§ 2696.2. Definitions.
10 CA ADC § 2696.2Barclays Official California Code of Regulations
10 CCR § 2696.2
§ 2696.2. Definitions.
For the purposes of these regulations:
(b) “Question of major insurance coverage” shall mean the core determination of whether earthquake, residential property, or automobile collision or physical damage insurance coverage is or is not in dispute. All disputes relating to canceled or non-renewed policies, non-mandated building code upgrades, and claims for damage where there is no underlying coverage involve a question of major insurance coverage and will not be referred to mediation. Disputes including, but not limited to, scope of damage, scope or method of repairs, cause of damage, asbestos or other contaminations, additional living expenses, aftershock damage and disputes over preexisting damage do not concern a question of major insurance coverage and are eligible for referral to mediation;
(c) “Purely legal interpretation” means where the resolution of the dispute rests solely upon interpretation of law, including but not limited to statutes, regulations or case law. All disputes including but not limited to statutes of limitation, contractual deadlines, and allegations of bad faith, the resolution of which involves only a question of law, fall within a purely legal interpretation and will not be referred to mediation. Disputes including, but not limited to, questions of fact and questions of liability do not involve a purely legal interpretation and are eligible for referral to mediation;
(f) “Disputes in which a party is alleged to have committed fraud” means complaints in which the insurer is actively investigating the claim for fraud, including the insurer's compliance with Insurance Code section 1872.4, and there is no possibility of resolving the claim until the fraud investigation has been completed.
(g) “Calendar day” means each and every day including Saturdays, Sundays, Federal and California State Holidays, but if the last day for performance of any act required by these regulations falls on a Saturday, Sunday, Federal or State Holiday, then the period of time to perform the act is extended to and includes the next calendar day which is not a Saturday, Sunday, or Federal or State holiday;
(h) “Mediation” means the good faith participation by an insurer and insured, and their representatives, in a non-binding procedure before a neutral third party directed toward the resolution of a pending claim for damages caused by an earthquake or eligible homeowners, automobile collision, or automobile physical damage loss under a policy of insurance.
(i) “Policy” means the written contract between an insured and an insurance company stating the obligations and responsibilities of each party. A policy may include any applications, binders, declaration forms, endorsements, certificates, and any other documents which describe, affect or limit coverage under the policy;
(m) An eligible homeowners loss is either a claim that arises under a homeowners insurance policy and that involves a loss due to a fire for which the Governor has declared a state of emergency pursuant to Section 8558 of the Government Code; or a claim that arises under a policy covering earthquake damage and involves loss due to an earthquake for which the Governor has declared a state of emergency pursuant to Section 8558 of the Government Code.
Credits
Note: Authority cited: Section 10089.83, Insurance Code. Reference: Sections 660, 675, 10089.7, 10089.70 and 10089.83, Insurance Code.
History
1. New section filed 10-15-96; operative 10-15-96 (Register 96, No. 42). A Certificate of Compliance must be transmitted to OAL by 2-12-97 or emergency language will be repealed by operation of law on the following day.
2. Repealed by operation of Government Code section 11346.1(g) (Register 97, No. 10).
3. New section filed 3-4-97 as an emergency; operative 3-4-97 (Register 97, No. 10). A Certificate of Compliance must be transmitted to OAL by 7-2-97 or emergency language will be repealed by operation of law on the following day.
4. Editorial correction of subsection (c) (Register 97, No. 33).
5. Certificate of Compliance as to 3-4-97 order transmitted to OAL 7-3-97 and filed 8-13-97 (Register 97, No. 33).
6. Amendment of subsections (b) and (h), new subsections (l)-(n) and amendment of Note filed 12-29-2006; operative 1-28-2007 (Register 2006, No. 52).
This database is current through 5/10/24 Register 2024, No. 19.
Cal. Admin. Code tit. 10, § 2696.2, 10 CA ADC § 2696.2
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