California Fair Claims Settlement Practices Regulations (10 CCR 2695)
A section-by-section analysis of California's Fair Claims Settlement Practices Regulations — every rule your insurer must follow on a property claim, explained in plain English.
Title 10, California Code of Regulations, Sections 2695.1 through 2695.14 — commonly called the Fair Claims Settlement Practices Regulations — are the detailed rules that govern how every insurance company in California must handle your claim. They were promulgated by the Insurance Commissioner under the authority of Insurance Code Section 790.10 and carry the force and effect of law.
This is an important distinction. These are not guidelines or suggestions. They are binding administrative regulations adopted through California's formal rulemaking process under the Administrative Procedure Act (Government Code § 11340 et seq.). Courts treat them with the same authority as statutes. An insurer that violates these regulations is violating California law — and those violations can form the basis of a CDI complaint, evidence of bad faith, or both.
The regulations work hand-in-hand with Insurance Code Section 790.03(h), which lists prohibited unfair claims settlement practices. Where Section 790 says what insurers cannotdo in broad terms, 10 CCR 2695 fills in the operational details — specific deadlines, documentation requirements, disclosure obligations, and settlement standards. Think of Section 790 as the “thou shalt not” list and 10 CCR 2695 as the operating manual that tells the insurer exactly how to comply. For the full Section 790 analysis alongside these regulations, see our California Insurance Regulations reference page.
Scope of This Analysis
The Fair Claims Regulations contain sections that apply to automobile claims (2695.8), surety bonds (2695.10), and life and disability insurance (2695.11). This analysis covers only the sections that apply to residential and commercial property insurance claims — the regulations most relevant to homeowners, landlords, and business owners dealing with fire, water, wind, and other property losses in California.
Regulatory Violations and Bad Faith: Understanding the Relationship
One of the most important things to understand about these regulations is their relationship to bad faith. A regulatory violation is not automatically bad faith — but it can be powerful evidence of it.
Under Moradi-Shalal v. Fireman's Fund Insurance Companies (1988) 46 Cal.3d 287, the California Supreme Court held that there is no private right of action directly under Insurance Code Section 790.03. You cannot sue your insurer solely for violating the statute or its implementing regulations. Instead, violations of the Fair Claims regulations serve as evidence in a claim for breach of the implied covenant of good faith and fair dealing — the legal theory behind every insurance bad faith case in California.
In Jordan v. Allstate Insurance Co.(2007) 148 Cal.App.4th 1062, the court confirmed that Fair Claims regulation violations are relevant and admissible evidence of bad faith. The regulations define the standard of conduct insurers must meet, and failure to meet that standard — even if it doesn't automatically equal bad faith — shows the insurer's general disregard for doing things correctly.
However, the Wilson v. 21st Century Insurance Group(2007) 42 Cal.4th 713 “genuine dispute” doctrine provides insurers with some protection: if there is a genuine dispute about coverage or the amount of loss, and the insurer's position is fairly debatable, bad faith may not lie. But this protection has limits. In Chateau Chamberay Homeowners Assn. v. Associated International Insurance Co.(2001) 90 Cal.App.4th 335, the court held that the genuine dispute doctrine does not shield an insurer whose investigation was itself unreasonable. An insurer cannot conduct a sloppy or biased investigation, arrive at a low number, and then claim the dispute is “genuine.”
Why Documenting Violations Matters — Even If You Never Sue
Even if a regulatory violation does not rise to the level of bad faith on its own, documenting every violation preserves your rights and strengthens your position in several ways:
- CDI complaints. The California Department of Insurance investigates complaints based on these specific regulations. A complaint citing regulation numbers, dates, and facts is far more effective than a general grievance.
- Pattern evidence. A single missed deadline may be excusable. A pattern of missed deadlines, ignored communications, and undisclosed coverages paints a very different picture — one that looks like systemic bad faith, not an honest mistake.
- Litigation leverage. If your claim eventually ends up in litigation or appraisal, a documented history of regulatory violations gives your attorney or public adjuster significant leverage in settlement negotiations.
- Punitive damages. Under Egan v. Mutual of Omaha (1979) 24 Cal.3d 809, bad faith can support punitive damages. A record of multiple, documented regulatory violations makes the case for punitive damages far stronger.
If You Don't Ask, You Don't Benefit: The Written Demand Principle
Many of the regulations below are only triggered when the insured takes a specific action — typically making a written request or demand. The insurer may be in technical compliance simply because no one asked them to do something they are required to do upon request. But the moment you make that request in writing, the clock starts, and any failure to comply becomes a documented regulatory violation.
This is one of the most important practical lessons in claims handling: the insured who puts things in writing creates leverage; the insured who only makes phone calls does not. Consider these examples:
- If you never request the name of a contractor who can do the repairs for the insurer's estimate, the insurer has no obligation to provide one. But if you make that request in writing citing §2695.9(d)(2), and they fail to respond within 15 days, you now have a documented violation of both §2695.9(d)(2) and§2695.5(b) (the 15-day response requirement).
- If you never ask for your claim file, the insurer has no obligation to send it to you proactively. But once you make that request in writing, they must produce it — and any failure or delay is a violation of §2695.3 and §2695.5(b).
- If you never challenge the insurer's estimate at all, the insurer has no reason to change its number. But the moment you demand — in writing — the name of a contractor who will do the work for the insurer's estimated amount under §2695.9(d)(2), the insurer must respond. If they cannot name a contractor, their estimate is rebutted. Silence becomes a violation.
The principle works like this: your written demand either gets you what you need, or — if the insurer fails to comply — it documents a regulatory violation and potential bad faith. Either way, you win.If you don't ask, you get neither.
Every Written Demand Should Cite the Regulation
When you make a request, cite the specific regulation number. “Per 10 CCR §2695.9(d)(2), I am requesting the name of a contractor who will perform the repairs for the amount of your estimate” is far more effective than “please send me a contractor name.” The regulation citation signals that you know the rules, you are creating a paper trail, and any failure to respond will be documented as a specific regulatory violation.
