State Codes and Statutes

Statutes > California > Ins > 1858-1858.7

INSURANCE CODE
SECTION 1858-1858.7



1858.  (a) Any person aggrieved by any rate charged, rating plan,
rating system, or underwriting rule followed or adopted by an insurer
or rating organization, may file a written complaint with the
commissioner requesting that the commissioner review the manner in
which the rate, plan, system, or rule has been applied with respect
to the insurance afforded to that person. In addition, the aggrieved
person may file a written request for a public hearing before the
commissioner, specifying the grounds relied upon.
   (b) The commissioner shall advise the insurer or rating
organization that a complaint has been filed against it and the
nature of the complaint and provide the insurer or rating
organization with an opportunity to respond to the complaint.
   (c) If the commissioner has information concerning a similar
complaint, he or she may deny the request for a public hearing until
a determination is made or a public hearing is held on the similar
complaint or may consolidate similar complaints for determination or
public hearing. If he or she believes, after review and investigation
of the facts alleged in the complaint and the facts alleged in any
response to the complaint, that probable cause for the complaint does
not exist or that the complaint is not made in good faith, he or she
shall so advise the complainant and shall deny any request made for
a public hearing. If he or she believes, after review and
investigation of the facts alleged in the complaint and the facts
alleged in any response to the complaint, that probable cause for the
complaint does exist, that the complaint charges a violation of this
chapter, and that the complainant would be aggrieved if the
violation is proven, he or she shall proceed as provided in Section
1858.1 unless the complaint was accompanied by a request for public
hearing, in which case he or she shall proceed as provided in Section
1858.2.
   (d) Nothing in this section prohibits or limits the right of any
aggrieved person, either prior to or in conjunction with the filing
of a written complaint with the commissioner under this section, from
requesting an insurer or rating organization to review the manner in
which the rate, plan, system, or rule has been applied with respect
to the insurance afforded to that person.



1858.01.  (a) Whenever a written complaint has been filed with the
commissioner, the commissioner shall review and investigate the
matter complained of as provided by Section 1858 and shall make a
determination whether there is probable cause to believe that a
violation of this chapter has occurred. This determination shall be
made within a reasonable time, but in no event more than 60 days
after the complaint regarding a policy in a personal line of
insurance or 90 days in the case of a policy in a class of commercial
insurance is filed unless the complainant consents to a greater time
or unless the complainant enters into informal conciliation of the
complaint. The time and location of the conciliation shall be
mutually agreeable to the complainant and to the insurer.
   (b) Whenever a written complaint is accompanied by written request
for a public hearing, the commissioner shall review and investigate
the matter complained of as provided in Section 1858 and shall grant
or deny the request for a public hearing within a reasonable time,
but in no event more than 90 days when the complaint is regarding a
policy in a personal line of insurance or 120 days in the case of a
policy in a class of commercial insurance, unless the complainant
consents to a greater time or unless the complainant enters into
informal conciliation of the complaint. The time and location of the
conciliation shall be mutually agreeable to the complainant and to
the insurer.
   (c) In the event the complainant enters into informal conciliation
of the complaint, the time set forth in subdivisions (a) and (b) for
making a determination or for granting or denying a request for a
public hearing shall be tolled for up to 10 working days until
informal conciliation results in resolution of the complaint or
informal conciliation is ended without resolution of the complaint.
Should informal conciliation fail to result in resolution of the
complaint, the commissioner shall review the facts presented by the
complainant and the insurer or rating organization, together with the
facts alleged in the complaint and any response to the complaint, to
determine whether probable cause exists to believe that a violation
of this chapter has occurred.
   (d) For purposes of this subdivision, "personal insurance" means
all coverages combined in private passenger automobile insurance
policies as those policies are described in Section 660 and all forms
combined in property or multiperil insurance policies as those
policies are described in Section 675.
   (e) For purposes of this subdivision, "commercial insurance" means
any class, as defined by the Insurance Services Office of commercial
insurance and any class of insurance designated under subdivisions
(b) and (c) of Section 1857.9.


1858.02.  (a) The commissioner may seek resolution of a complaint by
informal conciliation at any time and may require the complainant
and insurer or rating organization to meet and confer for the
purposes of resolving the matter complained of by informal
conciliation. The commissioner may decline to find probable cause for
a complaint and may deny a request for a public hearing if the
complainant refuses to enter into informal conciliation at the
commissioner's request. Likewise, the commissioner may find probable
cause for a complaint and may act to hold a public hearing, whether
or not a request for a public hearing accompanied the complaint, if
the insurer or rating organization refuses to enter into informal
conciliation at the commissioner's request.
   (b) Communications to the commissioner in respect to resolution of
a complaint by informal conciliation shall be made to him or her in
official confidence within the meaning of Sections 1040 and 1041 of
the Evidence Code and shall not be disclosed by the commissioner.
However, the commissioner may report on the results of informal
conciliation.


1858.05.  Whenever a written complaint and request for hearing with
the commissioner has been filed pursuant to Section 1858, and the
complaint concerns medical malpractice insurance, the commissioner
shall within 30 days either by order deny the hearing or proceed as
provided in Sections 1858.1 or 1858.2. The complainant may petition
the court for an order to compel compliance with this section.




