BAD FAITH AAA (CSAA)
AAA CLAIMS NO FAULT OR LIABILITY , BASED ON THE POLICE REPORT
Last updated
AAA CLAIMS NO FAULT OR LIABILITY , BASED ON THE POLICE REPORT
Last updated
LEGAL : STEVE DORENZO
February 25, 2021
Re: Insured: Subhi Abdelhalim
Claim No.: 1004-09-1054
Date of Loss: February 04, 2021
Dear Rosario: We have concluded our investigation of your claim. Based on our investigation, and after carefully reviewing the facts and circumstances of your claim, we have concluded that our insured is not liable for your damages resulting from this loss. Therefore we must decline your claim. In addition, we dispute your right to recover the amount of damages you have claimed. Our decision is based on the facts currently available. If you have any additional information which you believe is relevant to your claim, please submit that information to us for our consideration. If you believe this claim has been wrongfully denied or rejected in whole or in part, you may have the matter reviewed by the Claims Services Bureau of the California Department of Insurance, 300 South Spring Street, Los Angeles, California 90013; Telephone: 800.927.4357 or 213.897.8921. According to California law, you have two (2) years from the date of an incident to file a lawsuit for damages as a result of personal injury. If you sustained personal injuries as a result of the incident, you must settle your claim or file a lawsuit against those responsible for your personal injuries within two years from the date of the incident. Should you fail to do so, we will be entitled to deny your personal injury claim on that basis. According to California law, you have three (3) years from the date of an incident to file a lawsuit for damages as a result of damage to your property. If you sustained damage to your property as a result of the incident, you must settle your claim or file a lawsuit against those responsible for the damage to your property within three years from the date of the incident. Should you fail to do so, we will be entitled to deny your property damage claim on that basis. Should you have any questions, please do not hesitate to contact me. Sincerely, Sarah Rash
Claims Representative Phone: 856-209-7086
1. California Insurance Code § 790.03 – Unfair Claims Practices
California Insurance Code § 790.03 enumerates various unfair claims practices that insurers must avoid. The following subsections are particularly pertinent when an insurer uses a police report as the sole basis for denying a claim:
§ 790.03(a)(2) – Misrepresentation of Policy Provisions
Text of § 790.03(a)(2):
“(a) Any of the following shall constitute an unfair claim practice:
(2) Misrepresenting to the policyholder in a misleading statement, either directly or indirectly, the provisions, benefits, or obligations of the policy so as to induce the policyholder to accept its benefits.”
Implications:
Prohibition: Insurers cannot misrepresent the policy's provisions or benefits to deny a claim.
Application: An insurer cannot falsely assert that certain coverages are excluded based solely on a police report if other evidence (e.g., a driver's admission of fault) supports the claim.
§ 790.03(a)(11) – Failing to Conduct a Reasonable Investigation
Text of § 790.03(a)(11):
“(a) Any of the following shall constitute an unfair claim practice:
(11) Failing to conduct a reasonable investigation of claims within a reasonable time after receiving the claim.”
Implications:
Prohibition: Insurers must conduct thorough and timely investigations of claims.
Application: Relying solely on a police report without considering additional evidence (such as 911 call admissions or witness statements) violates this requirement.
§ 790.03(a)(12) – Failing to Provide a Reasonable Explanation for Denial
Text of § 790.03(a)(12):
“(a) Any of the following shall constitute an unfair claim practice:
(12) Failing to provide a reasonable explanation in writing of the basis in the policy or law for denying a claim.”
Implications:
Prohibition: Insurers must provide clear and reasonable explanations when denying a claim.
Application: Using only a police report without addressing contradictory evidence or policy terms fails to meet this standard.
2. California Code of Regulations, Title 10, § 2695.2 – Standards for Claims Handling
California Code of Regulations, Title 10, § 2695.2 sets forth standards for how insurers must handle claims, ensuring fairness and thoroughness.
Text of Title 10, § 2695.2:
“(a) An insurer shall investigate every claim submitted to it and shall, in a fair and prompt manner, evaluate the claim and determine the appropriate amount of compensation payable under the policy.
(b) The investigation shall be thorough and objective and shall include an examination of all relevant evidence, including but not limited to, statements, documents, and other materials submitted by the claimant or otherwise obtained by the insurer.
(c) An insurer shall not rely solely on initial reports, such as police reports, to make determinations regarding claims, especially when additional evidence is available that could influence the outcome of the claim.”
Implications:
Thorough Investigation: Insurers must investigate claims comprehensively, considering all relevant evidence.
Prohibition of Sole Reliance: Insurers cannot base their decisions solely on initial reports like police reports if additional evidence exists that could influence the claim's outcome.