Section 2695.1 — Preamble and Scope
Regulation Text (Summary):
Section 790.03(h) of the California Insurance Code enumerates sixteen claims settlement 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. The Insurance Commissioner has promulgated these regulations to: (1) delineate minimum standards for claim settlement; (2) promote good faith, prompt, efficient and equitable settlement of claims; (3) discourage fraudulent claims; and (4) encourage prompt investigation and reporting of suspected fraud.
These regulations are not the exclusive definition of unfair claims settlement practices. Other acts not specifically listed may also violate Insurance Code §790.03(h). The regulations apply to all claims except: workers' compensation, medical malpractice liability, bona fide ERISA plans not covered by insurance, and other lawful self-funded plans.
Policy provisions relating to claims shall be consistent with or more favorable to the insured than these regulations. The use of third-party data or tools to value claims does not absolve the insurer of its obligation to comply.
Explanation
The Preamble establishes several critical principles. First, a single knowing violationis enough — the insurer does not have to engage in a “pattern or practice” for a single act to constitute an unfair claims practice. Second, the regulations set minimum standards — any policy language that is less favorable to the insured than the regulations is unenforceable to that extent. Third, the insurer cannot hide behind third-party tools — if the tool produces an unfair result, the insurer is still responsible.
Real-World Examples
- The Xactimate defense.An insurer pays your claim based on an Xactimate estimate that uses incorrect local pricing, omits line items, or applies depreciation to labor. When challenged, the adjuster says “that's what Xactimate says.” Under §2695.1(g), the insurer bears full responsibility for the accuracy of its third-party tools. “Xactimate said so” is not a defense.
- Policy language less favorable than the regulations. Your policy says the insurer has 60 days to acknowledge your claim. The regulation says 15 days. The regulation controls — the insurer must meet the 15-day standard regardless of what the policy says.
How to Use This
When the insurer cites Xactimate, a third-party valuation service, or any external tool to justify a low estimate, respond in writing: “Per 10 CCR §2695.1(g), the use of a third-party source does not absolve you of your obligation to effectuate a prompt, fair and equitable settlement. Your estimate does not reflect actual local repair costs for the following reasons…” Then list the specific deficiencies. This shifts the burden back to the insurer to justify their number on the merits, not by pointing at a software program.
Section 2695.2 — Definitions
Key Definitions (Selected):
- “Calendar days” — each and every day including weekends and holidays, but if the last day falls on a weekend or holiday, the deadline extends to the next business day.
- “Claimant” — includes the insured, an attorney, a public adjuster, or any family member properly designated in writing.
- “Insurer”— broadly defined to include admitted and non-admitted carriers, the California FAIR Plan, the California Earthquake Authority, home protection companies, and any entity subject to Insurance Code §790.03(h). Does not include agents and brokers.
- “Knowingly committed” — includes actual, implied, or constructive knowledge. Knowledge the insurer had or should have had.
- “Proof of claim” — any evidence or documentation, whether submitted by the claimant or obtained by the insurer during its own investigation, that provides evidence of the claim and reasonably supports the amount of the loss.
Explanation
The definitions section contains several terms with major practical significance. The definition of “proof of claim”is critical: it includes evidence the insurer already has from its own investigation. This means the 40-day clock to accept or deny your claim (in §2695.7) can start ticking based on the insurer's own adjuster's report — the insurer cannot stall by claiming it is “waiting for proof of claim” when its own files contain the evidence.
The definition of “knowingly committed” includes constructive knowledge — meaning the insurer cannot claim ignorance of facts it should have known through reasonable investigation. This ties directly to Chateau Chamberay— an insurer that conducts a sloppy investigation and then claims it didn't know the extent of the damage is charged with the knowledge a proper investigation would have revealed.
Real-World Examples
- The “we're waiting for your proof of loss” stall. The insurer's own adjuster has inspected the property, taken photos, and written an estimate. Yet the insurer tells you they cannot make a decision because they haven't received your sworn proof of loss. Under the definition of “proof of claim,” the insurer's own investigation data is proof of claim. The 40-day clock may already be running.
- Refusing to communicate with your PA.You designate a public adjuster in writing. The insurer's adjuster continues contacting you directly, ignoring your PA's calls and emails. Under the definition of “claimant,” your properly designated PA has the same communication rights as you do. The insurer's refusal to communicate with your representative is a violation.
- The adjuster who doesn't look.The adjuster inspects only the first floor but never enters the attic, crawlspace, or detached garage — all of which have damage. The adjuster denies those portions of the claim. Under the definition of “knowingly committed” (which includes constructive knowledge), the insurer is charged with the knowledge a thorough investigation would have produced.
How to Use This
If the insurer is stalling by demanding additional documentation when it already has enough information to make a decision, write: “Per the definition of ‘proof of claim’ in 10 CCR §2695.2(s), proof of claim includes evidence obtained by the insurer during its own investigation. Your adjuster inspected my property on [date] and prepared an estimate. The 40-day deadline under §2695.7(b) commenced no later than that date.”
Section 2695.3 — File and Record Documentation
Regulation Text (Summary):
Every licensee's claim files shall be subject to examination by the Commissioner. Files shall contain all documents, notes and work papers (including copies of all correspondence)in such detail that pertinent events and dates can be reconstructed and the licensee's actions can be determined. Insurers shall maintain claim data for all open and closed files for the current year and four preceding years. The date every material document was received, processed, and transmitted must be recorded.
Explanation
The insurer must maintain a complete, detailed paper trail — every phone call note, every email, every internal memo, every estimate version, every supervisor instruction. The five-year retention requirement means these records are available for CDI investigations and litigation long after the claim is closed.