1858.07.  (a) Any person who uses any rate, rating plan, or rating
system in violation of this chapter is liable to the state for a
civil penalty not to exceed five thousand dollars ($5,000) for each
act, or, if the act or practice was willful, a civil penalty not to
exceed ten thousand dollars ($10,000) for each act. The commissioner
shall have the discretion to establish what constitutes an act.
However, when the issuance, amendment, or servicing of a policy or
endorsement is inadvertent, all of those acts shall be a single act
for the purpose of this section.
   (b) The penalty imposed by this section shall be imposed by and
determined by the commissioner as provided by Section 1858.3, except
that no penalty shall be imposed by the commissioner if a person has
used any rate, rating plan, or rating system that has been approved
for use by the commissioner in accordance with the provisions of this
chapter.
   The penalty imposed by this section is appealable by means of any
remedy provided by Section 12940 or by Chapter 5 (commencing with
Section 11500) of Part 1 of Division 3 of Title 2 of the Government
Code.



1858.1.  If after examination of an insurer, rating organization,
advisory organization, or group, association, or other organization
of insurers which engages in joint underwriting or joint reinsurance,
or upon the basis of other information, or upon sufficient complaint
as provided in Section 1858, the commissioner has good cause to
believe that the insurer, organization, group, or association, or any
rate, rating plan or rating system made or used by any such insurer
or rating organization, does not comply with the requirements and
standards of this chapter applicable to it, he or she shall give
notice in writing to that insurer, organization, group, or
association stating therein in what manner and to what extent that
noncompliance is alleged to exist and specifying therein a reasonable
time, not less than 10 days thereafter, in which that noncompliance
may be corrected, and specifying therein the amount of any penalty
that may be due under Section 1858.07.
   An insurer, organization, group, or association served with that
notice of noncompliance may, within the time specified therein, (a)
establish to the satisfaction of the commissioner that the
noncompliance does not exist, or (b) request a public hearing, notice
of which shall be given at least 30 days prior to the date set for
hearing, or (c) enter into an informal conciliation with the
commissioner and any complainant making a complaint pursuant to
Section 1858 to resolve the matter complained of, or (d) enter into a
consent order with the commissioner to correct the specified
noncompliance within a period of time specified in the consent order,
and to pay any penalty due under Section 1858.07. A consent order
shall provide that in the event the noncompliance is not corrected
within the time specified therein that, in addition to any penalty
due under Section 1858.07, a money penalty of not to exceed ten
thousand dollars ($10,000) shall attach and be collected by the
commissioner for each day the violation of the consent order
continues. This money penalty shall not exceed in the aggregate the
sum of one hundred thousand dollars ($100,000) plus the penalty due
under Section 1858.07. In addition to or in lieu of the procedure
provided herein the commissioner may proceed with a public hearing as
provided in Section 1858.2.
   For the purposes of this section, the failure to pay any penalty
imposed pursuant to Section 1858.07 which has become final shall
constitute a violation of a notice of noncompliance or of a consent
order issued under this section.


1858.15.  Once commenced, an examination pursuant to Section 1858.1
shall be promptly conducted and concluded within a reasonable time.
If the examination is being conducted as the result of a written
complaint and request for hearing filed pursuant to Section 1858, and
the complaint concerns medical malpractice insurance, the
complainant may petition the court for an order to compel compliance
with this section.



1858.2.  (a) If the insurer, organization, group, or association
does not make those changes as may be necessary to correct the
noncompliance specified in the notice issued under Section 1858.1, or
if the insurer, organization, group, or association has failed to
establish to the satisfaction of the commissioner that the
noncompliance does not exist, the commissioner shall hold a public
hearing by mailing a notice to that insurer, organization, group, or
association not less than 30 days prior to the date set for hearing
specifying the matters to be considered at the hearing.
   (b) In the event that the insurer and complainant resolve the
matter and the insurer has consented to a rating modification, then
that modification shall apply to other policyholders underwritten by
the insurer for that class of insurance.
   (c) If the insurer, organization, group, or association has
refused to enter into informal conciliation at the request of the
commissioner, the commissioner may hold a public hearing, whether or
not the complaint was accompanied by a request for a public hearing,
by mailing a notice to the insurer, organization, group, or
association not less than 30 days prior to the date set for hearing
specifying the matters to be considered at the hearing.
   (d) If a hearing noticed under subdivisions (a) and (c) is based
upon a complaint made pursuant to Section 1858, the commissioner
shall also mail notice to the complainant not less than 30 days prior
to the date set for hearing specifying the matters to be considered
at the hearing.
   (e) If upon sufficient complaint as provided in Section 1858 and
upon review and investigation of the complaint, the commissioner has
good cause to believe that the insurer, organization, group, or
association, or any rate, rating plan, or rating system made or used
by that insurer or rating organization, does not comply with the
requirements and standards of this chapter applicable to it, the
commissioner shall hold a public hearing by mailing a notice to the
complainant and to the insurer, organization, group, or association
not less than 30 days prior to the date set for hearing specifying
the matters to be considered at the hearing.
   (f) Within 60 days of submission of a matter for decision
following a public hearing thereon pursuant to this section, the
commissioner shall issue his or her decision or order.
   (g) With respect to public hearings under this section, the
commissioner may at his or her discretion, grant preference to a
hearing in which the complainant has reached the age of 70 years.




