California · Insurance Adjuster SampleInteractive Mind Map
California Adjuster Regulations
Division 5, the single knowing act, and the numbers that changed on 1 January 2026
Start with the correction almost every source needs: California does license independent adjusters. The Department of Insurance issues the Insurance Adjuster (Independent) license under Insurance Code Division 5 — three chapters, not one — and it is examined, bonded and carries continuing education. The belief that no license exists is built out of four true premises: a broad staff-adjuster exemption, a clause telling the Department it need not investigate whether that exemption applies, a definition written by exclusion from the private investigator statute, and the state's own consumer disclosure, which says company adjusters are not individually licensed and never says independent adjusters are.
From there the map works through the places California answers a national assumption backwards. There is no general business practice requirement — the chapeau of section 790.03(h) is disjunctive, so a single knowing act violates. There is no private right of action, and that answers who can sue rather than what is owed: third-party claimants are still owed the regulatory duties. An adjuster cannot be sued personally for bad faith or ordinary negligence, but can be sued for negligent misrepresentation. Every claim deadline is in calendar days, the acknowledgment need not be in writing while the denial must be, and there is no total loss percentage anywhere in the Vehicle Code.
The last cluster covers the tranche that took effect 1 January 2026 and that most published material has not caught up with: the contents advance at 60 percent of the contents limit up to $350,000 with no inventory, the 36-month replacement-cost window, the additional living expense clocks, the post-wildfire moratorium reaching ZIP codes adjacent to the fire perimeter, and the appraisal clause that cannot be compelled once a disaster is declared. Section 10103.7 carries a second operative date of 1 July 2026 that no code reproduction flags.
Six clusters, seventy-plus flagged traps and a ten-question scenario quiz written as fact patterns rather than definition recall.
California licenses independent adjusters — and the belief that it does not is manufactured by four true premises.
The regime is Insurance Code Division 5, added in 1980, and it has three chapters — not one. § 14020 is the requirement; § 14021 is the definition. Most company adjusters are exempt under § 14022(a)(1), and that is a different statement entirely.
Division 5 chapter
Sections
What it does
Ch. 1 — Insurance Adjuster Act
14000–14099
Licenses the adjuster who works on behalf of an insurer. Class AJ. No prelicensing.
Ch. 2 — Public Insurance Adjusters Act
15000–15062
Licenses the adjuster who works for the insured. Class PJ. 20 hours prelicensing.
Ch. 3 — Emergency Disaster Assessment
16000–16032
Licenses no one. It issues the identification badge that gets a representative past an incident commander.
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Why every source says California has no adjuster license — four true premises, one wrong conclusion
1. The staff exemption is broad. § 14022(a)(1) exempts a person “employed exclusively and regularly by one employer in connection with the affairs of the employer only.” Almost every adjuster an ordinary Californian meets is carrier staff and holds no license.
2. The Department is told it need not check. § 14022(a)(3): “In enforcing this chapter, the department shall not be required to investigate whether a person is employed exclusively and regularly by one employer.” That is a rule about enforcement effort, not about whether the requirement exists.
3. The definition is written by exclusion. § 14021 opens “a person other than a private investigator as defined in Section 7521 of the Business and Professions Code.” It does not read like an insurance licensing definition, and it does not surface in searches phrased the way an insurance person phrases them.
4. The state’s own consumer disclosure says the quiet part. The scripted disclosure tells consumers that company adjusters are not individually licensed. It never says independent adjusters are. A reader completing the sentence reaches exactly the wrong conclusion — from an official document.
⚠ The correct statement has TWO halves: California licenses independent adjusters under Division 5 ch. 1 and exempts most carrier staff under § 14022(a)(1). An answer offering only the first half is wrong; an answer offering only the second is the trap.
§ 14020 is the REQUIREMENT — § 14021 is the DEFINITIONRead them in that order, because they are easy to reverse. § 14020:“A person shall not engage in a business regulated by this chapter, or act or assume to act as, or represent themselves to be, a licensee unless the person is licensed under this chapter.” Subdivision (b) adds that a person “shall not falsely represent that the person is employed by a licensee.”§ 14021 then supplies the definition — a person other than a private investigator who “for any consideration whatsoever” makes any investigation to obtain information in the course of adjusting or otherwise participating in the disposal of any claim “on behalf of an insurer.” That last phrase is the line between chapter 1 and chapter 2.
✅ EXEMPT — § 14022
(a)(1) A person “employed exclusively and regularly by one employer in connection with the affairs of the employer only” — the staff adjuster exemption
(k) A building contractor, engineer or technical expert engaged to evaluate extent, cause or origin of damage
Government officers and employees performing official duties
A person furnishing information only as to financial rating
An attorney performing the duties of an attorney
A licensed collection agency, on an investigation incidental to its business
Admitted insurers, agents and brokers“performing duties in connection with insurance transacted by them”
An incorporated charitable society; banks and the Comptroller of the Currency; the legal owner under a conditional sales agreement
A person “engaged solely in the business of securing information about persons or property from public records”
❌ LICENSE REQUIRED
The independent adjuster — an independent contractor, or the employee of one, adjusting on behalf of an insurer
An adjuster serving more than one employer, or handling anything beyond “the affairs of the employer only” — the (a)(1) exemption is written in the singular
The public adjuster, who works for the insured — separate act, separate exam, 20 hours prelicensing, $20,000 bond
⚠ The expert who keeps going. § 14022(k) ends “but who does not otherwise participate in the process of adjusting claims.” The engineer who writes a causation report is exempt. The same engineer who starts negotiating the settlement is not.
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After a declared emergency the staff exemption is PARTLY switched off
§ 14022(a)(1) exempts the staff adjuster “except as provided in paragraph (2)” — and paragraph (2) operates only after a declared state of emergency under Government Code § 8558, or another emergency declared by a public official.
It provides that a licensee or qualified manager shall REQUIRE that all nonlicensed adjusters under their supervision “read and understand the most recent notice and adjuster handbook” no later than 15 calendar days from the date the nonlicensed adjuster began claims adjusting activity in California. § 14046(c) says the same from the other direction and makes the reach explicit: the duty attaches both to nonlicensed adjusters registered under § 14022.5 and to those exempted under § 14022(a).
⚠ Exempt from the LICENSE is not exempt from the HANDBOOK. This is the only place in Division 5 where an obligation reaches into the exempt population, and it looks like a contradiction until you see that it is about knowledge, not status.
💼 CHAPTER 1 — ADJUSTER (AJ)
🏠 CHAPTER 2 — PUBLIC ADJUSTER (PJ)
Works on behalf of an INSURER. Prelicensing: NONE. Experience: two years (§ 14025(c)). Bond: $2,000 (§ 14050), with an exemption cascade. Exam: permissive on the face of § 14026 “may require”, mandatory in practice. Discipline: twelve grounds at § 14061. Term: two years from the last day of the month of initial issue.
Works for the INSURED. Prelicensing: 20 hours (§ 15009.1(a)). Experience: two years. Bond: $20,000 (§ 15033). Also required: an office in California with public access during regular business hours. Unlicensed practice: up to $10,000, or $25,000 if willful; the contract “may be voided at the option of the insured”; cease and desist “without any requirement of notice or hearing” at $100 a day to a $5,000 maximum.