Real-World Example
You request your claim file and discover internal notes showing the adjuster recommended paying $180,000, but a supervisor instructed the adjuster to reduce the estimate to $120,000 with no documented justification. These internal records — which the insurer is required to maintain — become powerful evidence in a bad faith case. In Gruenberg v. Aetna Insurance Co.(1973) 9 Cal.3d 566, the California Supreme Court established that the insurer owes a duty of good faith and fair dealing. Internal records showing a supervisor overriding a field adjuster's recommendation without justification is exactly the kind of evidence that demonstrates breach of that duty.
How to Use This
Request your complete claim file in writing.Cite §2695.3 and request all documents, notes, work papers, correspondence, internal emails, adjuster reports, supervisor notes, estimates (all versions), and photographs. The insurer must respond within 15 days under §2695.5(b). If they produce an incomplete file — missing internal notes or supervisor communications — that itself may be a violation. The claim file is the single most valuable discovery tool available to a policyholder short of litigation.
Section 2695.4 — Representation of Policy Provisions and Benefits
Regulation Text (Summary):
- (a) Every insurer shall disclose to a first party claimant all benefits, coverage, time limits or other provisions of the policy that may apply to the claim.
- (d) Except where specified in the policy, no insurer shall require a first party claimant to give notice or proof of claim within a specific time.
- (e)No insurer shall request a release that extends beyond the subject matter of the claim unless the legal effect is disclosed and fully explained in writing. A Civil Code §1542 waiver may be included, but its legal effect must be disclosed and explained in writing before execution.
- (f) No insurer shall issue checks in partial settlement containing release language unless the policy limit has been paid or there is a compromise settlement agreed to by the claimant.
Explanation
Subsection (a) is one of the most important and most frequently violated regulations in the entire code. The insurer must affirmatively tell you about every coverage that may apply to your claim. The duty is on the insurer to disclose — not on you to ask.
Subsection (f) prohibits “full and final settlement” language on partial payment checks. If the insurer sends a partial payment with release language, that language is unenforceable unless you have expressly agreed to a compromise or the policy limit has been exhausted.
Real-World Examples
- Failure to disclose coverages. After a total loss fire, the insurer processes your dwelling claim but never mentions ordinance or law coverage, debris removal coverage beyond the basic dwelling limit, extended replacement cost, or the separate Coverage B (other structures) limit. Months later you discover these coverages existed. The insurer violated §2695.4(a) from day one. In a bad faith context, failing to tell you about coverages you are paying for is precisely the kind of conduct Gruenberg addresses — the insurer placed its financial interest above its duty to the policyholder.
- Broad release on a partial payment.You settle the dwelling portion of your claim for $200,000, but the insurer's release form says you are releasing “any and all claims arising from the loss.” You still have an open contents claim and an ALE claim. Under §2695.4(e), the insurer must explain the legal effect of this broad release in writing before you sign. And under §2695.4(f), release language on a partial settlement check is unenforceable if you did not agree to compromise the remaining coverages.
- The “full and final” check.You receive a check for $75,000 with “full and final payment” printed on it, but you believe your claim is worth $150,000 and you never agreed to settle. This violates §2695.4(f). See our guide on insurance checks for what to do.
How to Use This
Early in your claim, send a written request: “Per 10 CCR §2695.4(a), please identify all benefits, coverages, time limits, and policy provisions that may apply to my claim, including but not limited to: Coverage A (dwelling), Coverage B (other structures), Coverage C (personal property), Coverage D (loss of use), ordinance or law coverage, debris removal, extended replacement cost, and any other applicable endorsements.” If the insurer fails to respond or omits coverages, you have a documented violation. If you never ask, the insurer may never volunteer the information — and you leave money on the table.
The Duty to Disclose All Coverages
In practice, many insurers fail to mention coverages like ordinance or law, extended replacement cost, debris removal beyond the dwelling, or the additional contents coverage available under some policies. If your insurer never mentioned a coverage and you later discover you were entitled to it, their failure to disclose is a regulatory violation under §2695.4(a) — and potentially evidence of bad faith. The insured who asks in writing forces the insurer to either disclose everything or create a documented violation.
Section 2695.5 — Duties Upon Receipt of Communications
Regulation Text (Summary):
- (a) Upon receiving any inquiry from the CDI, the insurer must furnish a complete written response within 21 calendar days.
- (b) Upon receiving any communication from a claimant that reasonably suggests a response is expected, the insurer must furnish a complete response within 15 calendar days.
- (c)A claimant's designation of a public adjuster, attorney, or family member must be in writing, signed and dated, and is valid until the claim is settled or revoked in writing.
- (e) Upon receiving notice of claim, the insurer must within 15 calendar days: (1) acknowledge receipt; (2) provide forms, instructions, and reasonable assistance; and (3) begin investigation. Failure of an agent to transmit notice is imputed to the insurer.
Explanation
The 15-day response rule(§2695.5(b)) is one of the most frequently violated and most useful regulations. It applies to every communication that reasonably expects a response. Every email, every letter, every voicemail you send that asks a question, requests information, or submits documentation triggers a 15-calendar-day response obligation. Each day past 15 is a separate regulatory violation.
The 15-day acknowledgment deadline(§2695.5(e)) starts the moment you file your claim. The insurer has 15 days to acknowledge it, tell you what they need, and begin investigating. An insurer that takes three weeks to assign an adjuster has already violated this regulation.
Real-World Examples
- The silent adjuster.You send your contractor's estimate to the adjuster by email on March 1. By March 20, you have received no response. That is a violation of §2695.5(b). You send a follow-up on March 21 noting the missed deadline. By April 5, still no response — that is now a second violation (of the follow-up communication). Each unanswered communication is a separate, documentable violation.
- Slow claim acknowledgment. You file your claim on January 15 after a pipe burst. On February 10 — 26 days later — you finally receive a letter acknowledging the claim. The insurer violated the 15-day deadline by 11 days.