1858.3.  If after a hearing pursuant to Section 1858.2 the
commissioner finds:
   (a) That any rate, rating plan, or rating system violates the
provisions of this chapter applicable to it, he or she shall issue an
order to the insurer or rating organization which has been the
subject of the hearing specifying in what respects that violation
exists and stating when, within a reasonable period of time, the
further use of that rate or rating system by that insurer or rating
organization in contracts of insurance made thereafter shall be
prohibited. The commissioner may, in addition to that order, direct
the insurer or rating organization to take such other corrective
action as he or she may deem necessary and proper.
   (b) That an insurer, rating organization, advisory organization,
or a group, association or other organization of insurers which
engages in joint underwriting or joint reinsurance, is in violation
of the provisions of this chapter applicable to it other than the
provisions dealing with rates, rating plans, or rating systems, he or
she may issue an order to that insurer, organization, group, or
association which has been the subject of the hearing specifying in
what respects that violation exists and requiring compliance within a
reasonable time thereafter.
   (c) Any order of the commissioner issued pursuant to subdivision
(a) shall specify the amount of the penalty due under Section
1858.07, and any order issued pursuant to subdivision (a) or (b)
shall provide that, in addition, a money penalty of not to exceed ten
thousand dollars ($10,000) shall attach and be collected by the
commissioner for each day such person fails to comply within the time
specified therein with the provisions of that order in the same
manner as that provided in Section 1858.1. This penalty shall not
exceed in the aggregate the sum of one hundred thousand dollars
($100,000) plus any penalty due under Section 1858.07.



1858.35.  On or before May 1 of each year, the commissioner shall
submit a report to the Legislature and the Governor stating the
number and type of complaints received under this article and the
status and disposition of these complaints. The commissioner may make
any recommendations for improving the efficiency and effectiveness
of complaint handling under this article.
   No information shall be provided under this section pertaining to
a specified complaint against a specific insurer or rating
organization. However, the commissioner may report that information
in the aggregate.



1858.4.  In addition to other penalties provided in this code, the
commissioner shall suspend or revoke, in whole or in part, the
license of any rating organization or the certificate of authority of
any insurer with respect to the class or classes of insurance
specified in that order, which fails to comply within the time
limited by that order or any extension thereof which the commissioner
may grant, with an order of the commissioner lawfully made by him or
her pursuant to Section 1858.3 and effective pursuant to Section
1858.6.


1858.5.  Except as otherwise provided in this chapter, all
proceedings in connection with the denial, suspension or revocation
of a license or certificate of authority under this chapter shall be
conducted in accordance with the provisions of Chapter 5 of Part 1 of
Division 3 of Title 2 of the Government Code, and the commissioner
shall have all the powers granted to him therein.



1858.6.  Any finding, determination, rule, ruling or order made by
the commissioner under this chapter shall be subject to review by the
courts of the State and proceedings on review shall be in accordance
with the provisions of the Code of Civil Procedure. In such
proceedings on review, the court is authorized and directed to
exercise its independent judgment on the evidence and unless the
weight of the evidence supports the findings, determination, rule,
ruling or order of the commissioner, the same shall be annulled.
   Notwithstanding any other provision of law to the contrary, a
petition for review of any such finding, determination, rule or
order, may be filed at any time before the effective date thereof. No
such finding, determination, rule, or order shall become effective
before the expiration of 20 days after notice and a copy thereof are
mailed or delivered to the person affected, and any finding,
determination, rule, or order of the commissioner so submitted for
review shall not become effective for a further period of 15 days
after the petition for review is filed with the court. The court may
stay the effectiveness thereof for a longer period.



1858.7.  Whenever the commissioner determines that a rate is
excessive or not excessive, he shall, upon the written request of any
complainant, disclose the basis upon which such rate was determined
to be excessive or not excessive in writing to the complainant.


State Codes and Statutes

Statutes > California > Ins > 1858-1858.7

INSURANCE CODE
SECTION 1858-1858.7



1858.  (a) Any person aggrieved by any rate charged, rating plan,
rating system, or underwriting rule followed or adopted by an insurer
or rating organization, may file a written complaint with the
commissioner requesting that the commissioner review the manner in
which the rate, plan, system, or rule has been applied with respect
to the insurance afforded to that person. In addition, the aggrieved
person may file a written request for a public hearing before the
commissioner, specifying the grounds relied upon.
   (b) The commissioner shall advise the insurer or rating
organization that a complaint has been filed against it and the
nature of the complaint and provide the insurer or rating
organization with an opportunity to respond to the complaint.
   (c) If the commissioner has information concerning a similar
complaint, he or she may deny the request for a public hearing until
a determination is made or a public hearing is held on the similar
complaint or may consolidate similar complaints for determination or
public hearing. If he or she believes, after review and investigation
of the facts alleged in the complaint and the facts alleged in any
response to the complaint, that probable cause for the complaint does
not exist or that the complaint is not made in good faith, he or she
shall so advise the complainant and shall deny any request made for
a public hearing. If he or she believes, after review and
investigation of the facts alleged in the complaint and the facts
alleged in any response to the complaint, that probable cause for the
complaint does exist, that the complaint charges a violation of this
chapter, and that the complainant would be aggrieved if the
violation is proven, he or she shall proceed as provided in Section
1858.1 unless the complaint was accompanied by a request for public
hearing, in which case he or she shall proceed as provided in Section
1858.2.
   (d) Nothing in this section prohibits or limits the right of any
aggrieved person, either prior to or in conjunction with the filing
of a written complaint with the commissioner under this section, from
requesting an insurer or rating organization to review the manner in
which the rate, plan, system, or rule has been applied with respect
to the insurance afforded to that person.