⚠ “Does California require prelicensing for adjusters?” — the honest answer NAMES THE CHAPTERChapter 1 adjuster: none. Chapter 2 public adjuster: twenty hours. A single unqualified answer is wrong half the time. And note the arbitrage in § 15011(c): a person licensed as an apprentice (class PI) “for 12 full months, shall be considered to have met the two-year experience requirement.” Twelve months of apprenticeship substitutes for twenty-four months of experience — and the apprentice license itself runs a maximum of twelve months and is not renewable, with no examination under § 15016(b)(6).
Class AJ — Insurance Adjuster (Independent)
The chapter 1 license. Exam required in practice; no prelicensing.
Class PJ — Public Insurance Adjuster
The chapter 2 license. 20 hours prelicensing, exam, $20,000 bond, California office.
Class CR — Crop Insurance Adjuster
⚠ No examination. § 14085(a)(1) licenses crop adjusters “with the exception of the examination requirement of Section 14026.”
Class PI — Interim Public Insurance Adjuster
12 months maximum, not renewable, no examination (§ 15016(b)(6)) — but 20 hours of prelicensing still applies under § 15016(b)(12).
All four on ONE form
The Department offers AJ, PJ, CR and PI on application form LIC 041-A — which is itself proof that the AJ license exists.
The private-investigator fossil
§ 14021 defines the adjuster by exclusion from Bus. & Prof. Code § 7521. The same lineage is why § 14061 lists tear gas weapons and impersonating a police officer as discipline grounds.
There is NO prelicensing education for the AJ license — and the proof is structural, not a search that came up empty. § 14025 tells the commissioner what to find before granting a license, and the list is closed. What replaces classroom hours is two years of experience. Then note that continuing education is only one of FOUR training duties, and they are cumulative.
§ 14025 — four findings, and none of them is education“Before an application for a license is granted, the applicant, or his or her manager, shall meet all of the following: (a) Be at least 18 years of age. (b) Not have committed acts or crimes constituting grounds for denial of licensure under Section 480 of the Business and Professions Code. (c) Shall have had at least two years of experience in adjusting insurance claims or the equivalent thereof as determined by the commissioner. (d) Comply with such other qualifications as the commissioner may fix by rule.”
The corroboration is equally structural: the Department’s own prelicensing requirements page lists Life, Accident and Health; Property and Casualty; and Personal Lines — and contains no adjuster entry at all. Producers must complete prelicensing hours; adjusters are simply not in that scheme.
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The 2,000-hour conversion is agency practice, not law
§ 14025(c) requires two years of experience“or the equivalent thereof as determined by the commissioner.” The Department makes that determination on form LIC 041-A: “2,000 hours of compensated time in the adjusting field is equal to one year of experience.”
⚠ That figure appears in NO section of Division 5 and in no regulation. Expect the Department to apply it; do not cite it as statute. And note what it means practically — experience cannot be bought as a course, which is why the two-year requirement is the one candidates most often underestimate.
📝 THE EXAM
🔑 FINGERPRINTS & BACKGROUND
100 questions, 70 percent to pass. The exam is the Department’s, not a vendor’s — the Department publishes the objectives and sets the standard; PSI Services, LLC is the delivery vendor, and exams are given at both Department sites and PSI centers. § 14026 is permissive on its face — “the commissioner may require” — which is what lets § 14085(a)(1) license crop adjusters without one.
⚠ The examination fee is not published anywhere. The re-examination fee is capped at $29 by § 14097(g); the Department’s published schedule shows $26 — and that schedule is stamped 17 March 2014.
§ 14024(a)(7) requires “Two recent photographs of the applicant … and two classifiable sets of his or her fingerprints.” The statute dates from 1981 and predates Live Scan, so the capture process and the vendors are agency practice: Capital Live Scan for residents, effective 14 February 2025, at $74 — $17 FBI, $32 Department of Justice, $25 rolling; Accurate Biometrics for non-residents at $75. Neither figure traces to any section of Division 5.
The substantive standard is imported: § 14025(b) points to Bus. & Prof. Code § 480, the general professional licensing denial standard.
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Two published time limits — and no instrument reconciles them
150 minutes — the Department’s own examination objectives document, which states two hours and thirty minutes. 158 minutes — the PSI candidate information bulletin.
Both are current publications of the two organizations that run the exam between them. Neither figure is wrong on its own terms, and no statute, regulation or bulletin explains the difference. The eight-minute gap is consistent with a tutorial or agreement allowance, but nothing says so.
⚠ Plan on 150 minutes of testing time and be unsurprised if the vendor screen says 158. If a question asks for the time limit, the safest answer NAMES THE SOURCE.
⚠ § 14097 sets fee CAPS, not fee amounts — and the renewal figures are MAXIMUMSOriginal application $72; original branch office certificate $47; renewal “not more than $283”; branch renewal “not more than $56”; delinquency 50% of the renewal fee, capped at $72; re-examination $29. The Department’s published schedule shows lower figures — $65, $257, $43, $51, $26 — but it is stamped 17 March 2014 and no more recent schedule was located. Because the statute sets ceilings and the schedule is a decade old, treat any specific dollar figure as provisional. And there is a live conflict on the apprentice: § 15016(b)(4) states the applicant “is required to pay a license fee of one hundred dollars ($100)” while the Department’s own interim public adjuster page states $264. These do not reconcile on the face of the statute.
💳 THE BOND — § 14050
📅 THE TERM — § 14090
$2,000, “conditioned for the faithful and honest conduct of business by the applicant.” Public adjusters post $20,000 under § 15033.
⚠ But § 14050 does NOT require every adjuster to file one. No bond is needed for a licensed adjuster or employee adjusting “on behalf of, and under the direction of, a licensee who is qualified as a manager and who has filed a surety bond or certificate of insurance”, nor for one adjusting for an entity that has filed. The instrument must name everyone who may perform duties under it, and changes “shall be made within 30 days.” The real question is never whether this adjuster has a bond — it is whose bond names them.
California does NOT use a birth month. § 14090: every license “shall expire on the day two years after the last calendar day of the month in which the initial license was issued.” A license issued on 3 March expires on 31 March two years on — exactly as one issued on 28 March does. The day is irrelevant; only the month matters.
Legacy rule: licenses issued before 1 January 2011 expire “on May 31 of each even-numbered year.” The only late mechanism in § 14097 is the delinquency fee; no separate reinstatement fee appears in the statute.
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Continuing education is ONE of FOUR training duties — and they are cumulative, not substitutes
1. Continuing education — Ins. Code § 14090.1.24 hours biennially, of which 3 are ethics, “reported to the insurance commissioner on a biennial basis in conjunction with his or her license renewal cycle.” The three sit inside the twenty-four. Public adjusters carry an identical 24 and 3 under § 15059.1. Three exemptions: a licensee not licensed one full year before the end of the biennium; a nonresident who has met the requirements of a designated resident state; and an individual licensed both as an adjuster and as a property or casualty broker-agent under § 1625 who satisfied § 1749.3 — one set of hours covers both.
