Communication
Must be sent to the insured every 28 calendar days while a claim remains open
What is a Status Letter
Before issuing any payment, this must first be established
What is coverage
According to FAIR Plan expectations, this should document significant claim activity and the reasoning behind important decisions
What are file notes
This estimating platform is most commonly used by property adjusters
What is Xactimate
These regulations establish standards for fair claims handling in California
What are the Fair Claims Settlement Practices Regulations
This communication explains the claim process, applicable coverages, and available benefits to the insured.
What is the initial claim explanation
This document ultimately determines whether a loss is covered
What is the insurance policy
QA reviews evaluate this to determine whether another examiner could understand how the claim was handled
What is claim documentation
Before recommending payment, estimates should be compared with others for this purpose
What is reconciliation
These regulations require insurers to conduct prompt, fair, and equitable investigations
What are the California Fair Claims Settlement Practices Regulations
CFP Guidelines require insurers to respond to communications within this number of calendar days.
What is 10 days
This principle allows payment for amounts that are reasonably clear, even while the remainder of the claim is still under investigation
What is an undisputed payment
A payment recommendation should include this in addition to the amount requested
What is a coverage analysis
Differences between contractor and carrier estimates should be resolved using this rather than simply choosing one estimate
What is estimate reconciliation
This agency regulates insurers doing business in California
What is the California Department of Insurance