- Agent delay imputed to insurer.You report a fire loss to your insurance agent on Monday. The agent doesn't transmit the claim to the carrier until the following Friday. Under §2695.5(e)(1), the agent's delay is imputed to the insurer — the 15-day clock started Monday, not Friday.
How to Use This
Create a communication log.Every time you send the insurer something, log the date and what you sent. If 15 calendar days pass without a response, send a follow-up letter: “On [date], I sent [description]. Per 10 CCR §2695.5(b), a response was due within 15 calendar days. No response has been received. This constitutes a regulatory violation. Please respond immediately.” This accomplishes two things: it gets the insurer's attention, and it creates a paper trail documenting the violation. Even if the insurer responds the next day, the violation is documented for any future CDI complaint or bad faith claim.
Section 2695.6 — Training and Certification
Regulation Text (Summary):
Every insurer shall provide thorough and adequate training regarding these regulations to all claims agents and shall certify that training annually, under penalty of perjury, by September 1. Where independent adjusters are retained, the insurer must provide training and maintain certifications at its principal place of business.
Explanation and How to Use This
Every adjuster who handles your claim — including independent adjusters brought in after a catastrophe from other states — is required to have been trained on these regulations and to have certified under penalty of perjury that they understand them. When an adjuster tells you “we don't have to do that” or “that's not how it works in California,” they are either violating this regulation (by being insufficiently trained) or they are knowingly misrepresenting the regulations to you (which is itself a violation of §790.03(h)(1) — misrepresenting policy provisions). After a major wildfire, when carriers bring in hundreds of out-of-state adjusters, this regulation is particularly relevant. “My adjuster didn't know the rule” is not a defense — it is a separate violation.
Section 2695.7 — Standards for Prompt, Fair and Equitable Settlements
This is the longest and most important section of the regulations. It contains 17 subsections (a through q). Each property-relevant subsection is addressed below with the regulation text, explanation, examples, and practical guidance.
§2695.7(a) — Anti-Discrimination
No insurer shall discriminate in its claims settlement practices based upon the claimant's age, race, gender, income, religion, language, sexual orientation, ancestry, national origin, or physical disability, or upon the territory of the property or person insured.
Explanation: Every claim must receive the same investigation and settlement standards regardless of who the claimant is or where the property is located. A claim in a lower-income neighborhood must receive the same level of attention as one in a wealthy area. A non-English-speaking claimant must receive the same treatment as an English speaker.
How to use this: If you observe that the insurer is providing lesser service — longer delays, less thorough investigations, lower estimates — in certain communities, this regulation provides a basis for a CDI complaint and may support a broader pattern-and-practice investigation.
§2695.7(b) — 40-Day Accept/Deny Deadline
Upon receiving proof of claim, every insurer shall immediately, but in no event more than forty (40) calendar days later, accept or deny the claim, in whole or in part. Where a claim is denied, the insurer shall do so in writing, listing all bases and the factual and legal basesfor each reason. The denial shall cite specific policy provisions or law and explain their application. Written notification shall include the CDI's contact information and the claimant's right to CDI review.
Explanation:Once the insurer has proof of your loss — from your submissions or its own investigation — they have 40 calendar days to decide. A vague denial that says “claim denied — insufficient documentation” without citing the specific policy exclusion, the factual basis, and the CDI's contact information fails the regulatory standard on multiple grounds. Every denial must tell you exactly why, cite the exact policy language, explain how it applies, and tell you how to contact the CDI.
Real-world example:Your insurer denies your water damage claim with a one-paragraph letter stating: “After review, we have determined this loss is not covered under your policy.” This denial violates §2695.7(b)(1) in multiple ways: it does not list all bases for denial, does not cite the specific exclusion, does not provide the factual basis, and does not include CDI contact information. In Brizuela v. CalFarm Ins. Co.(2004) 116 Cal.App.4th 578, the court found that an insurer's failure to adequately explain a denial was relevant evidence of bad faith.
How to use this:If you receive a deficient denial, respond in writing: “Your denial letter of [date] does not comply with 10 CCR §2695.7(b)(1). It fails to identify the specific policy provision, condition, or exclusion relied upon; fails to provide the factual basis for each reason; and fails to include CDI contact information. Please provide a compliant denial letter within 15 days per §2695.5(b).” This either forces a proper explanation (which may reveal the denial is weak) or creates another documented violation.
§2695.7(c) — 30-Day Written Status Updates
If the insurer needs more than 40 days, it must provide written notice within the 40-day period specifying additional information needed and reasons for the delay. Thereafter, written notice shall be provided every thirty (30) calendar days until a determination is made.
Explanation: The insurer cannot leave your claim in limbo. Every 30 days without a written update is a separate violation.
Real-world example: Your wildfire claim has been open for six months. You received one status letter in month two and nothing since. That is potentially four separate 30-day violations — each one individually documentable in a CDI complaint.
How to use this:After 30 days without an update, write: “Per 10 CCR §2695.7(c)(1), you are required to provide written status updates every 30 calendar days. The last written status was dated [date], more than 30 days ago. Please provide a written status update immediately, including any additional information you require and the reasons for the continued delay.”
§2695.7(d) — Thorough, Fair and Objective Investigation
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.
Explanation: This is a two-sided regulation. The insurer must investigate thoroughly — but it also cannot demand unnecessary information as a delay tactic. The investigation must be objective, not designed to support a predetermined outcome.
Real-world example and case law:The insurer sends a forensic engineer to inspect your fire-damaged roof. The engineer spends 20 minutes on-site, looks at two small areas, and writes a report attributing all damage to “pre-existing wear and tear.” Your contractor, who spent two full days on the property, documents extensive fire damage in areas the engineer never inspected. Under Chateau Chamberay(2001) 90 Cal.App.4th 335, the genuine dispute doctrine does not protect an insurer whose investigation was unreasonable. An insurer cannot conduct a 20-minute inspection, ignore contradicting evidence, and then claim the resulting low estimate is a “genuine dispute.” See our guide on defeating carrier engineer reports and the insurer's duty to investigate.