2. Fair Claims training and certification — 10 CCR 2695.6.NO hours. An annual certification under penalty of perjury, due on or before 1 September each calendar year.
3. Post-emergency read-and-understand — §§ 14022(a)(2), 14046(c).NO hours. 15 calendar days from the start of claims activity.
4. Earthquake claims training — 10 CCR 2695.42.NO hours stated, and it binds the INSURER.
⚠ Completing one does nothing for the others. A candidate who answers a training question with “24 hours biennially” and stops has answered a quarter of it.
10 CCR 2695.6 — the annual certification nobody diariesIt is the obligation most likely to be missed, because it sits in the claims regulations rather than the licensing statute, so nothing about a license renewal ever surfaces it. For an individual licensee it is personal and sworn: the licensee “shall annually certify in writing under penalty of perjury that the licensee has read and understands the regulations.” For an adjuster retained by an insurer under § 14021 there are two routes — the insurer trains and certifies, or the adjuster “may annually certify in writing, under penalty of perjury, that the insurance adjuster has read and understands these regulations … or has successfully completed a training seminar which explains these regulations.”Duly licensed attorneys are exempt from both the training and the certification. ⚠ The regulation specifies NO number of hours. Any material assigning it an hour count is wrong — the examinable fact is the 1 September date.
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Earthquake training — three things routinely misstated
1. It is not part of the Fair Claims regulations. It sits in a separate subchapter, “Insurance Adjuster Training for Evaluating Earthquake Damage”, 10 CCR 2695.40–2695.45, and its authority is Ins. Code § 10089.3 — the California Earthquake Authority statute — not § 790.03.
2. It binds the INSURER, not you.“Every insurer shall provide training regarding the handling of earthquake claims to insurance adjusters who evaluate earthquake claims for or on behalf of the insurer.”
3. The accreditation is PORTABLE.“An adjuster trained and accredited by one insurer shall be deemed accredited in order to adjust claims for a different insurer unless such insurer includes additional requirements.” It is a one-time accreditation you carry with you, not a recurring cycle.
Eight prescribed content areas, including distinguishing pre-existing from new cracks in concrete surfaces and foundations, and subsequently discovered earthquake damage. 10 CCR 2695.44 requires five-year records of completion and of accreditation.
⚠ Neither § 2695.42 nor the definitions in § 2695.41 states a number of hours. Commercial CE vendors market a five-hour earthquake course; that figure appears nowhere in the regulation.
⚠ § 14022.5 — the adjuster does NOT file the registrationAfter an emergency declared by the commissioner, a nonlicensed adjuster may work California claims upon registration — and the three requirements split between two different people. Supervision: the work must be “under the active direction, control, charge, or management of a licensed adjuster or an insurer authorized to do business in this state.”Registration:“The licensee or insurer registers the nonlicensed adjuster with the commissioner no later than 15 calendar days” from the start of activity — subdivision (b) confirms it is “submitted by the supervising licensed adjuster or admitted insurer.”Certification: this one the adjuster files personally, under penalty of perjury, that they have read and understand the Notice and Handbook. Term: 180 days, extendable in 180-day increments on written request from the supervisor. And subdivision (f) switches the whole scheme off for carrier staff — it “does not apply” to an adjuster meeting the § 14022(a)(1) criteria. The regime exists for the out-of-state surge workforce.
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The certification is a VALIDITY CONDITION, not paperwork — and it must be CURRENT
§ 14022.5(d):“A registration is not valid unless a current certification is on file with the commissioner.”
No current certification means no valid registration — which means the nonlicensed adjuster is working without the § 14022.5 authorization at all, and is exposed under § 14020.
⚠ Note the word CURRENT. The Department reissues the Notice annually — the current editions are dated 9 January 2026 — so this is a continuing obligation. A registration that was valid last season is not automatically valid this one.
⏰ § 14022.5(a)(2) — 15 DAYS
⏰ § 14046(b) — 15 DAYS
Who acts: the LICENSEE OR INSURER. Trigger: a nonlicensed adjuster begins claims activity in California. What is done:registers that adjuster with the commissioner.
Who acts: the INSURER. Trigger: the insurer receives notice of a residential property claim arising from a declared state of emergency. What is done: gives the claimant the Department’s most recent Notice.
Same number, nothing else in commonTwo fifteen-day clocks, different actors, different triggers, different outputs. A question that supplies fifteen days and asks what happens is testing whether you know which clock you are on. And § 14046 also imposes the source duty: the Department must annually prepare and deliver both a Notice describing the most significant California property insurance laws “including those related to a declared state of emergency” and a Handbook for adjusting “relevant to evaluating damage caused by an emergency, catastrophe, disaster, or other similar occurrence, including wildfires” — and must make them and the certification process available “through a dedicated page on the department’s internet website.”
§ 14047 — the third-adjuster rule
Residential claim in a declared emergency. If within six months the insurer assigns a third or subsequent adjuster primarily responsible, it must give a written status report, establish a primary point of contact and provide direct means of communication. The contact stays “until the insurer determines that the … claim is closed or litigation has been filed”, and on request must escalate to a first-tier or second-tier manager with authority over claim handling.
§ 16021 — the identification badge
The commissioner issues badges to insurers, who distribute them; they “shall permit access to disaster areas as soon as determined safe and practical by the incident commander.” They “shall not be used as identification for other purposes” and must state in bold lettering LARGER than the other identifying information that the bearer is not a state employee or public official and possesses no governmental authority.
⚠ § 14041 — there is NO retention period for you
The only records provision in the Act: “Each licensee shall maintain a record containing such information relative to his or her employees as may be prescribed by the commissioner.”It states no period. Subchapter 7 has ten articles and no records article.
10 CCR 2691.12 — notification, not retention
The licensee files a list of employees authorized to negotiate claim settlements with the application, and must notify the Commissioner in writing “within 30 days from the date of the occurrence” of any employee hired or terminated afterwards.
Where the five-year figures actually live
10 CCR 2695.3 — the INSURER keeps claim files “for the current year and the preceding four years.”10 CCR 2695.44 — earthquake training records, five years. ⚠ If an answer offers a number of years for a California ADJUSTER, no number is right.
§ 14061 — twelve grounds, and a fossil
The conventional grounds sit beside impersonating a law enforcement officer, assault, battery or kidnapping, acting “as a runner or capper for any attorney” and possessing “any tear gas weapon except as authorized by law.” One ground reaches conduct committed while the license was expired.
§ 14065 — the middle option
The commissioner may, “in lieu of suspending or revoking a license … impose a civil penalty not to exceed $500” where a penalty better serves the purposes of the chapter.
⚠ § 14026.5 — the restricted license
Issued with “any reasonable conditions”. The holder “has no property right in it and the commissioner may, with or without either hearing or cause, suspend or revoke” it. An unrestricted license carries ordinary due process; a restricted one expressly does not.
California has NO general business practice requirement — and every claim deadline is in CALENDAR days.
The chapeau of § 790.03(h) is disjunctive: a practice violates either because it was committed knowingly once, or because it was performed frequently enough to indicate a general business practice. There is no private right of action — and that answers who can sue, not what is owed.
