(1) Existing law establishes a Fraud Division within the Department of Insurance to investigate fraudulent claims. Existing law requires an insurer that reasonably believes or knows that a fraudulent claim is being made to send a prescribed form and additional information about the fraudulent claim to the Fraud Division within 60 days after determination by the insurer that the claim appears to be a fraudulent claim.
This bill would instead require an insurer to send that form and information within 60 days after it that has determined, after the completion of an investigation, that it reasonably suspects or knows an act of insurance fraud may have occurred or might be occurring. The bill would require an agent or broker to use the electronic form within Fraud Division's Consumer Fraud Reporting Portal before placing an insurance application with an insurer to report if they reasonably suspect or know that a fraudulent application is being made. If the agent or broker reasonably suspects or knows that a fraud has been perpetrated after an insurance application has been placed with an insurer, the bill would require the agent or broker to report that information directly to the insurer's special investigative unit. The bill would insulate an agent or broker who furnishes this information, or a governmental agency or its employees that furnishes or receives this information or assists in an insurance fraud investigation, from civil liability if they acted in good faith, as specified.
Existing law requires the Department of Justice to maintain state summary criminal history information, authorizes the Department of Justice to furnish that information to another agency, and makes it a crime to furnish that information to an unauthorized person. Existing law regulates the licensing and the renewal of licensing of insurance agents, adjusters, and brokers. Existing law requires an individual to apply with the Insurance Commissioner for a specified license using a form prescribed by the commissioner. Existing law requires specified licensees and applicants for specified licenses to complete a course of study on ethics, which is 12 hours for new applicants and 3 hours before each license renewal for existing licensees. Existing law requires a person licensed to transact specified types of insurance to include their license number on business cards, written price quotations, and print advertisements in a specified type size.
This bill would require the commissioner to submit fingerprint images and related information regarding specified license applicants to the Department of Justice, and would require the Department of Justice to provide state or federal criminal history information for each applicant to the commissioner. Because the bill would expand the scope of a crime, the bill would impose a state-mandated local program. On and after March 1, 2023, the bill would require an ethics course for a specified licensee or applicant to include one hour of study on insurance fraud. This bill would require specified licensees to include their license number in the emails the person sends that involve an activity for which a license is required. The bill would set forth size and location requirements for including the license number in an email.
(2) Existing law requires an insurer to provide a long-term care insurance policyholder or certificate holder a statement with specified information, including that the policyholder or certificate holder may cancel the payment before the payment date, at least 30 days before the first payment of an accelerated death benefit for long-term care. Existing law also requires an insurer to provide a report to a policyholder or certificate holder no later than 30 days after every payment of an accelerated death benefit for long-term care. Under existing law, a loan or withdrawal from the cash value of a life insurance policy that accelerates benefits for long-term care is incomplete until the insurer provides specified information to the policyholder or certificate holder.
This bill would clarify the information that is to be provided in the statement at least 30 days before the expected first payment of an accelerated death benefit for long-term care, would alternatively authorize an insurer to provide the statement at the time of payment if the insurer allows cancellation for at least 30 days after the payment, and would specify the information to be included if the statement is provided at the time of payment. The bill would require an insurer to provide a policyholder or certificate holder with a statement summarizing the effect of the payment on the remaining policy values no later than 30 days after every payment, or 45 days after the first payment, of an accelerated death benefit for long-term care. The bill would authorize an insurer to immediately approve a loan from the cash value of a life insurance policy that accelerates benefits for long-term care if the loan is not treated as a taxable distribution for federal income tax purposes and the insurer permits cancellation of the loan for at least 30 days after the loan payment has been made.
(3) Existing law requires an insurer to include a written disclosure with contact information of the unit within the Department of Insurance that deals with consumer affairs when a specified policy of automobile, residential property, life, or disability insurance, or a certificate of coverage for a group disability master policy, is first issued to or delivered to a new insured or a new policyholder.
This bill would additionally require that disclosure to be included when a bail bond is first executed or delivered.
Existing law requires an insurer to include a statement indicating that it is a crime to present false and fraudulent information to obtain or amend insurance coverage on a form it uses for an application, policy changes, or making a claim in connection with an insurance application, contract, or provision of contract for liability insurance, or on a rider attached to that form.