How to use this:When the insurer's investigation is superficial, document the deficiencies in writing: “Your adjuster spent approximately [X] minutes on the property and did not inspect [list areas]. Per 10 CCR §2695.7(d), you are required to conduct a thorough, fair and objective investigation. The following areas of damage were not inspected: [list]. I request a reinspection that includes all damaged areas.”
§2695.7(e) — No Delay Based on Other Parties
No insurer shall delay or deny settlement of a first party claim on the basis that responsibility for payment should be assumed by others.
Explanation:Your insurer cannot tell you to “go after the other guy first.” If your neighbor's tree fell on your house and you have coverage, your insurer must pay — their right to subrogate does not delay their obligation to pay you.
How to use this:If your insurer says “you should file a claim against your neighbor's insurance,” respond: “Per 10 CCR §2695.7(e), you may not delay or deny settlement of my first party claim on the basis that responsibility should be assumed by others. I am filing this claim under my own policy. Please process it accordingly.”
§2695.7(f) — Statute of Limitations Notice
Every insurer shall provide written notice of any statute of limitation or time period requirement upon which it may rely to deny a claim. Notice must be given at least 60 days before the expiration date. Does not apply to claimants represented by counsel.
Explanation and case law: An insurer that silently waits for a deadline to pass and then denies your claim as time-barred has committed one of the most clear-cut bad faith violations possible. This regulation reflects the principle established in cases like Egan v. Mutual of Omaha(1979) 24 Cal.3d 809 — the insurer has a duty of good faith that includes affirmatively protecting the insured's interests, not laying traps. See our guide on equitable tolling for how the statute of limitations works in insurance disputes.
How to use this:If you are approaching any deadline — the one-year suit limitation in many policies, the two-year statute under CCP §339(1) — write to your insurer: “Per 10 CCR §2695.7(f), please identify any statute of limitation or time period requirement that may apply to my claim and the applicable expiration dates.” This forces disclosure and prevents the insurer from later claiming a deadline passed without notice.
§2695.7(g) — Prohibition on Unreasonably Low Offers
No insurer shall attempt to settle a claim by making a settlement offer that is unreasonably low. The Commissioner considers: whether the insurer considered the claimant's evidence; legal authority reasonably available; the adjuster's own advice on damages; the procedures used to determine dollar amount; and whether the final amount is below what a reasonable person with knowledge of the facts would have offered.
Explanation and case law: This is the regulation behind lowball offers. The standard is objective: would “a reasonable person with knowledge of the facts and circumstances” have offered this amount? Under Insurance Code §790.03(h)(5), failing to attempt in good faith to effectuate a prompt, fair settlement when liability is reasonably clear is a statutory violation. Under §790.03(h)(6), compelling the insured to institute litigation by offering substantially less than the amount ultimately recovered is also prohibited. Together with §2695.7(g), these provisions create a powerful framework against lowball tactics.
Real-world example:You submit a contractor estimate for $175,000. The insurer offers $65,000 with no explanation of why your contractor's estimate is wrong — no competing line items, no analysis, just a lower number from their software. Under §2695.7(g), the Commissioner would look at whether the insurer considered your evidence (it ignored your contractor's estimate) and whether the procedures used were reasonable (running Xactimate with below-market pricing is not a reasonable procedure when local contractors are bidding 2.5x higher).
How to use this:When you receive a lowball offer, respond in writing with your competing evidence: “Your settlement offer of $[X] is unreasonably low under 10 CCR §2695.7(g). I have submitted written estimates from [number] licensed contractors totaling $[Y]. Your offer does not address or rebut the specific line items in my contractors' estimates. A reasonable person with knowledge of local repair costs would not have offered $[X] for this scope of damage.”
§2695.7(h) — 30-Day Payment Deadline After Acceptance
Upon acceptance, the insurer shall immediately, but in no event more than thirty (30) calendar days, tender payment. In multi-coverage claims, accepted amounts shall be paid within 30 days if payment would terminate liability under that individual coverage.
Explanation: Once the insurer agrees to pay — even a partial amount — they have 30 days to write the check. They cannot hold undisputed amounts hostage while other portions of the claim are still being evaluated. If they accepted your dwelling claim for $200,000 but are still working on contents, the $200,000 must be paid now.
How to use this:If the insurer has accepted all or part of your claim and 30 days pass without payment, write: “On [date], you accepted my [coverage] claim in the amount of $[X]. Per 10 CCR §2695.7(h), payment was due within 30 calendar days. [X] days have elapsed without payment. Please tender payment immediately.”
The Complete Timeline at a Glance
- 15 days — Acknowledge claim, provide forms, begin investigation (§2695.5(e))
- 15 days — Respond to any claimant communication (§2695.5(b))
- 40 days — Accept or deny claim after receiving proof of claim (§2695.7(b))
- 30 days — Pay undisputed amounts after acceptance (§2695.7(h))
- Every 30 days — Written status updates if claim remains open (§2695.7(c))
- 60 days — Notice before any time-bar deadline (§2695.7(f))
§2695.7(i) — No False Urgency on Forms
No insurer shall inform a claimant that their rights may be impaired if a form or release is not completed within a specified time period unless the deadline is based on an applicable statute of limitations or policy provision.
Explanation:The insurer cannot create artificial urgency — telling you “you must sign this release within 10 days or you'll lose your rights” — unless there is an actual legal deadline. This prevents pressure tactics designed to rush claimants into signing unfavorable settlements.
How to use this:If the insurer imposes an artificial deadline on a release or form, respond: “Per 10 CCR §2695.7(i), you may not inform me that my rights will be impaired if this form is not completed by [date] unless that deadline is based on an applicable statute of limitations or policy provision. Please identify the specific statute or policy provision that establishes this deadline.”
