Cal. Code Regs. tit. 10 § 2274.59

Current through Register 2024 Notice Reg. No. 40, October 4, 2024

Section 2274.59 - The Request for a Hearing Pursuant to Insurance Code Section 10273.7(c); Hearing Procedure

(a) Within 15 days after receipt of an order by the commissioner to reinstate a policyholder, certificate holder or other insured, the insurer shall either reinstate the policyholder, certificate holder or other insured, or request a hearing pursuant to subdivision (c) of Insurance Code section 10273.7. In order to request a hearing pursuant to subdivision (c) of Insurance Code section 10273.7, the insurer shall submit any and all of the evidence required to be submitted pursuant to Sections 2274.56, 2274.57 or 2274.60 that is applicable, but for purposes of this Section 2274.59 the information shall be submitted to the commissioner at the following address:

ADMINISTRATIVE HEARING BUREAU

CALIFORNIA DEPARTMENT OF INSURANCE

1901 HARRISON STREET, 3RD FLOOR MAILROOM

OAKLAND, CA 94612

(b) Simultaneously with the submittal described in subdivision (a) of this section, the insurer shall:

(1) Send one copy of the submittal to the address specified in subdivision (a) of Section 2274.55; and

(2) Send one copy of the submittal to the policyholder, certificate holder or other insured who requested review of the insurer's rescission, cancellation or failure to renew.

(c) The policyholder, certificate holder or other insured who requested review of the insurer's rescission, cancellation or failure to renew shall be deemed to be a party to the hearing.

(d) Department staff shall appear at any hearing requested pursuant to subdivision (c) of Insurance Code section 10273.7 and shall file with the court any evidence upon which staff rely for the proposition that the rescission, cancellation or failure to renew was contrary to existing law. The evidence submitted by Department staff may include information obtained at any time from any source, including information that the insurer provided in its submittal pursuant to Paragraph (c)(1) of Section 2274.55 but did not provide in its submittal pursuant to subdivision (a) of this section.

(e) To the extent not inconsistent with this article, the hearing shall be conducted pursuant to the procedural provisions of Chapter 4.5 of Part 1 of Division 3 of Title 2 of the Government Code, commencing with section 11400, except that the hearing shall be conducted by an administrative law judge appointed by the commissioner pursuant to subdivision (b) of Insurance Code section 21.5.

(f) The administrative law judge shall exercise all powers relating to the conduct and course of the hearing. The administrative law judge shall take any action necessary or appropriate to the discharge of his or her duties, consistent with the statutory or other authority under which the commissioner functions. The administrative law judge shall conduct a de novo review of the evidence, including any evidence submitted in connection with the hearing that was not received by Department staff when it reviewed the insurer's request for a hearing under subdivision (b) of Insurance Code section 10273.7.

(g) The insurer shall identify in the submittal described in subdivision (a) of this section each and every difference, if any, between that submittal and the information that the insurer submitted pursuant to Paragraph (c)(1) of Section 2274.55.

(h) The insurer shall have the burden of proving, by a preponderance of the evidence, every fact necessary to establish that the insurer satisfied all legal requirements pertaining to the cancellation, rescission or nonrenewal.

(i) The insurer shall have the burden of presenting its evidence and witnesses first.

Cal. Code Regs. Tit. 10, § 2274.59

1. New section filed 11-20-2013; operative 1-1-2014 (Register 2013, No. 47).
2. Change without regulatory effect amending subsection (a) filed 8-27-2020 pursuant to section 100, title 1, California Code of Regulations (Register 2020, No. 35).

Note: Authority cited: Sections 10273.7 and 12926, Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989); and 20th Century Ins. Co. v. Garamendi, 8 Cal. 4th 216 (1994). Reference: Sections 10273.4, 10273.6, 10273.7, 10384, 10384.17 and 10713, Insurance Code.