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The asymmetry is KNOWLEDGE, not frequency — and it is not the statute-versus-regulation split most material offers
§ 790.03(h) enumerates sixteen unfair claims settlement practices and opens: “Knowingly committing or performing with such frequency as to indicate a general business practice any of the following.”
Read the conjunction. It is OR. And 10 CCR 2695.1(a) says exactly the same thing about the regulations: sixteen practices that, “when either knowingly committed on a single occasion, or performed with such frequency as to indicate a general business practice, are considered to be unfair claims settlement practices.”
So the two routes are NOT “statute” and “regulation” — both instruments carry both routes. The two routes are knowing single act and frequent practice:
⚠ ONE KNOWING violation is enough. ONE INADVERTENT violation is not — unless it is part of a pattern frequent enough to show a general business practice. That is the distinction to carry.
Two provisions people miss inside the regulationsThe list is not exclusive. The regulations “are not meant to provide the exclusive definition of all unfair claims settlement practices. Other methods, act(s), or practices not specifically delineated in this set of regulations may also be unfair claims settlement practices.”And there is a personal knowledge duty. 10 CCR 2695.1(b):“All licensees … shall have thorough knowledge of the regulations contained in this subchapter.” That is a duty on you, by regulation — and it is why the § 2695.6 certification is sworn.
Year
Case
What changed
1979
Royal Globe, S.F. No. 23843
Created a third-party private action under § 790.03(h), though not until the underlying action concluded
1988
Moradi-Shalal, L.A. No. 32222
Overruled it — but preserved fraud, infliction of emotional distress, and (as to the insured) contract and the implied covenant
2013
Zhang, S178542
Closed the UCL route predicated on § 790.03; opened a UCL claim resting on independent grounds. ⚠ Confined to FIRST-party claims and says so.
⚠ Read the parenthetical in the Moradi-Shalal savings clause“The courts retain jurisdiction to impose civil damages or other remedies against insurers in appropriate common law actions, based on such traditional theories as fraud, infliction of emotional distress, and (as to the insured) either breach of contract or breach of the implied covenant of good faith and fair dealing.” The contract and covenant theories belong to the insured. Fraud and emotional distress are not so limited by that sentence. And Zhang itself states: “Our holding here is confined to the first party context. Third party claims raise distinct analytical and policy issues.” Anyone describing Zhang as opening a third-party UCL route is overreading it — a third-party claimant reaches the insurer chiefly by assignment after an excess judgment, or through the insured’s own failure-to-settle claim. Enforcement belongs to the Commissioner: § 790.035 sets $5,000 per act, $10,000 if willful — and gives the Commissioner “the discretion to establish what constitutes an act.”
Calendar days — every single clockWorking days — NONE exist in this article
Clock
Period
Runs from
Respond to a DEPARTMENT inquiry — 2695.5(a)
21 days
Receipt of any written or oral inquiry — a “complete written response based on the facts as then known”
Respond to a claimant communication — 2695.5(b)
15 days
Receipt, where a response is reasonably suggested. Does not apply after a notice of legal action
Acknowledge, provide forms, begin investigating — 2695.5(e)
15 days
Notice of claim — “unless payment is made within that period of time”
Accept or deny, in whole or in part — 2695.7(b)
40 days
Receipt of proof of claim
Continuing delay notices — 2695.7(c)
every 30 days
The first written notice, which itself must issue inside the same 40 days
Tender payment — 2695.7(h)
30 days
Acceptance and, where necessary, receipt of a properly executed release
Limitations warning — 2695.7(f)
60 / 30 / now
60 days before expiry; 30 for first-party UM; immediately if noticed inside the window
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The ACKNOWLEDGMENT may be oral. The DENIAL may not. Most candidates carry the opposite of both.
10 CCR 2695.5(e)(1) requires acknowledgment within fifteen calendar days “unless payment is made within that period of time” — and then adds that where the acknowledgment is not in writing, a dated notation of it must be made in the insurer’s claim file. An oral acknowledgment, properly noted and dated, complies.
10 CCR 2695.7(b)(1) then goes the other way for denials — and the two sentences inside it are not identical:
First party:“it shall do so in writing and shall provide to the claimant a statement listing all bases for such rejection or denial and the factual and legal bases for each reason given … which is then within the insurer’s knowledge.” Third party:“Every insurer that denies or rejects a third party claim, in whole or in part, or disputes liability or damages, shall do so in writing.”
⚠ The WRITING requirement covers both. The itemized factual-and-legal-bases sentence attaches, on the face of the text, to FIRST-party denials only.
And the duty to identify the policy provision relied on comes from neither sentence — it is in the statute, § 790.03(h)(13). Read together they reach the same place, but the words are in different instruments.
The investigation standard cuts BOTH ways — 10 CCR 2695.7(d)“Every insurer shall conduct and diligently pursue a thorough, fair and objective investigation and shall not persist in seeking information not reasonably required for or material to the resolution of a claim dispute.” Failing to investigate thoroughly violates it — and so does persisting in demands for information you do not need. Two related prohibitions sit alongside it: 2695.7(l), no denial “based upon information obtained in a telephone conversation or personal interview with any source unless the telephone conversation or personal interview is documented in the claim file”; and 2695.7(g), “No insurer shall attempt to settle a claim by making a settlement offer that is unreasonably low.”
⚠ You must WARN before the clock runs out — and the statute only forbids MISLEADING10 CCR 2695.7(f):“Except where a claim has been settled by payment, every insurer shall provide written notice of any statute of limitation or other time period requirement upon which the insurer may rely to deny a claim … not less than sixty (60) days prior to the expiration date.” If the claim first arrives inside that window, “notice of the expiration date must be given to the claimant immediately.” For a first-party uninsured motorist matter, “at least thirty (30) days prior.” And: “This subsection shall not apply to a claimant represented by counsel on the claim matter.” The statutory counterpart, § 790.03(h)(15), only makes it unfair to mislead a claimant about the limitations period. Silence complies with the statute and violates the regulation.
✅ OWED TO THIRD-PARTY CLAIMANTS TOO
The 15-day response to communications
The 15-day acknowledgment and forms duty
The 40-day accept-or-deny and the 30-day extension notices
The limitations warning and the bar on unreasonably low offers
The denial in writing — express in 2695.7(b)(1)
❌ FIRST PARTY ONLY
The itemized factual and legal bases sentence in 2695.7(b)(1)
The subrogation notification duty in 2695.7(p)
The whole of 2695.9 — residential and commercial property
⚠ The reach comes from the DEFINITION. 10 CCR 2695.2 defines “claimant” to include a first OR third party claimant, a surety bond claimant, an attorney, anyone authorized by operation of law, and a designated adjuster, public adjuster or family member — so every duty written to “claimant” follows.
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Two different axes — and conflating them is the most common error in this area
A third-party claimant is owed regulatory duties by the insurer, and has no private action to enforce them.
No private right of action answers the question WHO CAN SUE. It does not answer the question WHAT IS OWED. The Commissioner enforces what is owed, under § 790.035 — and the enumerated practices also survive as jury factors in a properly pleaded common-law action.
⚠ An answer choice that reasons “no private action, therefore no duty” has jumped axes.