§2695.7(k) — Extended Timeline for Suspected Fraud
Where there is a reasonable basis, supported by specific information available for CDI review, for belief that the claim is fraudulent, the 40-day deadline may be increased to 80 calendar days, or suspended entirely if the insurer has filed a fraud report under Insurance Code §1872.4 and can demonstrate diligent investigation.
Explanation: The insurer gets extra time only with genuine, documented fraud suspicion — not a vague hunch. If the insurer is using fraud referral as a pretext to delay a legitimate claim, that is itself a violation. The abuse of SIU referrals to delay claims is a recognized bad faith tactic. See our guide on SIU investigations.
How to use this:If your claim is sent to SIU without apparent justification, write: “I understand my claim has been referred to your Special Investigations Unit. Per 10 CCR §2695.7(k), extension of the 40-day deadline requires a reasonable basis supported by specific information. Please identify the specific information that supports a fraud investigation, or confirm that the 40-day deadline in §2695.7(b) remains in effect.”
§2695.7(l) — Denials Must Be Based on Documented Evidence
No insurer shall deny a claim based upon information obtained in a telephone conversation or personal interview unless that conversation is documented in the claim file per §2695.3.
Explanation:If the adjuster denies part of your claim based on “a contractor I spoke to said the damage is pre-existing,” that conversation must be documented in the file — the contractor's name, the date, and what was said. Undocumented verbal evidence cannot be the basis for a denial.
How to use this:When the insurer cites verbal information in a denial, request documentation: “Your denial references information obtained from [source]. Per 10 CCR §2695.7(l), this information must be documented in the claim file. Please provide a copy of the documentation, including the date of the communication and the identity of the source.”
§2695.7(o) — No Retaliation for CDI Complaints
No insurer shall require that a claimant withdraw or refrain from submitting any CDI complaint as a condition of settlement.
Explanation and how to use this:The insurer cannot condition your settlement on dropping a CDI complaint. If an adjuster says “we'll settle if you withdraw your complaint,” that statement itself is a violation you should immediately document and report to the CDI. You have an absolute right to file and maintain a CDI complaint regardless of settlement status.
§2695.7(p)–(q) — Subrogation and Deductible Recovery
(p) The insurer shall notify you in writing whether it intends to pursue subrogation. If not, it shall tell you that recovery is your responsibility.
(q) In subrogation, the insurer must include your deductible in its demand and share recoveries proportionately. Legal and collection expenses cannot be deducted from your deductible recovery unless an outside firm was retained.
Explanation: If someone else caused your damage, the insurer must tell you whether it will pursue that party. If it does, your deductible must be included, and any recovery is shared proportionately — the insurer cannot recover its full payout first and leave you with nothing.
How to use this:If a third party caused your loss, write: “Per 10 CCR §2695.7(p), please advise in writing whether you intend to pursue subrogation against [responsible party]. If you do not intend to pursue subrogation, please confirm that any recovery is my responsibility so that I may take appropriate action to recover my deductible and uninsured losses.”
Section 2695.9 — Additional Standards for Residential and Commercial Property
This section contains property-specific standards that supplement the general requirements in §2695.7. These are the rules that apply specifically to your homeowner, renter, condo, or commercial property insurance claim — and they contain some of the most powerful tools available to policyholders.
§2695.9(a) — Replacement Cost and Matching
- (a)(1) When a loss requires repair or replacement, any consequential physical damage incurred in making the repair shall be included in the loss. The insured shall not pay for depreciation nor any other cost except the deductible.
- (a)(2) When replaced items do not match in quality, color or size, the insurer shall replace all items in the damaged area to conform to a reasonably uniform appearance.
Explanation:Subsection (a)(1) requires the insurer to pay for “tear-out” — the damage caused by making repairs. If the plumber cuts through drywall and tile, repairing the drywall and tile is part of the covered loss. Subsection (a)(2) is the matching regulation— if new materials don't match existing undamaged materials in the same area, the insurer must replace enough to achieve a uniform appearance.
Real-world example:Your kitchen has hardwood flooring throughout. A water loss damages 30% of the floor. The insurer replaces the damaged section, but the new wood doesn't match the existing floor in color or grain pattern — even after staining. Under §2695.9(a)(2), the insurer must replace the entire kitchen floor to achieve a reasonably uniform appearance. See our guide on matching disputes.
How to use this:When the insurer proposes a partial repair that won't match, write: “Per 10 CCR §2695.9(a)(2), when replaced items do not match the existing items in quality, color, or size, you are required to replace all items in the damaged area to conform to a reasonably uniform appearance. The proposed partial replacement of [describe] will not match the existing [describe] in [color/size/quality]. I am requesting replacement of the entire [area] to achieve a uniform appearance as required by the regulation.”
§2695.9(b)–(c) — Right to Choose Your Own Contractor
(b) No insurer shall require that the insured have the property repaired by a specific individual or entity.
(c)No insurer shall suggest a specific repair entity unless: (1) the claimant expressly requests it; or (2) the claimant has been informed in writing of the right to select their own. If the claimant accepts the insurer's recommendation, the insurer shall guarantee the work meets trade standards at no additional cost.
Explanation:You have the absolute right to choose your own contractor. The insurer cannot require their preferred vendor or “managed repair” program. If the insurer recommends a contractor, they must first tell you in writing that you can choose someone else. If you use the insurer's contractor and the work is substandard, the insurer guarantees it.
Real-world example:Your insurer says: “We have a preferred vendor network. We can only guarantee payment if you use one of our contractors.” This is a violation of §2695.9(b). The insurer cannot require you to use a specific contractor, and implying that payment depends on using their vendor is coercive. See our guides on choosing your contractor and right to repair clauses.
How to use this:If the insurer pressures you to use their contractor, write: “Per 10 CCR §2695.9(b), you may not require me to have my property repaired by a specific individual or entity. I will be selecting my own licensed contractor. Please process my claim accordingly.”