1858.01.  (a) Whenever a written complaint has been filed with the
commissioner, the commissioner shall review and investigate the
matter complained of as provided by Section 1858 and shall make a
determination whether there is probable cause to believe that a
violation of this chapter has occurred. This determination shall be
made within a reasonable time, but in no event more than 60 days
after the complaint regarding a policy in a personal line of
insurance or 90 days in the case of a policy in a class of commercial
insurance is filed unless the complainant consents to a greater time
or unless the complainant enters into informal conciliation of the
complaint. The time and location of the conciliation shall be
mutually agreeable to the complainant and to the insurer.
   (b) Whenever a written complaint is accompanied by written request
for a public hearing, the commissioner shall review and investigate
the matter complained of as provided in Section 1858 and shall grant
or deny the request for a public hearing within a reasonable time,
but in no event more than 90 days when the complaint is regarding a
policy in a personal line of insurance or 120 days in the case of a
policy in a class of commercial insurance, unless the complainant
consents to a greater time or unless the complainant enters into
informal conciliation of the complaint. The time and location of the
conciliation shall be mutually agreeable to the complainant and to
the insurer.
   (c) In the event the complainant enters into informal conciliation
of the complaint, the time set forth in subdivisions (a) and (b) for
making a determination or for granting or denying a request for a
public hearing shall be tolled for up to 10 working days until
informal conciliation results in resolution of the complaint or
informal conciliation is ended without resolution of the complaint.
Should informal conciliation fail to result in resolution of the
complaint, the commissioner shall review the facts presented by the
complainant and the insurer or rating organization, together with the
facts alleged in the complaint and any response to the complaint, to
determine whether probable cause exists to believe that a violation
of this chapter has occurred.
   (d) For purposes of this subdivision, "personal insurance" means
all coverages combined in private passenger automobile insurance
policies as those policies are described in Section 660 and all forms
combined in property or multiperil insurance policies as those
policies are described in Section 675.
   (e) For purposes of this subdivision, "commercial insurance" means
any class, as defined by the Insurance Services Office of commercial
insurance and any class of insurance designated under subdivisions
(b) and (c) of Section 1857.9.


1858.02.  (a) The commissioner may seek resolution of a complaint by
informal conciliation at any time and may require the complainant
and insurer or rating organization to meet and confer for the
purposes of resolving the matter complained of by informal
conciliation. The commissioner may decline to find probable cause for
a complaint and may deny a request for a public hearing if the
complainant refuses to enter into informal conciliation at the
commissioner's request. Likewise, the commissioner may find probable
cause for a complaint and may act to hold a public hearing, whether
or not a request for a public hearing accompanied the complaint, if
the insurer or rating organization refuses to enter into informal
conciliation at the commissioner's request.
   (b) Communications to the commissioner in respect to resolution of
a complaint by informal conciliation shall be made to him or her in
official confidence within the meaning of Sections 1040 and 1041 of
the Evidence Code and shall not be disclosed by the commissioner.
However, the commissioner may report on the results of informal
conciliation.


1858.05.  Whenever a written complaint and request for hearing with
the commissioner has been filed pursuant to Section 1858, and the
complaint concerns medical malpractice insurance, the commissioner
shall within 30 days either by order deny the hearing or proceed as
provided in Sections 1858.1 or 1858.2. The complainant may petition
the court for an order to compel compliance with this section.




1858.07.  (a) Any person who uses any rate, rating plan, or rating
system in violation of this chapter is liable to the state for a
civil penalty not to exceed five thousand dollars ($5,000) for each
act, or, if the act or practice was willful, a civil penalty not to
exceed ten thousand dollars ($10,000) for each act. The commissioner
shall have the discretion to establish what constitutes an act.
However, when the issuance, amendment, or servicing of a policy or
endorsement is inadvertent, all of those acts shall be a single act
for the purpose of this section.
   (b) The penalty imposed by this section shall be imposed by and
determined by the commissioner as provided by Section 1858.3, except
that no penalty shall be imposed by the commissioner if a person has
used any rate, rating plan, or rating system that has been approved
for use by the commissioner in accordance with the provisions of this
chapter.
   The penalty imposed by this section is appealable by means of any
remedy provided by Section 12940 or by Chapter 5 (commencing with
Section 11500) of Part 1 of Division 3 of Title 2 of the Government
Code.



