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D. Market Regulation - General (Part 1)

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Educational Objective
  • I.C4.1. Be able to identify: a. The California Insurance Code (CIC) and how it may be changed; b. The California Code of Regulations (CCR Title 10, Chapter 5) and how it may be changed; c. How the Insurance Commissioner is selected, the terms of office, and the responsibilities of the position (CIC 12900 and 12921).

1. California Insurance Code

The California Insurance Code (CIC) is the primary body of laws established by the state legislature that regulates the business of insurance in California. The present form of the Code, as amended, was enacted in 1935, as a restatement and expansion of previously established law. It is a dynamic, fluid device, constantly being reviewed, amended, added to, and even having outdated sections repealed, all consistent with current issues and practices in the marketplace.

How the Code May be Changed

In order to change the Insurance Code in any way, legislative action is required. A bill amending or repealing an existing section, or desiring to add something new, is introduced into either the Assembly or the Senate, where it undergoes a variety of committee hearings and revisions before it is presented to the full body for a vote. If approved, it goes to the other body for the same sort of process. If more changes are made before the bill is approved, it must be returned to the first body for re-approval. Once approved by both houses, the bill goes to the Governor for approval or veto, or it may also become law without action, positive or negative, by the Governor.

Definitions

Shall and May (CIC 16). Certain concepts or terms have special relevance to insurance, but they do not have different legal interpretations in insurance law than elsewhere. For example, the words shall and may always have the same implications, whether they appear in the Insurance Code or any other law.

Shall is a word that compels action; it normally indicates that a specific action or response is mandatory. Where the Code states that a person "shall" or "shall not" do something, there is usually no room for misunderstanding what that means. The word may, on the other hand, is normally a word of options or permission; it leaves room to act or not act and still remain in compliance with the law. However, the Code leaves open the possibility that, in context, even the word may could be interpreted the same as the word shall.

Person (CIC 19). As it relates to insurance contracts, the term "person" means any natural person, association, organization, partnership, business trust, limited liability company, or corporation. Whether a natural person or an entity, all persons are distinguished by their ability to contract, sue, or be sued. An entity will need to designate a natural person to represent them or act as their agent.

2. California Code of Regulations

The California Code of Regulations (CCR), also known as the California Administrative Code, is the set of regulations issued by the Department of Insurance that identifies the standards for the Insurance Code, and how it is to be administered. The CCR contains the regulations that have been issued by the Insurance Commissioner for clarification and administration of the Insurance Code.

3. The Commissioner

Selection of Commissioner

The Commissioner of Insurance is an elected officer in California. The Commissioner may be elected to serve not more than two consecutive 4-year terms.

The Commissioner is expected to be a person knowledgeable in the business of insurance, but cannot be an active agent, officer, director, or employee of an insurance company. If a licensed person is elected Commissioner, the licensee must surrender their license within 10 days of taking office. At the conclusion of the term of office, the licensee may have the license reinstated for the remainder of their license term without penalties or fees.

Responsibilities

The Commissioner of Insurance has no power or authority to write or change the law, but has the authority to enforce the law. The Commissioner's duty is to issue regulations which establish how the Department of Insurance intends to interpret and enforce the law. The regulations proposed by the Commissioner must undergo a public hearing process to determine their fairness or applicability before they may actually go into effect.

The Commissioner has the responsibility to oversee the California Department of Insurance (CDI) and direct all of the CDI's affairs and staff. The Commissioner can appoint persons to act on the Commissioner's behalf. These representatives can negotiate settlements with agents or insurers who have violated the Insurance Code. However, it is the Commissioner's responsibility to make the final approval of a sanction.

The Commissioner is responsible for a procedure to investigate complaints and respond to inquiries, and, when warranted, to bring enforcement actions against insurers. The system for managing complaints must include the following:

  • A toll-free number published in telephone books throughout the state, dedicated to the handling of complaints and inquiries;
  • Public service announcements to inform consumers of the toll-free telephone number and how to register a complaint or make an inquiry to the department;
  • A simple, standardized complaint form designed to assure that complaints will be properly registered and tracked;
  • Retention of records on complaints for at least 3 years; and
  • Guidelines to disseminate complaint and enforcement information to the public that includes license status, number and type of complaints filed within the last calendar year, number and type of violations found, and enforcement actions taken. Also included is the ratio of complaints received to total policies in force, or premium dollars paid in a given line, or both.

The Commissioner's duty is to provide the insurer with a description of any complaint against the insurer that the Commissioner received and deemed to be justified, at least 30 days prior to public release of a report summarizing the information required. This description includes the name of the complainant, the date it was filed, a description of facts, and a statement of the rationale for determining whether the complaint is valid.

The Commissioner must prepare a written report, to be made available by the CDI to interested individuals upon written request, that details complaints and enforcement information on individual insurers in accordance with the California Insurance Code. The report must be made available by mail, telephone, internet, and email. All public records of the Department and the Commissioner must be available for inspection and copying.

Upon receipt of a written complaint with respect to the handling of an insurance claim or other obligation under a policy by an insurer, or alleged misconduct by an insurer, the Commissioner must notify the complainant of receipt within 10 working days, and of the final action taken on that complaint within 30 days of the final action.

The Commissioner has the authority to issue a cease and desist order against any person acting as an insurance agent or broker without being licensed, and against any person transacting insurance without having been issued a certificate of authority. The Commissioner may issue a cease and desist order without holding a hearing prior to issuance of the order, and may also impose a fine of up to $5,000 for each day the order is violated. A person to whom a cease and desist order is issued may request a hearing by filing a request with the Commissioner within 7 days after service of the order.

Commissioner of Insurance
Supervise Insurance Business
Licensing
Approve Policies and Forms
Enforce Insurance Laws and Impose Penalties for Violations
Conduct Examinations, Investigations, Hearings