After a crash, the insurance company sets the pace of the claim, and many people we talk to about auto accident cases feel they are being ignored. California does not leave that pace entirely to the insurer. The Department of Insurance's Fair Claims Settlement Practices Regulations, in title 10 of the California Code of Regulations, set deadlines for acknowledging a claim, answering letters, deciding the claim and paying it.
This guide lists those deadlines, explains what "proof of claim" means, and says what you can do when an insurer misses a date.
How does an insurance claim move, step by step?
- You give notice of the claim. Any written or oral message that reasonably tells the insurer you want to make a claim counts as notice, according to the Department of Insurance's consumer guide.
- The insurer acknowledges it within 15 days. It must acknowledge the claim, begin its investigation, send any forms and instructions, and give reasonable help, no later than 15 days after notice.
- You send proof of claim. Proof of claim is documentation that supports the claim and its amount, such as a police report, medical bills or a repair estimate. Our guide on how to get a crash report in Sonoma County explains how to request the report.
- The insurer answers your letters within 15 days. The Department's guide says insurers must respond to communications from you within 15 days.
- The insurer accepts or denies within 40 days of proof of claim. This is the central deadline (10 CCR 2695.7(b)).
- If it needs more time, it says so in writing. The notice must list what information it still needs and why it cannot decide yet, and a new notice is due every 30 days until it decides or a lawsuit is served (10 CCR 2695.7(c)(1)).
- Once accepted, it pays within 30 days. Payment is due no more than 30 days after acceptance and, where needed, receipt of a signed release (10 CCR 2695.7(h)).
What are the deadlines, and where do they come from?
| What the insurer must do | Deadline | Source |
|---|---|---|
| Acknowledge the claim, start investigating, send forms | Within 15 days of notice of claim | Department of Insurance consumer guide, fair claims regulations |
| Respond to your letters, calls or emails | Within 15 days | Department of Insurance consumer guide |
| Accept or deny the claim | Within 40 days of proof of claim | 10 CCR 2695.7(b) |
| Explain a delay in writing and say what it needs | Within the 40 days, then every 30 days | 10 CCR 2695.7(c)(1) |
| Deny in writing | With the denial; for your own policy, every reason and the policy terms or law relied on | 10 CCR 2695.7(b)(1) |
| Tell you the Department can review a denial | In the written denial, with the unit's address and phone number | 10 CCR 2695.7(b)(3) |
| Pay an accepted claim | Within 30 days of acceptance and any needed release | 10 CCR 2695.7(h) |
| Warn you of a time limit it may rely on | At least 60 days before it expires (30 days for your own uninsured motorist claim), unless a lawyer represents you | 10 CCR 2695.7(f) |
Do these rules apply to the other driver's insurer?
Yes. The 40-day rule applies to "every insurer" that receives proof of a claim, and the same section requires an insurer that denies or rejects a third party claim, or disputes liability or damages, to do so in writing (10 CCR 2695.7(b)(1)). A claim against the other driver's policy is a third party claim, so the decision deadline and the written-denial rule reach that insurer too.
The detail of a denial differs. When your own insurer denies a claim under your policy, the written denial must list every basis for the denial, with the facts and the policy provision, statute or exclusion it relies on. For a claim against another driver's insurer, the regulation requires a written denial but not the same detailed list. Our guide on claiming through your own insurance or the other driver's compares the two routes.
What if the insurer's offer seems too low?
An insurer may not try to settle a claim by making an offer that is unreasonably low (10 CCR 2695.7(g)). In deciding whether an offer is unreasonably low, the Insurance Commissioner considers how far the insurer considered the evidence you submitted, the legal authority and evidence available to it, its own adjuster's view of the damages, and the probable liability of its insured, among other factors.
The Insurance Code also lists, as an unfair claims practice, not attempting in good faith to reach a prompt, fair and equitable settlement of a claim where liability has become reasonably clear (Insurance Code 790.03(h)(5)). These rules do not set a dollar figure for any claim; they describe how the insurer must handle it. For what a settlement may include, see how pain and suffering is valued.
What can I do if the insurer misses a deadline?
Start in writing. Send the adjuster a short letter or email that notes the date you sent proof of claim and asks for a decision or a written explanation of what is still needed. Keep a copy, and note the date of every reply.
If the insurer still does not respond, or you believe a claim was wrongly denied, you can ask the California Department of Insurance to review it. A written denial must tell you that, and give the address and phone number of the Department unit that reviews claims practices (10 CCR 2695.7(b)(3)). The Department's consumer line is 1-800-927-4357, and its website takes complaints online.
A complaint does not stop any deadline for suing the driver who caused the crash. For most injuries that is two years from the crash (Code of Civil Procedure 335.1); see California personal injury deadlines.