1858.1.  If after examination of an insurer, rating organization,
advisory organization, or group, association, or other organization
of insurers which engages in joint underwriting or joint reinsurance,
or upon the basis of other information, or upon sufficient complaint
as provided in Section 1858, the commissioner has good cause to
believe that the insurer, organization, group, or association, or any
rate, rating plan or rating system made or used by any such insurer
or rating organization, does not comply with the requirements and
standards of this chapter applicable to it, he or she shall give
notice in writing to that insurer, organization, group, or
association stating therein in what manner and to what extent that
noncompliance is alleged to exist and specifying therein a reasonable
time, not less than 10 days thereafter, in which that noncompliance
may be corrected, and specifying therein the amount of any penalty
that may be due under Section 1858.07.
   An insurer, organization, group, or association served with that
notice of noncompliance may, within the time specified therein, (a)
establish to the satisfaction of the commissioner that the
noncompliance does not exist, or (b) request a public hearing, notice
of which shall be given at least 30 days prior to the date set for
hearing, or (c) enter into an informal conciliation with the
commissioner and any complainant making a complaint pursuant to
Section 1858 to resolve the matter complained of, or (d) enter into a
consent order with the commissioner to correct the specified
noncompliance within a period of time specified in the consent order,
and to pay any penalty due under Section 1858.07. A consent order
shall provide that in the event the noncompliance is not corrected
within the time specified therein that, in addition to any penalty
due under Section 1858.07, a money penalty of not to exceed ten
thousand dollars ($10,000) shall attach and be collected by the
commissioner for each day the violation of the consent order
continues. This money penalty shall not exceed in the aggregate the
sum of one hundred thousand dollars ($100,000) plus the penalty due
under Section 1858.07. In addition to or in lieu of the procedure
provided herein the commissioner may proceed with a public hearing as
provided in Section 1858.2.
   For the purposes of this section, the failure to pay any penalty
imposed pursuant to Section 1858.07 which has become final shall
constitute a violation of a notice of noncompliance or of a consent
order issued under this section.


1858.15.  Once commenced, an examination pursuant to Section 1858.1
shall be promptly conducted and concluded within a reasonable time.
If the examination is being conducted as the result of a written
complaint and request for hearing filed pursuant to Section 1858, and
the complaint concerns medical malpractice insurance, the
complainant may petition the court for an order to compel compliance
with this section.



1858.2.  (a) If the insurer, organization, group, or association
does not make those changes as may be necessary to correct the
noncompliance specified in the notice issued under Section 1858.1, or
if the insurer, organization, group, or association has failed to
establish to the satisfaction of the commissioner that the
noncompliance does not exist, the commissioner shall hold a public
hearing by mailing a notice to that insurer, organization, group, or
association not less than 30 days prior to the date set for hearing
specifying the matters to be considered at the hearing.
   (b) In the event that the insurer and complainant resolve the
matter and the insurer has consented to a rating modification, then
that modification shall apply to other policyholders underwritten by
the insurer for that class of insurance.
   (c) If the insurer, organization, group, or association has
refused to enter into informal conciliation at the request of the
commissioner, the commissioner may hold a public hearing, whether or
not the complaint was accompanied by a request for a public hearing,
by mailing a notice to the insurer, organization, group, or
association not less than 30 days prior to the date set for hearing
specifying the matters to be considered at the hearing.
   (d) If a hearing noticed under subdivisions (a) and (c) is based
upon a complaint made pursuant to Section 1858, the commissioner
shall also mail notice to the complainant not less than 30 days prior
to the date set for hearing specifying the matters to be considered
at the hearing.
   (e) If upon sufficient complaint as provided in Section 1858 and
upon review and investigation of the complaint, the commissioner has
good cause to believe that the insurer, organization, group, or
association, or any rate, rating plan, or rating system made or used
by that insurer or rating organization, does not comply with the
requirements and standards of this chapter applicable to it, the
commissioner shall hold a public hearing by mailing a notice to the
complainant and to the insurer, organization, group, or association
not less than 30 days prior to the date set for hearing specifying
the matters to be considered at the hearing.
   (f) Within 60 days of submission of a matter for decision
following a public hearing thereon pursuant to this section, the
commissioner shall issue his or her decision or order.
   (g) With respect to public hearings under this section, the
commissioner may at his or her discretion, grant preference to a
hearing in which the complainant has reached the age of 70 years.




1858.3.  If after a hearing pursuant to Section 1858.2 the
commissioner finds:
   (a) That any rate, rating plan, or rating system violates the
provisions of this chapter applicable to it, he or she shall issue an
order to the insurer or rating organization which has been the
subject of the hearing specifying in what respects that violation
exists and stating when, within a reasonable period of time, the
further use of that rate or rating system by that insurer or rating
organization in contracts of insurance made thereafter shall be
prohibited. The commissioner may, in addition to that order, direct
the insurer or rating organization to take such other corrective
action as he or she may deem necessary and proper.
   (b) That an insurer, rating organization, advisory organization,
or a group, association or other organization of insurers which
engages in joint underwriting or joint reinsurance, is in violation
of the provisions of this chapter applicable to it other than the
provisions dealing with rates, rating plans, or rating systems, he or
she may issue an order to that insurer, organization, group, or
association which has been the subject of the hearing specifying in
what respects that violation exists and requiring compliance within a
reasonable time thereafter.
   (c) Any order of the commissioner issued pursuant to subdivision
(a) shall specify the amount of the penalty due under Section
1858.07, and any order issued pursuant to subdivision (a) or (b)
shall provide that, in addition, a money penalty of not to exceed ten
thousand dollars ($10,000) shall attach and be collected by the
commissioner for each day such person fails to comply within the time
specified therein with the provisions of that order in the same
manner as that provided in Section 1858.1. This penalty shall not
exceed in the aggregate the sum of one hundred thousand dollars
($100,000) plus any penalty due under Section 1858.07.



1858.35.  On or before May 1 of each year, the commissioner shall
submit a report to the Legislature and the Governor stating the
number and type of complaints received under this article and the
status and disposition of these complaints. The commissioner may make
any recommendations for improving the efficiency and effectiveness
of complaint handling under this article.
   No information shall be provided under this section pertaining to
a specified complaint against a specific insurer or rating
organization. However, the commissioner may report that information
in the aggregate.