§2695.9(d) — The Contractor Name Requirement: The Most Powerful Tool for Property Policyholders
Regulation Text:
If losses are settled on the basis of a written scope and/or estimate prepared by or for the insurer, the insurer shall supply the claimant with a copy. The estimate shall be in accordance with applicable policy provisions, of an amount which will restore the damaged property to no less than its condition prior to the loss and which will allow for repairs in a manner which meets accepted trade standards for good and workmanlike construction. The insurer shall take reasonable steps to verify that repair or rebuilding costs are accurate and representative of costs in the local market area.
If the claimant contends, based on a written estimate, that necessary repairs will exceed the insurer's estimate, the insurer shall:
- (1) pay the difference between its estimate and the claimant's higher estimate; or
- (2) if requested by the claimant, promptly provide the name of at least one repair individual or entity that will make the repairs for the amount of the insurer's estimate, and the insurer shall guarantee the work meets trade standards at no additional cost; or
- (3) reasonably adjust the claimant's repair estimate and provide a copy of the adjusted estimate.
Why This Regulation Changes Everything
This is, without exaggeration, the single most effective regulation for increasing a property insurance settlement. It works because it forces the insurer to put its money where its estimate is.
Here is how it works in practice: The insurer's adjuster — or a contractor hired by the insurer — writes an estimate for $80,000 to repair your fire-damaged home. You look at that estimate and you know the work cannot be done for that amount. You send a written demand: “Per 10 CCR §2695.9(d)(2), provide me with the name of a licensed contractor who will perform the repairs described in your estimate, to accepted trade standards for good and workmanlike construction, for $80,000.”
You do not need your own estimate to make this demand.All you need is the insurer's estimate. The regulation requires that the insurer's estimate be “of an amount which will restore the damaged property to no less than its condition prior to the loss” using “accepted trade standards for good and workmanlike construction.” If no contractor will do the work for the insurer's number, the estimate fails that standard on its face.
In the vast majority of cases, the insurer cannot produce a contractor. The estimate was generated by an adjuster using software, or by a contractor who wrote it for the carrier but has no intention of actually performing the work. No reputable, licensed contractor will agree to do the repairs for a number that does not reflect the actual cost of construction in your area.
This is true even when the insurer used a contractor to write the estimate. Just because a contractor wrote the estimate for the insurance company does not mean that contractor — or any contractor — will actually dothe work for that amount. Many times the contractor who prepared the estimate for the insurer will say they don't want the job, or their estimate is incomplete on its face — missing line items, using incorrect measurements, or failing to account for code-required upgrades. The insurer still cannot name a contractor who will do the complete scope of work for their number.
When the insurer fails to produce a contractor, their own estimate is effectively rebutted — it cannot, by definition, “allow for repairs in a manner which meets accepted trade standards” if no one will do the work for that amount.
How to Write the Contractor Name Demand Letter
Your letter should include all of the following elements:
- Cite 10 CCR §2695.9(d)(2) by number.
- Reference the insurer's estimate by date and amount.
- Request the name, address, and telephone number of at least one repair individual or entity that will perform the repairs described in the insurer's estimate, for the amount of that estimate.
- Specify that the contractor must be willing to perform the work in accordance with accepted trade standards for good and workmanlike construction.
- Note that under the regulation, the insurer must guarantee the work at no additional cost to you beyond the deductible.
- Request a response within 15 calendar days per §2695.5(b).
You do not need to have your own competing estimate to make this demand. The insurer's own estimate is the trigger. If the insurer fails to respond within 15 days, you now have two documented violations: the failure to comply with §2695.9(d)(2) and the failure to respond within 15 days under §2695.5(b). If they respond but cannot name a contractor, their estimate is rebutted on the merits. Either way, the demand letter advances your claim.
Real-World Results
This regulation is used routinely by experienced public adjusters to increase settlements by tens of thousands of dollars — sometimes by six figures on large residential claims. The pattern is consistent: the insurer writes a low estimate, the contractor name demand is sent, the insurer cannot produce a contractor who will do the work for their number, and the settlement increases significantly. Having your own contractor estimates strengthens the demand even further — but it is the written demand itself, not the competing estimate, that creates the leverage.
The regulation also addresses the insurer's estimate quality independently. The first sentence requires the estimate to be “accurate and representative of costs in the local market area.” An insurer using Xactimate with default pricing that does not reflect Bay Area, Los Angeles, or any other California local market costs is already in violation of this requirement — even before anyone challenges the estimate.
Key point: This regulation requires you to take action. You need to make the written demand. If you never request a contractor name, you cannot benefit from this regulation. The insured who makes the written demand gets the settlement increase. The insured who accepts the insurer's number without challenging it gets the insurer's number. This is the clearest example of the principle: if you don't ask, you don't benefit.
§2695.9(e) — Appraisal Process Limitations
Once the appraisal provision is invoked, the appraisal process shall not include any legal proceeding or procedure not specified under Insurance Code Section 2071. Separate legal proceedings on unrelated issues are not precluded.
Explanation: The appraisal process follows Insurance Code §2071 — nothing more, nothing less. The insurer cannot inject additional procedures like demanding an EUO as a prerequisite. You retain the right to pursue separate legal action on coverage issues.
How to use this:If the insurer attempts to delay or condition appraisal on additional proceedings, write: “Per 10 CCR §2695.9(e), the appraisal process shall not include any legal proceeding or procedure not specified under Insurance Code Section 2071. Your requirement of [describe additional procedure] is not authorized under the appraisal provision. Please proceed with appraisal as provided in the policy.”
§2695.9(f) — Depreciation Standards and the Labor Depreciation Prohibition
Regulation Text:
When the amount claimed is adjusted because of betterment, depreciation, or salvage, all justification shall be contained in the claim file. Adjustments shall be discernable, measurable, itemized, and specified as to dollar amount, reflect a measurable difference in market value attributable to condition and age, and apply only to property normally subject to repair and replacement during the useful life of the property. The basis shall be fully explained to the claimant in writing.
