Claim Notice Pack (Policyholder) - California

CLAIM NOTICE PACK (POLICYHOLDER) — CALIFORNIA

Practice Note: California has among the most detailed claims-handling regulations in the country. The Fair Claims Settlement Practices Regulations (Cal. Code Regs. tit. 10, §§ 2695.1–2695.14) impose specific acknowledgment, investigation, and decision deadlines on all insurers. California follows the notice-prejudice rule — an insurer must prove it suffered actual, substantial prejudice from late notice before it can deny coverage on that ground. Shell Oil Co. v. Winterthur Swiss Ins. Co., 12 Cal. App. 4th 715 (1993). This pack provides the key documents a California policyholder needs to properly initiate, document, and pursue an insurance claim.

DOCUMENT 1: INITIAL CLAIM NOTICE LETTER

[INSURED LETTERHEAD]

[__/__/____]

VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED
AND VIA EMAIL TO: [________________________________]

Claims Department
[________________________________] (Carrier Name)
[________________________________] (Street Address)
[________________________________] (City, State, ZIP)

Re: Notice of Claim / Notice of Occurrence
Policy No.: [________________________________]
Policy Type: [________________________________] (e.g., CGL, Property, D&O, EPLI, Professional Liability, Auto)
Policy Period: [__/__/____] to [__/__/____]
Named Insured: [________________________________]
Date of Loss / Occurrence: [__/__/____]
Claim No. (if assigned): [________________________________]

Dear Claims Department:

This letter constitutes formal written notice of a claim and/or occurrence under the above-referenced policy, submitted on behalf of [________________________________] ("Insured"). This notice is provided pursuant to the policy's notice provisions and all applicable California law, including the California Insurance Code and the Fair Claims Settlement Practices Regulations (Cal. Code Regs. tit. 10, §§ 2695.1 et seq.).

1. Description of the Loss or Occurrence

Date of Loss / Occurrence: [__/__/____]

Location of Loss: [________________________________]

Description of Incident:
[________________________________]
[________________________________]
[________________________________]
[________________________________]

Parties Involved / Claimant(s):

• [________________________________]
• [________________________________]
• [________________________________]

Type of Loss (check all that apply):

• ☐ Property damage
• ☐ Bodily injury / personal injury
• ☐ Third-party liability claim / lawsuit
• ☐ Employment practices claim (discrimination, harassment, wrongful termination)
• ☐ Directors & officers claim (shareholder action, regulatory investigation, securities demand)
• ☐ Professional liability / errors & omissions claim
• ☐ Business interruption / loss of income
• ☐ Auto / vehicle accident
• ☐ Other: [________________________________]

Suit or Demand Received: ☐ Yes ☐ No
If yes, date received: [__/__/____]
Court/agency: [________________________________]
Case number: [________________________________]

2. Policy Identification and Coverage Trigger

Coverage Trigger Statement: [Select and complete the applicable statement:]

• ☐ The occurrence took place on [__/__/____], within the policy period.
• ☐ The claim was first made against the Insured on [__/__/____], within the policy period, and the alleged wrongful act occurred after the retroactive date of [__/__/____].
• ☐ The Insured became aware of circumstances reasonably likely to give rise to a claim on [__/__/____] and provides this notice of circumstances within the policy period.

3. Additional Policies That May Apply

The Insured holds or may hold the following additional policies that may provide coverage for this loss:

Notice is being provided simultaneously to all potentially applicable carriers. This notice to your company is not an election regarding priority of coverage or an acknowledgment of the applicability of any "other insurance" clause.

4. Requests

The Insured requests the following:

☐ Claim Number and Adjuster Assignment — Please assign a claim number and designated adjuster and provide their contact information within 15 calendar days as required by Cal. Code Regs. tit. 10, § 2695.5(e).

☐ Complete Copy of Policy — Please provide a complete, certified copy of the policy, including all endorsements, declarations, and amendatory endorsements, as required by Cal. Code Regs. tit. 10, § 2695.4(a).

☐ Defense and Indemnity — The Insured tenders defense and requests indemnification under the policy. Please confirm acceptance of the defense and identify assigned defense counsel.

☐ Advancement of Defense Costs — If the policy provides for advancement of defense costs, the Insured requests immediate advancement.

☐ Consent to Insured's Choice of Counsel — If a conflict of interest exists or the insurer issues a reservation of rights, the Insured reserves all rights to independent counsel under San Diego Navy Federal Credit Union v. Cumis Ins. Society, 162 Cal. App. 3d 358 (1984), and Cal. Civ. Code § 2860.

☐ Written Coverage Position — Please provide a written coverage determination within 40 calendar days of this notice, as required by Cal. Code Regs. tit. 10, § 2695.7(b).