1858.4.  In addition to other penalties provided in this code, the
commissioner shall suspend or revoke, in whole or in part, the
license of any rating organization or the certificate of authority of
any insurer with respect to the class or classes of insurance
specified in that order, which fails to comply within the time
limited by that order or any extension thereof which the commissioner
may grant, with an order of the commissioner lawfully made by him or
her pursuant to Section 1858.3 and effective pursuant to Section
1858.6.


1858.5.  Except as otherwise provided in this chapter, all
proceedings in connection with the denial, suspension or revocation
of a license or certificate of authority under this chapter shall be
conducted in accordance with the provisions of Chapter 5 of Part 1 of
Division 3 of Title 2 of the Government Code, and the commissioner
shall have all the powers granted to him therein.



1858.6.  Any finding, determination, rule, ruling or order made by
the commissioner under this chapter shall be subject to review by the
courts of the State and proceedings on review shall be in accordance
with the provisions of the Code of Civil Procedure. In such
proceedings on review, the court is authorized and directed to
exercise its independent judgment on the evidence and unless the
weight of the evidence supports the findings, determination, rule,
ruling or order of the commissioner, the same shall be annulled.
   Notwithstanding any other provision of law to the contrary, a
petition for review of any such finding, determination, rule or
order, may be filed at any time before the effective date thereof. No
such finding, determination, rule, or order shall become effective
before the expiration of 20 days after notice and a copy thereof are
mailed or delivered to the person affected, and any finding,
determination, rule, or order of the commissioner so submitted for
review shall not become effective for a further period of 15 days
after the petition for review is filed with the court. The court may
stay the effectiveness thereof for a longer period.



1858.7.  Whenever the commissioner determines that a rate is
excessive or not excessive, he shall, upon the written request of any
complainant, disclose the basis upon which such rate was determined
to be excessive or not excessive in writing to the complainant.



State Codes and Statutes

State Codes and Statutes

Statutes > California > Ins > 1858-1858.7

INSURANCE CODE
SECTION 1858-1858.7



1858.  (a) Any person aggrieved by any rate charged, rating plan,
rating system, or underwriting rule followed or adopted by an insurer
or rating organization, may file a written complaint with the
commissioner requesting that the commissioner review the manner in
which the rate, plan, system, or rule has been applied with respect
to the insurance afforded to that person. In addition, the aggrieved
person may file a written request for a public hearing before the
commissioner, specifying the grounds relied upon.
   (b) The commissioner shall advise the insurer or rating
organization that a complaint has been filed against it and the
nature of the complaint and provide the insurer or rating
organization with an opportunity to respond to the complaint.
   (c) If the commissioner has information concerning a similar
complaint, he or she may deny the request for a public hearing until
a determination is made or a public hearing is held on the similar
complaint or may consolidate similar complaints for determination or
public hearing. If he or she believes, after review and investigation
of the facts alleged in the complaint and the facts alleged in any
response to the complaint, that probable cause for the complaint does
not exist or that the complaint is not made in good faith, he or she
shall so advise the complainant and shall deny any request made for
a public hearing. If he or she believes, after review and
investigation of the facts alleged in the complaint and the facts
alleged in any response to the complaint, that probable cause for the
complaint does exist, that the complaint charges a violation of this
chapter, and that the complainant would be aggrieved if the
violation is proven, he or she shall proceed as provided in Section
1858.1 unless the complaint was accompanied by a request for public
hearing, in which case he or she shall proceed as provided in Section
1858.2.
   (d) Nothing in this section prohibits or limits the right of any
aggrieved person, either prior to or in conjunction with the filing
of a written complaint with the commissioner under this section, from
requesting an insurer or rating organization to review the manner in
which the rate, plan, system, or rule has been applied with respect
to the insurance afforded to that person.



1858.01.  (a) Whenever a written complaint has been filed with the
commissioner, the commissioner shall review and investigate the
matter complained of as provided by Section 1858 and shall make a
determination whether there is probable cause to believe that a
violation of this chapter has occurred. This determination shall be
made within a reasonable time, but in no event more than 60 days
after the complaint regarding a policy in a personal line of
insurance or 90 days in the case of a policy in a class of commercial
insurance is filed unless the complainant consents to a greater time
or unless the complainant enters into informal conciliation of the
complaint. The time and location of the conciliation shall be
mutually agreeable to the complainant and to the insurer.
   (b) Whenever a written complaint is accompanied by written request
for a public hearing, the commissioner shall review and investigate
the matter complained of as provided in Section 1858 and shall grant
or deny the request for a public hearing within a reasonable time,
but in no event more than 90 days when the complaint is regarding a
policy in a personal line of insurance or 120 days in the case of a
policy in a class of commercial insurance, unless the complainant
consents to a greater time or unless the complainant enters into
informal conciliation of the complaint. The time and location of the
conciliation shall be mutually agreeable to the complainant and to
the insurer.
   (c) In the event the complainant enters into informal conciliation
of the complaint, the time set forth in subdivisions (a) and (b) for
making a determination or for granting or denying a request for a
public hearing shall be tolled for up to 10 working days until
informal conciliation results in resolution of the complaint or
informal conciliation is ended without resolution of the complaint.
Should informal conciliation fail to result in resolution of the
complaint, the commissioner shall review the facts presented by the
complainant and the insurer or rating organization, together with the
facts alleged in the complaint and any response to the complaint, to
determine whether probable cause exists to believe that a violation
of this chapter has occurred.
   (d) For purposes of this subdivision, "personal insurance" means
all coverages combined in private passenger automobile insurance
policies as those policies are described in Section 660 and all forms
combined in property or multiperil insurance policies as those
policies are described in Section 675.
   (e) For purposes of this subdivision, "commercial insurance" means
any class, as defined by the Insurance Services Office of commercial
insurance and any class of insurance designated under subdivisions
(b) and (c) of Section 1857.9.