This bill would require that statement to appear on the form, exclusive of schedules attached to the form, or an endorsement separate from the form, if used in connection with an insurance application, contract, or provision of contract. The bill would also make conforming changes.
(4) Existing law requires an insurance pool to furnish a copy of the pool's annual audited financial statement and most recent actuarial review to specified committees of the Legislature within 180 days of the close of the pool's fiscal year.
This bill would also require an insurance pool to furnish a copy of that statement and review to the Insurance Commissioner within 180 days of the close of the pool's fiscal year.
(5) Existing law generally regulates classes of insurance, including disability income insurance. Existing law defines "disability income insurance" to mean insurance against loss of occupational earning capacity arising from injury, sickness, or disablement.
This bill would make technical, nonsubstantive changes to provisions cross-referencing that definition.
(6) Existing law provides that mailing a specified notice is complete when the notice is deposited in a facility regularly maintained by the United States Postal Service, in a sealed envelope, with postage paid, and addressed to the person at the last address that person provided to the person mailing the notice. Existing law extends the period of notice and any right or duty to respond to that mailed notice by 5 calendar days if the place of mailing or the recipient's address is within California, 10 calendar days if the place of mailing or the recipient's address is outside of California but within the United States, or 20 calendar days if the place of mailing or the recipient's address is outside of the United States. Existing law specifies that these time periods and procedures are applicable to various insurance-related notices.
This bill would make technical, nonsubstantive changes to provisions referencing those time periods and procedures.
(7) Beginning January 1, 2023, existing law prohibits an insurer from declining an application or enrollment request for coverage under a policy or certificate for life insurance or disability income insurance based solely on the results of a positive HIV test if the policy's operation is contingent on medical review for other diseases or medical conditions.
This bill would make technical, nonsubstantive changes to those provisions.
(8) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.

Statutes affected:
SB1242: 106 INS, 396 INS, 785 INS, 10111.2 INS, 10144.55 INS
02/17/22 - Introduced: 106 INS, 396 INS, 785 INS, 10111.2 INS, 10144.55 INS
03/24/22 - Amended Senate: 106 INS, 396 INS, 676.2 INS, 676.8 INS, 677.2 INS, 677.4 INS, 678 INS, 678.1 INS, 785 INS, 1758.9 INS, 10111.2 INS, 10144.55 INS, 11664 INS, 13902 INS
06/15/22 - Amended Assembly: 106 INS, 396 INS, 510 INS, 676.2 INS, 676.8 INS, 677.2 INS, 677.4 INS, 678 INS, 678.1 INS, 785 INS, 1652 INS, 1725.5 INS, 1749 INS, 1749.3 INS, 1749.31 INS, 1749.32 INS, 1749.33 INS, 1758.9 INS, 1871.2 INS, 1872.4 INS, 1879.2 INS, 10111.2 INS, 10144.55 INS, 10235.45 INS, 11664 INS, 13902 INS, 5401.7 LAB
09/02/22 - Enrolled: 106 INS, 396 INS, 510 INS, 676.2 INS, 676.8 INS, 677.2 INS, 677.4 INS, 678 INS, 678.1 INS, 785 INS, 1652 INS, 1725.5 INS, 1749 INS, 1749.3 INS, 1749.31 INS, 1749.32 INS, 1749.33 INS, 1758.9 INS, 1871.2 INS, 1872.4 INS, 1879.2 INS, 10111.2 INS, 10144.55 INS, 10235.45 INS, 11664 INS, 13902 INS, 5401.7 LAB
09/18/22 - Chaptered: 106 INS, 396 INS, 510 INS, 676.2 INS, 676.8 INS, 677.2 INS, 677.4 INS, 678 INS, 678.1 INS, 785 INS, 1652 INS, 1725.5 INS, 1749 INS, 1749.3 INS, 1749.31 INS, 1749.32 INS, 1749.33 INS, 1758.9 INS, 1871.2 INS, 1872.4 INS, 1879.2 INS, 10111.2 INS, 10144.55 INS, 10235.45 INS, 11664 INS, 13902 INS, 5401.7 LAB
SB 1242: 106 INS, 396 INS, 785 INS, 10111.2 INS, 10144.55 INS