California policyholder answer

What should I do if my insurance claim is denied in California?

First, get the denial in writing with the specific policy provision the carrier is relying on — California regulators require this under 10 CCR §2695.7(b)(1), and 'not covered' by itself is a compliance failure. Then request your entire claim file in writing, preserve every document and photo, keep responding only in writing so the record builds itself, and either bring in a licensed California attorney or open an evidence file so the paper is ready when you do.

The first 30 days after a denial

Denials are usually first drafts. Carriers reverse or upgrade positions when the record is clean and the citations are precise. What you do in the first 30 days determines whether the record supports that.

  • Request the written denial with policy citation (10 CCR §2695.7(b)(1))
  • Request the full claim file in writing (adjuster notes, estimates, expert reports)
  • Stop verbal calls — respond in email or letter only
  • Photograph or scan every page of your policy, declarations, and endorsements
  • File a Department of Insurance complaint at cdiapps.insurance.ca.gov if timelines are being violated
  • Consult a California bad faith attorney and/or open an evidence file

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We build the bad faith evidence file for California policyholders: correspondence log, line-item estimate comparison, §790.03 citation map, and an exhibit-ready binder. $95/hour, client-directed.

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Educational information only. Legal Document Assistants provide evidence services under California Business & Professions Code §6400 et seq.; we do not provide legal advice.

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We provide self-help evidence organization for consumers directing their own claim. We are not attorneys, do not provide legal advice, and cannot represent you in court. If you need legal advice, consult a licensed California attorney.

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