5. Cooperation and Preservation

The Insured will cooperate fully in the investigation of this claim and provide additional information reasonably requested.

The Insured requests that the carrier:

• Preserve all documents, communications, and electronically stored information related to this claim and the coverage determination
• Refrain from destroying, altering, or discarding any materials related to this policy or claim
• Provide all communications regarding coverage decisions in writing

6. Reservation of Rights (Insured)

The Insured expressly reserves all rights, remedies, and defenses under the policy, under California law, and at equity, including but not limited to:

• The right to challenge any reservation of rights or coverage defense asserted by the carrier
• The right to independent counsel (Cumis counsel) under Cal. Civ. Code § 2860 if a conflict of interest arises
• The right to pursue statutory and common-law bad faith remedies under Cal. Ins. Code § 790.03(h) and Egan v. Mutual of Omaha Ins. Co., 24 Cal. 3d 809 (1979)
• All rights under the notice-prejudice rule as established in Shell Oil Co. v. Winterthur Swiss Ins. Co., 12 Cal. App. 4th 715 (1993)

Nothing in this notice, or any subsequent communications, constitutes a waiver of any right of the Insured.

7. Delivery Confirmation

This notice is sent via:

• ☐ Certified mail, return receipt requested (Tracking No.: [________________________________])
• ☐ Email to: [________________________________]
• ☐ Carrier claims portal (Confirmation No.: [________________________________])
• ☐ Hand delivery (Date/time: [________________________________])
• ☐ Overnight courier (Tracking No.: [________________________________])

Date of transmission: [__/__/____]

Sincerely,

________________________________________
[________________________________] (Name)
[________________________________] (Title)
[________________________________] (Company/Insured Entity)
[________________________________] (Address)
[________________________________] (Phone)
[________________________________] (Email)

cc: [Coverage Counsel, if any]

DOCUMENT 2: SWORN PROOF OF LOSS

SWORN STATEMENT IN PROOF OF LOSS

State of California
County of [________________________________]

The undersigned, being duly sworn, states:

Claimant and Policy Information

Loss Information

Ownership and Interest

The insured property was owned by: [________________________________]

The insured's interest in the property was: ☐ Owner ☐ Tenant ☐ Mortgagee ☐ Other: [________________________________]

At the time of loss, the property was occupied by: [________________________________]

Changes in title, use, or occupancy since policy inception: ☐ None ☐ Describe: [________________________________]

Encumbrances and Liens

Other Insurance

Itemization of Loss

Additional Amounts Claimed

Sworn Declaration

The above statements are true and correct to the best of my knowledge and belief. I understand that any material misstatement or omission in this proof of loss may void coverage under the policy. I have not misrepresented, concealed, or omitted any material fact. I submit this proof of loss without waiving any rights under the policy or California law.

Signed under penalty of perjury under the laws of the State of California.

________________________________________
Signature of Insured / Authorized Representative

[________________________________] (Printed Name)
[________________________________] (Title)

Date: [__/__/____]

Notarization

State of California
County of [________________________________]

On [__/__/____], before me, [________________________________], a Notary Public, personally appeared [________________________________], who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

________________________________________
Notary Public Signature

My Commission Expires: [__/__/____]

[NOTARY SEAL]

Supporting Documentation Checklist

☐ Photographs / video of damage or loss
☐ Police report / fire report / incident report (Report No.: [________________])
☐ Repair estimates from licensed contractors (minimum two recommended)
☐ Receipts and invoices for emergency repairs and mitigation
☐ Inventory of damaged or lost personal property with values
☐ Proof of ownership (receipts, appraisals, photos, credit card statements)
☐ Medical bills and records (if bodily injury)
☐ Income documentation for business interruption claims
☐ Lease or mortgage statements
☐ Prior inspection or appraisal reports
☐ Correspondence with the insurer
☐ Other: [________________________________]

DOCUMENT 3: FOLLOW-UP DEMAND FOR CLAIM ACKNOWLEDGMENT

[INSURED LETTERHEAD]

[__/__/____]

VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED
AND VIA EMAIL TO: [________________________________]

Claims Department
[________________________________] (Carrier Name)
[________________________________] (Street Address)
[________________________________] (City, State, ZIP)

Re: DEMAND FOR ACKNOWLEDGMENT AND COMPLIANCE — OVERDUE RESPONSE
Policy No.: [________________________________]
Insured: [________________________________]
Date of Loss: [__/__/____]
Date of Initial Notice: [__/__/____]
Claim No.: [________________________________] (if assigned)

Dear Claims Department:

On [__/__/____], the undersigned submitted formal notice of a claim under the above-referenced policy. As of today's date, [____] calendar days have elapsed since that notice, and the Insured has not received:

• ☐ Written acknowledgment of the claim
• ☐ Assignment of a claim number
• ☐ Identification of the assigned adjuster
• ☐ Necessary claim forms and instructions
• ☐ A copy of the policy as requested
• ☐ A written coverage determination

Regulatory Violations

This failure to respond violates multiple provisions of California law:

1. Cal. Code Regs. tit. 10, § 2695.5(e): Every insurer, upon receiving notice of claim, shall immediately, but in no event more than 15 calendar days later, acknowledge receipt of the claim, unless payment is made within that period. Your failure to acknowledge within 15 days is a violation.

