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A video explaining statutes and regulations on statutory justice requirements



Watch the full video at https://youtu.be/lYlbUYJgoKQ [1965653] California Insurance Code Section 790.03 (h)

(a) In an action for breach of a non-contractual obligation, where it is proved by clear and convincing evidence that the defendant has committed oppression, fraud or malice, the plaintiff may, in addition to the actual damages, recover damages for the sake of the example and by punishing the defendant

(h) To knowingly commit or perform with such frequency that it indicates a general business practice any of the following unfair claims settlement practices:

(1) Incorrect Explanation of Claims of Relevant Facts or Insurance Provisions Concerning Any Coverage in

(2) Fails to acknowledge and act reasonably quickly in communication with respect to claims arising under insurance policies.

(3) Failure to adopt and implement reasonable standards for rapid investigation

(4) Failure to confirm or deny coverage of claims within a reasonable time after proof of loss has been completed and submitted by the insured.

(5) Does not try in good faith to achieve prompt, fair and equitable solutions to claims where liability has become reasonably clear.

(6) Forcing the insured to initiate disputes to recover amounts under an insurance policy by offering significantly less than the amounts finally recovered in the action brought by the insured, when the insured has claimed amounts that are reasonably similar to the amounts finally recovered . he or she was right with reference to written or printed advertising material that accompanies or is made part of an application.

(8) Attempt to resolve cla ims on the basis of an application that has been amended without notice to, or knowledge or consent from, the insured, his or her representative, agent or broker.

(9) Fails, after payment of a claim, to inform insured persons or beneficiaries, at their request, of the coverage under which payment has been made.

(10) To make known to insured persons or tortfeasors a practice of the insurer to appeal against arbitration awards in favor of insured persons or claims in order to compel them to accept settlements or compromises less than the amount awarded in arbitration.

(11) Delay the investigation or payment of claims by requiring an insured person, the tortfeasor or the doctor to lodge a preliminary claim with one of them and then requiring the subsequent submission of formal proof of loss form, both submissions containing essentially the same information.

(12) Failure to settle claims immediately, where liability has become apparent, during part of the insurance cover in order to affect settlement during other parts of the insurance cover.

(13) Fails to provide immediately a reasonable explanation of the basis relied on in the insurance policy, in relation to facts or applicable law, for refusal of a claim or for the offer of a compromise solution.

(14) Advises a plaintiff directly not to obtain the services of a lawyer.

(15) Misleading a plaintiff with regard to applicable statute of limitations.

(16) Delay the payment or provision of hospital, medical or surgical benefits for services provided in respect of acquired immune deficiency syndrome or AIDS-related complex for more than 60 days after the insurer has received a claim for these benefits. , where the delay in the payment claim is for the purpose of examining whether the condition existed for the coverage. However, this 60-day period should not include any time during which the insurer waits for a response to relevant medical information from a healthcare provider.


© 2020 – Barry Zalma

Barry Zalma, Esq., CFE now limits his practice to working as an insurance consultant specializing in insurance coverage, handling insurance claims, cheating and insurance fraud almost equally for insurance policyholders. He also acts as an arbitrator or mediator for insurance-related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims lawyer and more than 52 years in the insurance industry. He is available at http://www.zalma.com and zalma@zalma.com.

Mr. Zalma is the first recipient of the first annual Claims Magazine / ACE Legend Award.

For the past 52 years, Barry Zalma has devoted his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to enable insurance companies and their claims staff to become insurance claims staff.

https://zalma.com/zalmas-insurance-fraud-letter-2/ Last read two issues of ZIFL here.

Go to Barry Zalma videos on Rumble.com at https://rumble.com/c/c-262921 [1965905] Read posts from Barry Zalma at https://parler.com/ profile / Zalma / post

Listen to the podcast: Zalma om försäkring https://anchor.fm/dashboard/episodesZalma om försäkring

Go to Barry Zalma on YouTube- https://www.youtube.com/channel/UCysiZklEtxZsSF9DfC0Expg/

Go to the Insurance Claims Library – https://zalma.com/blog/insurance -claims- library /

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