California Insurance Forms
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Insurance Forms FAQ
What is insurance?
Insurance is a contract, called an insurance policy, in which the insurer, agrees to pay the insured party all or a portion of any loss suffered by accident or death for a fee called an insurance premium. The losses covered by the policy may include property damage or loss from accident, fire, theft or intentional harm; medical costs and/or lost earnings due to physical injury; long-term or permanent loss of physical capacity; claims by others due to the insured's alleged negligence, or the loss of someone's life.
What laws govern insurers?
In 1944, Congress enacted the McCarran-Ferguson Act, which provided that the laws of the several states should control the insurance business, but that the Sherman Act, the Clayton Act, and the Federal Trade Commission Act were applicable to the insurance business to the extent that it was unregulated by state law.
The McCarran-Ferguson Act, broadly speaking, gives states the power to regulate the insurance industry. While state insurance statutes override most federal laws, some portions of federal law (like federal tax laws) are always controlling. To determine whether a particular law governs, the determining factor is whether the issue is related to the "business of insurance", where state law governs, or whether it is related to peripherals of the industry, such as labor, tax, and securities, where federal law governs.
What can be done is an insurer wrongfully denies a claim?
Insurers may be guilty of bad faith for failing to promptly and thoroughly investigate a claim, unreasonably delaying payment, unreasonably denying benefits to a claim, using unreasonable interpretations in translating policy language, or refusing to settle the case or reimburse you for the entirety of your loss, etc. Unless a time period for settling a claim is defined in the policy, a "reasonable time" generally applies, which is a subjective term, depending on the facts and circumstances in each case.