What changes the answer?
A lawyer represents you. The 60-day warning about time limits in 10 CCR 2695.7(f) does not apply to a claimant represented by counsel on the claim, so the lawyer must track every deadline.
It is your own uninsured motorist claim. The time-limit warning is due at least 30 days ahead instead of 60 (10 CCR 2695.7(f)), and the claim has its own two-year steps under Insurance Code 11580.2(i). See how uninsured and underinsured motorist coverage works.
The bill is for car repairs under your collision coverage. The 40-day decision rule does not apply to automobile repair bills under collision and comprehensive coverage, though the written-denial rules still do (10 CCR 2695.7(b)(4)).
The insurer suspects fraud. It does not have to disclose information that would alert a claimant that the claim is being investigated as possibly fraudulent (10 CCR 2695.7(b)(2) and (c)(2)).
The claim is against a city, county or the State. A public agency is not an insurer under these rules. A written government claim is due within six months, and the agency has 45 days to act on it (Government Code 911.2 and 912.4); see how to file a claim against a city or county.
What could this look like? An example
For example, imagine a driver hit at a Petaluma intersection on May 1. She calls the other driver's insurer on May 3, and on May 15 she receives a letter with a claim number and a form, inside the 15 days. On June 1 she sends the police report, her urgent care bills and a note from her doctor: that is her proof of claim.
By July 11, 40 days later, the insurer must accept or deny. Instead, on July 8 it writes that it needs her primary care records, which is allowed if the letter says what it needs and why. When no decision or update arrives by early August, more than 30 days after the July letter, she writes to the adjuster and then calls the Department of Insurance. Meanwhile the two years to sue the other driver keep running from May 1. This example is made up to show how the rules fit together; it says nothing about any real case.
What mistakes do people make with insurer deadlines?
- Never sending proof of claim, so the 40-day clock never starts.
- Keeping no record of when letters were sent and received.
- Accepting a phone call as an answer when the rules call for a written denial or a written request for more time.
- Assuming the insurer's investigation pauses the two-year deadline to sue.
- Signing a release before knowing the full medical picture, since payment often follows a release and ends the claim.
What should I do this week?
- Write down the date you first reported the claim and the claim number.
- Send proof of claim in writing: the report number, bills received so far, and a note from your doctor, and keep a copy.
- Put the 15-day, 40-day and 30-day dates on a calendar.
- Save every letter and email from the adjuster in one folder.
- Read our guide on who pays medical bills while the claim is pending, since bills will not wait for the insurer.
- If a deadline passes, follow up in writing, then contact the Department of Insurance.
Frequently asked questions
What counts as proof of claim?
The Department of Insurance describes it as documentation in your possession that provides evidence of the claim and supports the amount of the loss, such as estimates or a police report. For an injury claim, medical bills and records usually serve that role.
Does the insurer have to put a denial in writing?
Yes. A denial of a third party claim must be in writing, and a denial under your own policy must also list every reason, with the policy terms or law relied on (10 CCR 2695.7(b)(1)).
How soon must the insurer pay once it agrees?
No more than 30 days after it accepts the claim and receives any needed signed release (10 CCR 2695.7(h)). The Department's guide describes this as 30 days from the date settlement was reached.
Can an insurer say my rights are lost if I do not sign a form quickly?
Only to notify you of a real statute of limitations, policy provision or government claim deadline. Otherwise an insurer may not tell a claimant their rights may be impaired if a form or release is not completed within a set time (10 CCR 2695.7(i)).
How long does the whole case take?
The insurer's deadlines are only the first stage. Our guide on how long a personal injury case takes covers the court stages that follow if the claim does not settle.
Should I talk to a lawyer before the 40 days are up?
You can talk to one at any point. Bring the letters and the dates; our guide on what to bring to a first meeting lists what helps.
If an insurer is not responding to your injury claim, contact Young Law Group today at (707) 343-0556 or through our contact page for a free consultation.
Sources
- California Code of Regulations, title 10, section 2695.7 (standards for prompt, fair and equitable settlements)
- California Department of Insurance: Fair Claims Settlement Practices Regulations (California Code of Regulations, title 10, section 2695.7)
- California Department of Insurance: So you've had an accident, what's next? (your rights under the fair claims regulations)
- California Department of Insurance: consumer help and complaints
- Insurance Code section 790.03 (unfair claims settlement practices)
- Insurance Code section 11580.2 (uninsured motorist coverage)
- Code of Civil Procedure section 335.1 (two years for an injury or death)
- Government Code section 911.2 (six-month claim to a public entity)
- Government Code section 912.4 (45 days for the entity to act)