1858.02.  (a) The commissioner may seek resolution of a complaint by
informal conciliation at any time and may require the complainant
and insurer or rating organization to meet and confer for the
purposes of resolving the matter complained of by informal
conciliation. The commissioner may decline to find probable cause for
a complaint and may deny a request for a public hearing if the
complainant refuses to enter into informal conciliation at the
commissioner's request. Likewise, the commissioner may find probable
cause for a complaint and may act to hold a public hearing, whether
or not a request for a public hearing accompanied the complaint, if
the insurer or rating organization refuses to enter into informal
conciliation at the commissioner's request.
   (b) Communications to the commissioner in respect to resolution of
a complaint by informal conciliation shall be made to him or her in
official confidence within the meaning of Sections 1040 and 1041 of
the Evidence Code and shall not be disclosed by the commissioner.
However, the commissioner may report on the results of informal
conciliation.


1858.05.  Whenever a written complaint and request for hearing with
the commissioner has been filed pursuant to Section 1858, and the
complaint concerns medical malpractice insurance, the commissioner
shall within 30 days either by order deny the hearing or proceed as
provided in Sections 1858.1 or 1858.2. The complainant may petition
the court for an order to compel compliance with this section.




1858.07.  (a) Any person who uses any rate, rating plan, or rating
system in violation of this chapter is liable to the state for a
civil penalty not to exceed five thousand dollars ($5,000) for each
act, or, if the act or practice was willful, a civil penalty not to
exceed ten thousand dollars ($10,000) for each act. The commissioner
shall have the discretion to establish what constitutes an act.
However, when the issuance, amendment, or servicing of a policy or
endorsement is inadvertent, all of those acts shall be a single act
for the purpose of this section.
   (b) The penalty imposed by this section shall be imposed by and
determined by the commissioner as provided by Section 1858.3, except
that no penalty shall be imposed by the commissioner if a person has
used any rate, rating plan, or rating system that has been approved
for use by the commissioner in accordance with the provisions of this
chapter.
   The penalty imposed by this section is appealable by means of any
remedy provided by Section 12940 or by Chapter 5 (commencing with
Section 11500) of Part 1 of Division 3 of Title 2 of the Government
Code.



1858.1.  If after examination of an insurer, rating organization,
advisory organization, or group, association, or other organization
of insurers which engages in joint underwriting or joint reinsurance,
or upon the basis of other information, or upon sufficient complaint
as provided in Section 1858, the commissioner has good cause to
believe that the insurer, organization, group, or association, or any
rate, rating plan or rating system made or used by any such insurer
or rating organization, does not comply with the requirements and
standards of this chapter applicable to it, he or she shall give
notice in writing to that insurer, organization, group, or
association stating therein in what manner and to what extent that
noncompliance is alleged to exist and specifying therein a reasonable
time, not less than 10 days thereafter, in which that noncompliance
may be corrected, and specifying therein the amount of any penalty
that may be due under Section 1858.07.
   An insurer, organization, group, or association served with that
notice of noncompliance may, within the time specified therein, (a)
establish to the satisfaction of the commissioner that the
noncompliance does not exist, or (b) request a public hearing, notice
of which shall be given at least 30 days prior to the date set for
hearing, or (c) enter into an informal conciliation with the
commissioner and any complainant making a complaint pursuant to
Section 1858 to resolve the matter complained of, or (d) enter into a
consent order with the commissioner to correct the specified
noncompliance within a period of time specified in the consent order,
and to pay any penalty due under Section 1858.07. A consent order
shall provide that in the event the noncompliance is not corrected
within the time specified therein that, in addition to any penalty
due under Section 1858.07, a money penalty of not to exceed ten
thousand dollars ($10,000) shall attach and be collected by the
commissioner for each day the violation of the consent order
continues. This money penalty shall not exceed in the aggregate the
sum of one hundred thousand dollars ($100,000) plus the penalty due
under Section 1858.07. In addition to or in lieu of the procedure
provided herein the commissioner may proceed with a public hearing as
provided in Section 1858.2.
   For the purposes of this section, the failure to pay any penalty
imposed pursuant to Section 1858.07 which has become final shall
constitute a violation of a notice of noncompliance or of a consent
order issued under this section.


1858.15.  Once commenced, an examination pursuant to Section 1858.1
shall be promptly conducted and concluded within a reasonable time.
If the examination is being conducted as the result of a written
complaint and request for hearing filed pursuant to Section 1858, and
the complaint concerns medical malpractice insurance, the
complainant may petition the court for an order to compel compliance
with this section.



