. New section refiled
6-18-99 as an emergency; operative 6-18-99 (Register 99, No. 25). A Certificate of
Compliance must be transmitted to OAL by 10-18-99 or emergency language will be
repealed by operation of law on the following day.
3. New section refiled
10-18-99 as an emergency; operative 10-19-99 (Register 99, No. 43). A Certificate of
Compliance must be transmitted to OAL by 2-16-2000 or emergency language will be
repealed by operation of law on the following day.
4. Repealed by
operation of Government Code section
11346.1(g)
(Register 2000, No. 6).
5. New section filed 2-10-2000; operative
3-11-2000 (Register 2000, No. 6).
6. Change without regulatory effect
amending subsection (d) and amending NOTE filed 1-2-2003 pursuant to section
100, title 1, California Code of
Regulations (Register 2003, No. 1).
7. Change without regulatory effect
amending NOTE filed 6-3-2003 pursuant to section
100, title 1, California Code of
Regulations (Register 2003, No. 23).
8. Change without regulatory effect
amending subsection (d) filed 8-27-2020 pursuant to section
100, title 1, California Code of
Regulations (Register 2020, No. 35).
Note: Authority cited: Section 11400.20, Government Code; and Section 11753.1, Insurance Code. Reference: Section 11415.10, Government Code; and Sections 11734, 11737(f), 11750, 11752.6(c), 11753.1(a) and 11753.1(b), Insurance Code.