The bad-faith tort survives untouched — and YOUR personal exposure has three answers, not one.
It never depended on § 790.03, so Moradi-Shalal did nothing to it. Bad faith and ordinary negligence are foreclosed against the adjuster personally. Negligent misrepresentation is not. The exposure attaches to what you say, not to how you evaluate.
The two foundation casesGruenberg v. Aetna Insurance Co., L.A. No. 30082, 11 June 1973 — “When the insurer unreasonably and in bad faith withholds payment of the claim of its insured, it is subject to liability in tort.” Then Egan v. Mutual of Omaha Insurance Co., L.A. No. 30747, 14 August 1979, adds the duty that decides most modern files: “an insurer cannot reasonably and in good faith deny payments to its insured without thoroughly investigating the foundation for its denial.”You can be in bad faith for HOW you decided, not only for WHAT you decided. And note a structural point: Egan is cited in the authority note of 10 CCR 2695.7 itself — the claims regulation is expressly built on the bad-faith case law rather than sitting apart from it. The working elements: benefits due under the policy were withheld or delayed, and the withholding was unreasonable or without proper cause. Liability attaches to the unreasonableness, not merely to the breach.
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The tolling rule is worth more than the headline twelve months
The property suit clause is 12 months from inception of the loss under § 2071, extended to 24 months where the loss relates to a declared state of emergency.
Prudential-LMI Commercial Insurance v. Superior Court, S011415, 1 November 1990, defines inception of loss as when appreciable damage occurs and “is or should be known to the insured, such that a reasonable insured would be aware that his notification duty under the policy has been triggered” — and then tolls the period “from the time an insured gives notice of the damage to his insurer … until coverage is denied.”
⚠ The insurer’s own investigation time does not burn the insured’s clock. A slow investigation does not run out the suit clause. Separately, the bad-faith tort is generally treated as carrying a two-year period — that rests on practitioner consensus rather than on a located holding, so treat the 12 and 24 month policy clauses as the hard numbers.
⚠ The genuine dispute doctrine protects the FILE, not the positionWilson v. 21st Century Insurance Co., S141790, 29 November 2007, states the rule — an insurer denying benefits “due to the existence of a genuine dispute with its insured as to the existence of coverage liability or the amount of the insured’s coverage claim is not liable in bad faith” — and then states the limits, which are the operative part: “A genuine dispute exists only where the insurer’s position is maintained in good faith and on reasonable grounds”, and “The genuine dispute rule does not relieve an insurer from its obligation to thoroughly and fairly investigate, process and evaluate the insured’s claim.”A dispute manufactured by an inadequate investigation is not a genuine dispute. On summary judgment the court added that an insurer is not entitled to judgment as a matter of law “where, viewing the facts in the light most favorable to the plaintiff, a jury could conclude that the insurer acted unreasonably.” Two adjusters can reach the same denial and only one of them has the defense.
⚖ THE DUTY TO SETTLE
📄 CCP §§ 999–999.5 — FROM 2023
Comunale v. Traders & General Insurance Co., L.A. No. 24975, 22 July 1958: where there is “great risk of a recovery beyond the policy limits” so that the most reasonable disposal is a within-limits settlement, “a consideration in good faith of the insured’s interest requires the insurer to settle.” The exposure: such an insurer “is liable for the entire judgment against the insured even if it exceeds the policy limits.”Crisci v. Security Insurance Co., S.F. No. 22433, 21 April 1967, locates it precisely — liability is imposed “not for a bad faith breach of the contract but for failure to meet the duty to accept reasonable settlements, a duty included within the implied covenant.”
Applies to time-limited demands transmitted on or after 1 January 2023, in claims covered by “automobile, motor vehicle, homeowner, or commercial premises liability” policies for property damage, personal or bodily injury and wrongful death. § 999.1 required terms: an acceptance period “not fewer than 30 days from date of transmission”; a clear and unequivocal offer to settle all claims within limits; an offer of a complete release for the insureds; the date and location of the loss; the claim number if known; a description of all known injuries; and “Reasonable proof, which may include medical records or bills, sufficient to support the claim.”
⚠ Thirty days is a FLOOR, not a ceiling. A shorter demand does not comply — which matters when the question becomes whether the insurer had a reasonable opportunity to accept.
Brandt fees are DAMAGES, not an attorney fee award — and that controls the limitBrandt v. Superior Court, L.A. No. 31859, 28 January 1985: “When an insurer’s tortious conduct reasonably compels the insured to retain an attorney to obtain the benefits due under a policy, it follows that the insurer should be liable in a tort action for that expense.” The Court compared them to medical expenses in a personal injury case — an element of damages caused by the tort, not a fee shift. So the fees “may not exceed the amount attributable to the attorney’s efforts to obtain the rejected payment due on the insurance contract. Fees attributable to obtaining any portion of the plaintiff’s award which exceeds the amount due under the policy are not recoverable.” And expressly excluded are “attorney’s fees qua attorney’s fees, such as those attributable to the bringing of the bad faith action itself.”Time spent getting the policy benefits paid is recoverable; time spent prosecuting the tort is not.
Theory pleaded against YOU
Liable?
Authority
Bad faith / implied covenant
NO
Gruenberg, L.A. No. 30082 — non-insurer defendants “were not parties to the agreements for insurance; therefore, they are not, as such, subject to an implied duty”, and cannot be reached “on a theory of conspiracy”
Ordinary negligence
NO
Sanchez v. Lindsey Morden Claims Services, B123946, 19 May 1999 — “An independent adjuster engaged by an insurer owes no duty of care to the claimant insured, with whom the adjuster has no contract.”
Negligent misrepresentation
⚠ YES
Bock v. Hansen, A136567, 2 April 2014 — “A cause of action for negligent misrepresentation can lie against an insurance adjuster.” The court distinguishedSanchez as negligence rather than negligent misrepresentation
Fraud; intentional infliction of emotional distress
Preserved
By Moradi-Shalal’s own savings language — and Bock allowed an emotional distress count to be repleaded
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What you SAY is the exposure, not how you evaluate
The comforting version of this rule — an adjuster cannot be sued personally for bad faith — is true and dangerously incomplete.
Bad faith and ordinary negligence are foreclosed. Negligent misrepresentation is not. The risk attaches to statements made to a claimant about coverage, entitlement or process — rather than to the substantive claim decision.
⚠ Say less, document more, and never characterize coverage you have not confirmed.
A caveat on the two appellate cases.Sanchez and Bock come from different appellate districts, and Bockdistinguished rather than followed Sanchez. No citator pass was possible in preparing this material, so neither should be treated as beyond question. The structure of the rule — covenant no, negligence no, misrepresentation yes — is what to carry.
💰 PUNITIVE — CIV. CODE § 3294
⚖ COMPARATIVE FAULT & PROP 51
Available “where it is proven by clear and convincing evidence that the defendant has been guilty of oppression, fraud, or malice.”No dollar cap and no ratio cap in the statute. But § 3294(b) adds a WHO requirement for a corporate defendant: the advance knowledge of unfitness, authorization or ratification “must be on the part of an officer, director, or managing agent of the corporation.”