1858.2.  (a) If the insurer, organization, group, or association
does not make those changes as may be necessary to correct the
noncompliance specified in the notice issued under Section 1858.1, or
if the insurer, organization, group, or association has failed to
establish to the satisfaction of the commissioner that the
noncompliance does not exist, the commissioner shall hold a public
hearing by mailing a notice to that insurer, organization, group, or
association not less than 30 days prior to the date set for hearing
specifying the matters to be considered at the hearing.
   (b) In the event that the insurer and complainant resolve the
matter and the insurer has consented to a rating modification, then
that modification shall apply to other policyholders underwritten by
the insurer for that class of insurance.
   (c) If the insurer, organization, group, or association has
refused to enter into informal conciliation at the request of the
commissioner, the commissioner may hold a public hearing, whether or
not the complaint was accompanied by a request for a public hearing,
by mailing a notice to the insurer, organization, group, or
association not less than 30 days prior to the date set for hearing
specifying the matters to be considered at the hearing.
   (d) If a hearing noticed under subdivisions (a) and (c) is based
upon a complaint made pursuant to Section 1858, the commissioner
shall also mail notice to the complainant not less than 30 days prior
to the date set for hearing specifying the matters to be considered
at the hearing.
   (e) If upon sufficient complaint as provided in Section 1858 and
upon review and investigation of the complaint, the commissioner has
good cause to believe that the insurer, organization, group, or
association, or any rate, rating plan, or rating system made or used
by that insurer or rating organization, does not comply with the
requirements and standards of this chapter applicable to it, the
commissioner shall hold a public hearing by mailing a notice to the
complainant and to the insurer, organization, group, or association
not less than 30 days prior to the date set for hearing specifying
the matters to be considered at the hearing.
   (f) Within 60 days of submission of a matter for decision
following a public hearing thereon pursuant to this section, the
commissioner shall issue his or her decision or order.
   (g) With respect to public hearings under this section, the
commissioner may at his or her discretion, grant preference to a
hearing in which the complainant has reached the age of 70 years.




1858.3.  If after a hearing pursuant to Section 1858.2 the
commissioner finds:
   (a) That any rate, rating plan, or rating system violates the
provisions of this chapter applicable to it, he or she shall issue an
order to the insurer or rating organization which has been the
subject of the hearing specifying in what respects that violation
exists and stating when, within a reasonable period of time, the
further use of that rate or rating system by that insurer or rating
organization in contracts of insurance made thereafter shall be
prohibited. The commissioner may, in addition to that order, direct
the insurer or rating organization to take such other corrective
action as he or she may deem necessary and proper.
   (b) That an insurer, rating organization, advisory organization,
or a group, association or other organization of insurers which
engages in joint underwriting or joint reinsurance, is in violation
of the provisions of this chapter applicable to it other than the
provisions dealing with rates, rating plans, or rating systems, he or
she may issue an order to that insurer, organization, group, or
association which has been the subject of the hearing specifying in
what respects that violation exists and requiring compliance within a
reasonable time thereafter.
   (c) Any order of the commissioner issued pursuant to subdivision
(a) shall specify the amount of the penalty due under Section
1858.07, and any order issued pursuant to subdivision (a) or (b)
shall provide that, in addition, a money penalty of not to exceed ten
thousand dollars ($10,000) shall attach and be collected by the
commissioner for each day such person fails to comply within the time
specified therein with the provisions of that order in the same
manner as that provided in Section 1858.1. This penalty shall not
exceed in the aggregate the sum of one hundred thousand dollars
($100,000) plus any penalty due under Section 1858.07.



1858.35.  On or before May 1 of each year, the commissioner shall
submit a report to the Legislature and the Governor stating the
number and type of complaints received under this article and the
status and disposition of these complaints. The commissioner may make
any recommendations for improving the efficiency and effectiveness
of complaint handling under this article.
   No information shall be provided under this section pertaining to
a specified complaint against a specific insurer or rating
organization. However, the commissioner may report that information
in the aggregate.



1858.4.  In addition to other penalties provided in this code, the
commissioner shall suspend or revoke, in whole or in part, the
license of any rating organization or the certificate of authority of
any insurer with respect to the class or classes of insurance
specified in that order, which fails to comply within the time
limited by that order or any extension thereof which the commissioner
may grant, with an order of the commissioner lawfully made by him or
her pursuant to Section 1858.3 and effective pursuant to Section
1858.6.


1858.5.  Except as otherwise provided in this chapter, all
proceedings in connection with the denial, suspension or revocation
of a license or certificate of authority under this chapter shall be
conducted in accordance with the provisions of Chapter 5 of Part 1 of
Division 3 of Title 2 of the Government Code, and the commissioner
shall have all the powers granted to him therein.



1858.6.  Any finding, determination, rule, ruling or order made by
the commissioner under this chapter shall be subject to review by the
courts of the State and proceedings on review shall be in accordance
with the provisions of the Code of Civil Procedure. In such
proceedings on review, the court is authorized and directed to
exercise its independent judgment on the evidence and unless the
weight of the evidence supports the findings, determination, rule,
ruling or order of the commissioner, the same shall be annulled.
   Notwithstanding any other provision of law to the contrary, a
petition for review of any such finding, determination, rule or
order, may be filed at any time before the effective date thereof. No
such finding, determination, rule, or order shall become effective
before the expiration of 20 days after notice and a copy thereof are
mailed or delivered to the person affected, and any finding,
determination, rule, or order of the commissioner so submitted for
review shall not become effective for a further period of 15 days
after the petition for review is filed with the court. The court may
stay the effectiveness thereof for a longer period.



1858.7.  Whenever the commissioner determines that a rate is
excessive or not excessive, he shall, upon the written request of any
complainant, disclose the basis upon which such rate was determined
to be excessive or not excessive in writing to the complainant.