Question 92

Insurers must advise the claimant in writing when extending the time for a claim determination.

When an insurer needs to extend the time allowed for making a determination on a claim, they are required to advise the claimant in writing at specified intervals.

A) notify the California Department of Insurance.

This option is incorrect because while insurers must comply with regulatory requirements, the specific requirement related to extending the time for a claim determination focuses on communication with the claimant rather than notifying the California Department of Insurance.

B) make a partial payment as a statement of intent.

This option is also incorrect. Making a partial payment is not a mandated requirement when extending the time for a claim determination. The focus here is on the requirement to inform the claimant rather than on making partial payments.

C) advise the claimant in writing at specified intervals.

This is the correct answer. The Code of Regulations mandates that insurers must inform the claimant in writing when they need more time to make a determination on a claim, ensuring transparency and keeping the claimant informed throughout the process.

D) make a final decision after the first notification.

This option is incorrect as it suggests that the insurer must make a final decision immediately after the first notification. However, the requirement is to inform the claimant in writing when more time is needed, rather than rushing to a final decision without adequate communication.

Conclusion

The correct answer is option C, as it aligns with the regulatory requirement for insurers to communicate with claimants about time extensions. Options A, B, and D fail to address the specific communication obligation set forth by the Code of Regulations, emphasizing the importance of keeping the claimant informed during the claims process.