⚠ Conduct by a line adjuster does not automatically expose the carrier. The question is whose knowledge or ratification is shown — which is why escalation, and the documentation of escalation, matter on a high-exposure file. Federal due-process review constrains the ratio independently of the Insurance Code.
PURE comparative fault. A plaintiff who is partly at fault recovers reduced damages rather than nothing, no matter how large their share — ninety percent at fault still recovers ten percent.
Then Civ. Code § 1431.2 (Proposition 51) splits the allocation among defendants by category: liability for NON-ECONOMIC damages “shall be several only and shall not be joint”, each defendant liable “in direct proportion to that defendant’s percentage of fault.”ECONOMIC damages remain joint and several.
⚠ A defendant ten percent at fault can be pursued for ALL the medical bills and lost earnings, but only ten percent of the pain and suffering. Evaluate the two categories separately — a single blended reserve on a shared-liability file is wrong in both directions at once.
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Automobile — two national assumptions, both wrong here
1. The minimum limits changed.Veh. Code § 16056: through 31 December 2024 the minimums were $15,000 / $30,000 / $5,000. For any policy or bond issued or renewed on or after 1 January 2025 they are $30,000 / $60,000 / $15,000 — and a further step to $50,000 / $100,000 / $25,000 for policies issued or renewed on or after 1 January 2035 is already in the statute. The enacting act is SB 1107, Statutes of 2022, ch. 717. ⚠ The trigger is ISSUE OR RENEWAL, not the date of the accident — a policy written in late 2024 carried the old limits until its next renewal, so a 2025 accident can still be a $15,000 loss. California is a tort state: no PIP, no no-fault threshold.
2. There is NO total loss percentage.Veh. Code § 544 defines a total loss salvage vehicle as either a vehicle damaged to the extent that the owner, lessor, lienholder or insurer “considers it uneconomical to repair … and because of this, the vehicle is not repaired”, or a vehicle determined uneconomical to repair “for which a total loss payment has been made by an insurer, whether or not the vehicle is subsequently repaired” — with the claimant’s agreement to the settlement amount and notice that it must be reported to the DMV. ⚠ Not seventy-five, not eighty, not any number. The trigger is a qualitative economic judgment plus a conduct element. An answer that supplies a percentage is importing a rule this state does not have.
Title mechanics:Veh. Code § 11515 — the responsible party forwards the endorsed certificate of ownership, the license plates and a $15 fee to the DMV “within 10 days from the settlement of the loss”, whether or not the owner retains the vehicle.
⚠ 10 CCR 2695.8(b) — one-time charges IN FULL, annual charges PRO-RATEDA comparable automobile is one “of like kind and quality, made by the same manufacturer, of the same or newer model year, of the same model type, of a similar body type, with options and mileage similar to the insured vehicle” — an older model year is not comparable. Two methods, in order: where comparables “are available or were available in the local market area in the last 90 days”, the “average cost of two or more”; where they were not, the “average of two or more quotations from two or more licensed dealers in the local market area.” The insurer pays “all applicable taxes and one-time fees incident to transfer”in full, plus “the license fee and other annual fees to be computed based upon the remaining term of the loss vehicle’s current registration.”Condition deductions are constrained: no deduction for condition “unless the documented condition of the loss vehicle is below average” — though prior and unrelated damage may still be deducted — and in every case “Any adjustments shall be discernable, measurable, itemized, and specified as to dollar amount.” On repairs, an insurer specifying non-original equipment crash parts“warrants that such parts are at least equal to the original equipment manufacturer parts.”
A declared state of emergency rewrites almost every deadline on a residential property claim — and the figures changed on 1 January 2026.
The contents advance moved from 30% to 60%. The replacement-cost window moved to 36 months. Appraisal cannot be compelled in a government-declared disaster. And § 10103.7 carries a SECOND operative date — 1 July 2026 — that no code reproduction flags.
Provision
Ordinary rule
Declared state of emergency
Replacement cost collection — § 2051.5
≥ 12 months from first ACV payment
≥ 36 months, plus 6-month good-cause extensions
Proof of loss — § 2051.5
Per policy
Cannot be required < 100 days after the loss, plus 3-month extensions
Additional living expenses — § 2060
Per policy
≥ 24 months, extendable up to 12 more (36 total), then 6-month extensions
Advance living expenses — § 2061
—
On request, ≥ 4 months of living expenses
Premium grace — § 2062
Per policy
60 days in the affected area
Suit clause — § 2071
12 months
24 months
Contents advance — § 10103.7
—
≥ 60% of the contents limit, max $350,000, no inventory
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Sixty percent with no inventory — one act, TWO operative dates, and no code mirror flags the second
§ 10103.7, as amended by SB 495 (2025): on a covered total loss of a primary dwelling resulting from a state of emergency, the insurer “shall offer a payment under the contents (personal property) coverage in an amount no less than 60 percent of the policy limit applicable to the personal property … up to a maximum of three hundred fifty thousand dollars ($350,000).”
No itemized inventory. The insurer may require an attestation that the residence was furnished and the values claimed are reasonable. And the insured gives nothing up by taking it — the insurer must notify the insured “of the option to receive payment for loss of contents and of the insured’s option to subsequently file a full itemized claim.” The same section also permits combining payments up to the limits for the primary dwelling and other structures.
⚠ The two dates.1 January 2026 is the act’s general effective date — that is what commercial code reproductions show. 1 July 2026 lives inside § 10103.7 itself: “On and after July 1, 2026, all policy forms issued or renewed by an insurer shall comply with this section in its entirety.” Both dates have now passed. A source carrying only January is not wrong — it is incomplete in a way that matters for any form question.
⚠ Material describing a THIRTY percent contents advance is describing the pre-2026 rule.
§ 2061 — the inventory rules changed how contents claims are BUILTThe section bars an insurer from requiring a company-specific inventory form“if the insured can provide an inventory using a form that contains substantially the same information”, and requires the insurer to accept“an inventory that includes groupings of categories of personal property, including clothing, shoes, books, food items, CDs, DVDs, or other categories of items for which it would be impractical to separately list each individual item claimed.”Demanding an item-by-item list for an entire destroyed household is not compliant. Grouped categories are the standard the statute sets, not a concession. And § 2051.5(c) prevents the policy limiting or denying payment because the insured rebuilds at a different location — though the measure of indemnity “shall not exceed the replacement cost” at the original location.
📜 § 2071 — THE STANDARD FORM IS A STATUTE
🛡 § 2051(b) — WHAT MAY BE DEPRECIATED
California prescribes the standard form fire policy by statute, so its terms are law rather than contract. Appraisal is statutorily informal: “no formal discovery shall be conducted, including depositions, interrogatories, requests for admission … no formal rules of evidence shall be applied, and no court reporter shall be used.” Mechanics: appraisers named within 20 days; “failing for 15 days to agree upon the umpire”, a judge of a court of record selects one; an itemized award of any two determines actual cash value and loss; each side pays its own appraiser, umpire and appraisal expenses shared equally.
⚠ “In the event of a government-declared disaster … appraisal may be requested by either the insured or this company but shall not be compelled.” On a wildfire file that changes the whole dispute-resolution posture — the standard playbook of invoking appraisal to break a valuation dispute simply does not work.
