Question 92

The insurer must advise the claimant in writing at specified intervals.

When an insurer needs to extend the time allowed for making a determination on a claim, the Code of Regulations requires that the insurer advise the claimant in writing at specified intervals.

A) notify the California Department of Insurance.

This option is incorrect because the Code of Regulations does not mandate that the insurer notify the California Department of Insurance when extending the time for claim determination. The primary requirement is to communicate with the claimant, not the regulatory body.

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

While making a partial payment could be a common practice in some cases to show intent, it is not a requirement under the Code of Regulations for extending claim determination time. Therefore, this option does not align with the regulatory requirements.

C) advise the claimant in writing at specified intervals.

This is the correct answer, as the Code of Regulations explicitly requires insurers to inform claimants in writing when extending the timeframe for claim decisions. This ensures transparency and keeps the claimant informed about the status of their claim.

D) make a final decision after the first notification.

This option is incorrect because it suggests that a final decision must be made after the initial notification without allowing for an extension. The Code of Regulations allows for extensions but requires proper communication with the claimant rather than rushing to a final decision.

Conclusion

The correct answer, C, emphasizes the importance of clear communication with claimants when there are delays in claim determinations. Other options either misinterpret the requirements or suggest actions that are not mandated by the Code of Regulations, thereby failing to address the obligation of the insurer to keep the claimant informed.