(f)(1) — The Labor Depreciation Prohibition:
Except for the intrinsic labor costs included in the cost of manufactured materials or goods, the expense of labor necessary to repair, rebuild or replace covered property is not a component of physical depreciation and shall not be subject to depreciation or betterment.
Explanation
This section contains two crucial requirements. First, every depreciation deduction must be individually justified— not applied as a blanket percentage. The insurer cannot say “we depreciated everything 30%.” Each item must be depreciated separately, specified as a dollar amount, and explained in writing.
Second — and this is one of the most commonly violated regulations — labor cannot be depreciated on California property claims. The only exception is labor “intrinsic” to manufactured materials (factory labor in a pre-made cabinet, for example). Field labor — the roofer, carpenter, painter, electrician, demolition crew — cannot be depreciated. Period.
Real-World Example
Your insurer writes a replacement cost estimate of $200,000 for your fire damage. The ACV (actual cash value) payment depreciates the total by 25%, paying you $150,000 as the initial check. But buried in the depreciation calculation, the insurer applied 25% depreciation to everything— including $80,000 in labor costs (demolition, framing, roofing installation, painting, cleanup). Under §2695.9(f)(1), the $80,000 in labor should not have been depreciated at all. The correct ACV depreciation should have been applied only to the $120,000 in materials, producing an ACV payment of $170,000 — a $20,000 difference.
On large claims, the labor depreciation violation can mean $30,000, $50,000, or more in wrongfully withheld funds. See our detailed guide on labor depreciation.
How to Use This
Review the insurer's ACV estimate line by line. Identify every line item where depreciation is applied to labor. Then write: “Per 10 CCR §2695.9(f)(1), the expense of labor necessary to repair, rebuild or replace covered property is not a component of physical depreciation and shall not be subject to depreciation or betterment. Your ACV calculation applies depreciation to the following labor costs: [list items and amounts]. Please recalculate the ACV payment excluding labor from depreciation and issue a supplemental payment for the difference.”
Labor Depreciation Is Prohibited — But You Must Challenge It
Many insurers apply depreciation to total line items (materials + labor) rather than separating labor. This is a violation, but the insurer will not correct it unless you challenge it. If you accept the ACV payment without reviewing the depreciation calculation, you leave money on the table. If you challenge it in writing citing §2695.9(f)(1), the insurer must either correct the calculation or explain in writing why they believe labor depreciation is appropriate — which they cannot do under this regulation.
Again: if you don't ask, you don't benefit.
Section 2695.12 — Penalties
Regulation Text (Summary):
The Commissioner considers: extraordinary circumstances; good faith fraud belief; claim complexity; claimant exaggeration; the number of violations relative to total claims; remedial measures taken; previous violations; degree of harm; good faith compliance attempts; frequency of detriment to the public; management awareness; and reasonable valuation mistakes.
How This Affects You
These factors govern CDI enforcement decisions. Understanding them helps you build a stronger CDI complaint. The most impactful factors are: whether management was aware (showing the violations were not just one rogue adjuster), previous violations (the insurer's track record), and the degree of harm (the financial impact on you). When documenting violations, frame them in terms of these factors.
In litigation, the same factors that make the CDI impose penalties also make a jury award damages. Under Egan v. Mutual of Omaha, bad faith that is oppressive, fraudulent, or malicious can support punitive damages. A record of documented regulatory violations — especially if management was aware — is powerful evidence in that analysis.
Sections 2695.13–2695.14 — Severability and Compliance
§2695.13 (Severability): If one section is struck down, the rest remain in force.
§2695.14 (Compliance Date): Insurers have 90 days to comply with amendments. The regulations apply to all claims handling after the compliance date — not just claims filed after that date. If you have an existing claim and the regulations are amended, your insurer must comply with the new requirements on your existing claim.
Putting It All Together
These regulations are not abstract legal theory. They are practical tools that you can use today to advance your claim. Here is the framework:
- Make written demands, citing the regulation. The insurer is not going to volunteer compliance. You must ask — in writing, citing the specific section number. Every written demand either gets you what you need or documents a violation.
- Track every deadline. From the moment you file, start a log. Compare against the 15-day, 40-day, and 30-day deadlines. Each missed deadline is a separate, documentable violation.
- Use the contractor name requirement.The moment the insurer produces an estimate, you can demand the name of a contractor who will do the work for that amount under §2695.9(d)(2). You do not need your own competing estimate — though having one strengthens your position further.
- Challenge labor depreciation.Review the ACV calculation line by line. If labor is depreciated, cite §2695.9(f)(1) and demand correction.
- Request your claim file. The file often reveals what the insurer knew and when. Supervisor overrides, internal disagreements, and evidence of predetermined outcomes are all in there.
- Document violations for the future. Even if a single violation does not constitute bad faith, a pattern of violations — especially with documented written demands that were ignored — builds a compelling case for bad faith under Jordan v. Allstate and potentially punitive damages under Egan v. Mutual of Omaha.
- File CDI complaints when warranted.Cite specific regulation numbers, dates, and facts. A complaint that references “violation of 10 CCR §2695.7(b) — failure to accept or deny within 40 days of proof of claim submitted on [date]” carries far more weight than “my insurer is being unfair.” See our guide on filing a CDI complaint.
The Bottom Line
Regulatory violations are not automatically bad faith — but they are evidence of it. Even when they fall short of bad faith, they demonstrate the insurer's general disregard for doing things correctly, and they provide concrete leverage in negotiations and CDI complaints.
The key is documentation through written demands. Many regulations are not violated until the insured makes a request and the insurer fails to comply. The insured who puts everything in writing forces the insurer to either follow the regulations or create a documented violation. Either outcome benefits the policyholder.
Free Template Demand Letters
We've created free, downloadable template letters for the most important regulatory demands discussed in this article — including the contractor name requirement, 15-day response demand, coverage disclosure request, and more. Each letter cites the specific regulation and is ready to customize with your claim details.
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