Under an open policy paying actual cash value, the measure is repair, rebuild or replacement cost “less a fair and reasonable deduction for physical depreciation based upon its condition at the time of the injury or the policy limit, whichever is less.” Then the limit: “A deduction for physical depreciation shall apply only to components of a structure that are normally subject to repair and replacement during the useful life of that structure.”
⚠ You may NOT depreciate the structure itself. Roofing, finishes and mechanical components are normally repaired and replaced across a building’s life; framing and foundations are not. Added by AB 188 (2019), effective 1 January 2020 — so estimating practice or training predating 2020 may depreciate line items California no longer permits. Under a replacement cost policy, § 2051.5(a) removes the depreciation deduction entirely.
⚠ California HAS a matching regulation — and the DAMAGED AREA is the argument10 CCR 2695.9(a)(2):“When a loss requires replacement of items and the replaced items do not match in quality, color or size, the insurer shall replace all items in the damaged area so as to conform to a reasonably uniform appearance.” Four elements: the trigger is a mismatch in quality, color OR size — any one is enough; the obligation is to replace all items in the damaged area; the standard is reasonably uniform, which is not identical and not perfect; and the scope is the damaged area, the principal limiting term. The companion, 2695.9(a)(1), covers what the repair itself breaks: “any consequential physical damage incurred in making the repair or replacement not otherwise excluded by the policy shall be included in the loss”, and “The insured shall not have to pay for depreciation nor any other cost except for the applicable deductible.”Document the boundary of the damaged area and the basis for it — that is the part of the file the regulation actually tests.
⚠ § 675.1 — the moratorium reaches ADJACENT ZIP codes
After a state of emergency based on a wildfire, an insurer “shall not cancel or refuse to renew” residential property insurance “for a property located in any ZIP Code within or adjacent to the fire perimeter, for one year” — where the action is “based solely on the fact that the insured structure is located in an area in which a wildfire has occurred.”
⚠ Check the BULLETIN, not the statute
The perimeter “shall be determined by the Department of Forestry and Fire Protection in consultation with the Office of Emergency Services”, and then “The commissioner shall issue a bulletin to inform insurers which ZIP Codes are subject.” The operative list is in the bulletin. These recur one per declared emergency — eight in 2024, five in 2025, one so far in 2026.
§ 675.1(a) — the longer post-total-loss duty
Where the total loss to the primary insured structure was caused by a disaster, the insurer “shall offer, for at least the next two annual renewal periods, but no less than 24 months of coverage from the date of the loss, to renew the policy.”
§§ 676 and 678 — cancellation and nonrenewal
Nonrenewal notice: 75 days. Cancellation after 60 days in effect is limited to nonpayment; conviction of a crime with an element increasing a hazard; fraud or material misrepresentation; grossly negligent acts; and physical changes rendering the property uninsurable. Auto: 20 / 10 / 30 days.
⚠ Ground three links CLAIMS to UNDERWRITING
Fraud or material misrepresentation “in obtaining the insurance or in pursuing a claim” is a cancellation ground. What an adjuster documents can support cancellation of the policy, not merely denial of the claim.
SB 547 — commercial, from 1 January 2026
Extended the nonrenewal moratorium protections from residential to commercial policies — reaching businesses, homeowners associations, condominiums, affordable housing and non-profits.
⚠ No mandatory valued policy law — but not NO valued policy law
§ 412 defines the category. § 2051(a) frames the fire measure as applying “Under an open policy”. § 2052 creates an elective mechanism the insured initiates and pays for; § 2053 requires a clause saying the value has been fixed. The operative word throughout is MAY.
The FAIR Plan — § 10090 and following
Writes basic property insurance — fire and specified perils, not a homeowners policy. Limits: dwelling $3,000,000 (2022); commercial per building $20,000,000 (2023); per location $100,000,000 (2025). As of December 2025: $724 billion exposure across 668,609 policies. ⚠ An insured with a FAIR Plan policy and a companion difference-in-conditions policy has TWO carriers and TWO coverage grants for one loss.
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Smoke and ash — guidance, not regulation. And AB 1795 carries an URGENCY clause.
As of August 2026 there is NO adopted California statute or regulation establishing standards for smoke or ash inspection, sampling, testing or remediation. The general rules apply — the measure of indemnity, the matching regulation, the claims deadlines — but no smoke-specific instrument is in force.
What exists is Department guidance: Bulletin 2025-7 on coverage and handling of smoke damage claims in or near wildfire areas; Bulletin 2025-2 on wildfire consumer protections and advanced payments; Bulletin 2025-3 on flood, mudslide and earth movement claims relating to the wildfires; and an Agent and Broker Alert of 11 March 2025 recording the Commissioner ordering insurers to fully investigate smoke damage claims. A Smoke Claims and Remediation Task Force issued a report in 2025 — the Department describes its output as proposals rather than enforceable requirements.
AB 1795, the Smoke Damage Recovery Act, would add Ins. Code §§ 2060.1, 2060.2, 14048 and 15009.2 and Health and Safety Code § 25405 — statewide protocols for inspection, sampling and testing, remediation to pre-loss condition, a thirty-day inspection timeline, and no termination of additional living expenses until a home is cleared as safe. It passed the Assembly 56 to 7 on 8 June 2026 with an urgency clause adopted and is in Senate Appropriations. It is not law.
⚠ An ordinary bill chaptered in 2026 takes effect the following 1 January. An urgency bill takes effect IMMEDIATELY. And AB 1795 would add § 14048 inside the adjuster division and §§ 2060.1 and 2060.2 inside the ALE cluster — it touches this material in two places. Verify its status before relying on the absence of smoke standards.
🏦 CIGA — § 1063.1
🚨 FRAUD — §§ 1871.2, 1872.4, 1879.2
Three different caps, depending on the claim. General: covered claims exclude the portion “other than a claim for workers compensation benefits, that is in excess of five hundred thousand dollars ($500,000).” Dwelling: “a claim for damage to, or loss of, a dwelling structure under a policy of residential property insurance shall not exceed one million dollars ($1,000,000) or the amount recoverable under the policy, whichever is less.”Workers’ compensation benefits are UNCAPPED.
⚠ THE $100 IS A FLOOR, NOT A DEDUCTIBLE. § 1063.1(c)(6) excludes “a claim in an amount of one hundred dollars ($100) or less.” A $90 claim is not covered at all. A $150 claim is covered in full — not reduced by $100. If an answer offers $500,000 less $100, the subtraction half is wrong. Also excluded: life, annuity, health, disability; mortgage and financial guaranty; fidelity and surety INCLUDING BONDS; credit; title; ocean marine; claims servicing agreements; reinsurance; obligations to government, insurers and pools; and PUNITIVE damages — and CIGA is the payer of last resort.
§ 1872.4 — the clock runs from an event the insurer creates. A company that “reasonably suspects or knows an act of insurance fraud may have occurred” must report to the Fraud Division “within 60 days after that determination by the insurer.”⚠ Not from the date of loss, not from the date of the claim, not from discovery of the underlying facts — which is why the file must record when reasonable suspicion arose, not merely that it did.
Two warnings, different scope.§ 1871.2 reaches applications, amendments to coverage AND claim forms, and covers presenting false information “to obtain or amend insurance coverage or to make a claim”; it excludes reinsurance contracts. § 1879.2 reaches claim forms, and covers “a false or fraudulent claim for the payment of a loss.” Both require comparative prominence. ⚠ NEITHER prescribes a point size — the 10-point figure belongs to § 10102 and the Residential Property Insurance Disclosure. § 1872.5 gives immunity for reporting without malice; § 1875.20 requires every admitted insurer to run a continuous fraud investigation unit.
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Workers’ compensation — the 90-day deadline creates a PRESUMPTION, not a penalty
Lab. Code § 5402(b)(1):“If liability is not rejected within 90 days after the date the claim form is filed under Section 5401, the injury shall be presumed compensable under this division.” For the presumptive injuries in §§ 3212 to 3212.85 the period is 75 days. Missing the deadline does not produce a fine — it produces a compensable injury.
Meanwhile treatment must be authorized immediately. § 5402(c) requires the employer, “Within one working day after an employee files a claim form”, to authorize all treatment — and “Until the date the claim is accepted or rejected, liability for medical treatment shall be limited to ten thousand dollars ($10,000).”
2026 rates: maximum TTD $1,764.11 per week, minimum $264.61, from a state average weekly wage of $1,789 under § 4453(a)(10) — published November 2025, effective 1 January 2026. Waiting period 3 days (§ 4652), waived where TD continues more than 14 days or the employee is hospitalized as an inpatient. Notice to employer 30 days (§ 5400); claim form within one working day (§ 5401); limitations one year (§ 5405); first TD payment within 14 days (§ 4650), and a late payment “shall be increased 10 percent and shall be paid, without application, to the employee.”
⚠ Comp bad faith is not available.Charles J. Vacanti, M.D., Inc. v. State Compensation Insurance Fund, S071945, 4 January 2001, holds such claims within the exclusivity provisions, with Lab. Code § 5814 as the exclusive remedy: the delayed payment “shall be increased up to 25 percent or up to ten thousand dollars ($10,000), whichever is less”, with a 10 percent self-imposed alternative if paid within 90 days of discovery, and a two-year limitations period.
⚠ TWO mandatory comp competency regimes, TWO agencies, and NEITHER is a licenseOne — Department of Insurance, 10 CCR 2592 and following:160 hours of training for a workers’ compensation claims adjuster, of which 120 must be classroom with an instructor; 80 hours with 50 classroom for a medical-only adjuster; plus 30 hours of post-designation training every two years and 20 for medical-only. Five years of California comp adjusting experience within the past eight substitutes for the initial training. It is an employer-conferred designation certified annually to the Commissioner — not a license, and not issued to the individual by the state. Two — Department of Industrial Relations, 8 CCR 15452: self-insured claims must be adjusted under the direct supervision of a person who has passed the self-insurance administrator’s examination. And note the reach: 10 CCR 2592.01 defines the adjuster to include “an employee or agent of an entity that is NOT an insurer” — which captures third-party administrator staff adjusting on an insurer’s behalf.
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Reading California law without getting burned — the forward index EXISTS, is official, and cannot help you yet
California is a two-year-session state. The 2025–2026 Regular Session convened in December 2024 and adjourns 30 November 2026, so bills introduced in 2025 carry over. Second-year dates: 31 January for each house to pass its own odd-year bills; 31 August to pass bills; 30 September for the Governor. A bill chaptered in 2026 generally takes effect 1 January 2027 unless it carries an urgency clause.
⚠ So the live exposure is NOT the current session. It is the tranche that took effect 1 January 2026 — SB 495 and the FAIR Plan package among them — which commercial code reproductions do carry but many practitioners have not absorbed.
⚠ There is no usable forward index for the current biennium, and the reason is structural. The official Table of Sections Affected is compiled per biennium, after that biennium closes — the newest published volume covers 2023–2024, and the 2025–2026 volume cannot exist before roughly 2027. What is available instead is a code-scoped bill list on the Legislature’s own site: 146 Insurance Code bills this biennium, of which 31 were chaptered. Exhaustive as to acts touching the Insurance Code — but not keyed to sections.
⚠ A bill title tells you almost nothing.AB 487, approved 10 October 2025, is titled simply “Insurance”, amends more than twenty sections, and none of them is in Division 5 — yet it changed the law for adjuster applicants by adding insurance adjuster and public insurance adjuster licenses to the automatic-denial provision in § 1652, in an entirely different division. A search scoped to Division 5 would never have found it.
And one caution about the regulations. The Fair Claims regulations are old — the last substantive amendment became operative 30 August 2006 — and a tranche of 2003 amendments was enjoined and depublished under a court-approved settlement in 2004. Material printed in 2003 or 2004 may quote regulatory text that never took effect.
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Top Exam Tips — California Adjuster Regulations
1. CALIFORNIA DOES LICENSE INDEPENDENT ADJUSTERS — Division 5, class AJ. The correct statement has two halves: it licenses them and exempts most carrier staff.
2. DIVISION 5 HAS THREE CHAPTERS — and chapter 3 issues the disaster access badge, not a license.
3. NO PRELICENSING for AJ; TWENTY HOURS for PJ. Name the chapter or be wrong half the time.
4. TWO YEARS OF EXPERIENCE, converted at 2,000 hours = 1 year — agency practice, not statute.
5. 150 vs 158 MINUTES — two current publications, no instrument reconciles them. Name the source.
6. § 14097 SETS CAPS, NOT AMOUNTS, and the published schedule is stamped 2014.
7. FOUR TRAINING DUTIES, CUMULATIVE — CE has hours; the 1 September certification is sworn and has none.
8. THE LICENSEE OR INSURER REGISTERS; THE ADJUSTER CERTIFIES — and no current certification means no valid registration.
9. NO GENERAL BUSINESS PRACTICE REQUIREMENT — one KNOWING act violates. The asymmetry is knowledge, not instrument.
10. NO PRIVATE ACTION answers WHO CAN SUE, not WHAT IS OWED — third-party claimants are owed the regulatory duties.
11. ALL CALENDAR DAYS — 21 / 15 / 15 / 40 / 30 / 30. No business-day clock exists in the article.
12. ACKNOWLEDGMENT MAY BE ORAL; DENIAL MUST BE WRITTEN — and the itemized bases sentence is first-party.
13. YOU CAN BE PERSONALLY LIABLE FOR NEGLIGENT MISREPRESENTATION — bad faith and negligence, no.
14. NO TOTAL LOSS PERCENTAGE, and auto minimums are $30/$60/$15 on issue or renewal from 1 Jan 2025.
15. SIXTY PERCENT CONTENTS, MAX $350,000, NO INVENTORY — and § 10103.7 has a second date, 1 July 2026.
16. APPRAISAL CANNOT BE COMPELLED in a government-declared disaster, and CIGA’s $100 IS A FLOOR, NOT A DEDUCTIBLE.
Scenario Quiz — ten fact patterns.
Ten situations drawn from the places California answers a national assumption backwards, splits one duty between two people, or moved a number that most published material has not caught up with. Each explanation names the trap and says why the plausible wrong answer is wrong.
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