2. Cal. Code Regs. tit. 10, § 2695.5(b): Every licensee, upon receiving any communication from a claimant regarding a claim that reasonably suggests a response is expected, shall furnish the claimant with a complete response based on the facts then known within 15 calendar days.

3. Cal. Code Regs. tit. 10, § 2695.7(b): Every insurer shall accept or deny the claim, in whole or in part, within 40 calendar days of receipt of the proof of claim.

4. Cal. Ins. Code § 790.03(h): The following constitute unfair claims settlement practices:

• Failing to acknowledge and act reasonably promptly upon communications with respect to claims (subd. (h)(2))
• Failing to adopt and implement reasonable standards for the prompt investigation of claims (subd. (h)(3))
• Not attempting in good faith to effectuate prompt, fair, and equitable settlements of claims in which liability has become reasonably clear (subd. (h)(5))

Demand

The Insured hereby demands that within ten (10) calendar days of your receipt of this letter, you:

1. Provide written acknowledgment of the claim with an assigned claim number
2. Identify the assigned adjuster with direct contact information
3. Provide all claim forms and instructions required under Cal. Code Regs. tit. 10, § 2695.5(e)(3)
4. Provide a complete copy of the policy, including all endorsements
5. Confirm the status of the investigation and provide a timeline for the coverage determination

Notice of Intent to File DOI Complaint

If the Insured does not receive a substantive response within the time specified above, the Insured intends to file a formal complaint with the California Department of Insurance:

California Department of Insurance
Consumer Services Division
300 South Spring Street, South Tower
Los Angeles, CA 90013
Consumer Hotline: 1-800-927-4357
Online Complaint Portal: https://cdiapps.insurance.ca.gov/CP/login/

The Insured also reserves the right to pursue all remedies available under California law, including but not limited to common-law bad faith, statutory penalties under Cal. Ins. Code § 790.03(h), and any other applicable remedies.

Sincerely,

________________________________________
[________________________________] (Name / Title)
[________________________________] (Insured Entity)
[________________________________] (Contact Information)

DOCUMENT 4: DOCUMENT PRODUCTION COVER LETTER

[INSURED LETTERHEAD]

[__/__/____]

[________________________________] (Adjuster Name)
[________________________________] (Carrier Name)
[________________________________] (Street Address)
[________________________________] (City, State, ZIP)

Re: Document Production — Claim No. [________________________________]
Policy No.: [________________________________]
Insured: [________________________________]
Date of Loss: [__/__/____]

Dear [________________________________]:

Enclosed please find documents in support of the above-referenced claim. The documents are identified and organized in the index below. Please confirm receipt of these documents in writing within 15 calendar days pursuant to Cal. Code Regs. tit. 10, § 2695.5(b).

Document Index

Total Documents Enclosed: [____]
Total Pages: [____]

Privilege Log (if applicable)

The following documents are being withheld on the basis of privilege:

Requests

1. Please confirm receipt of the enclosed documents in writing
2. Please advise if you require any additional documentation
3. Please provide a timeline for your review and coverage determination
4. Do not contact any third parties identified in these documents without first notifying the Insured's counsel

The production of these documents does not waive any privilege, right, or defense of the Insured. The Insured reserves all rights under the policy and California law.

Sincerely,

________________________________________
[________________________________] (Name / Title)
[________________________________] (Insured Entity)
[________________________________] (Contact Information)

Enclosures: As indexed above

DOCUMENT 5: NOTICE TO ALL POTENTIALLY LIABLE INSURERS

[INSURED LETTERHEAD]

[__/__/____]

VIA CERTIFIED MAIL, RETURN RECEIPT REQUESTED

[________________________________] (Carrier Name)
Claims Department
[________________________________] (Address)
[________________________________] (City, State, ZIP)

Re: Notice of Claim — Multiple Policies May Apply
Insured: [________________________________]
Date of Loss / Occurrence: [__/__/____]

Dear Claims Department:

This letter constitutes formal notice of a claim under each policy identified below. The Insured holds multiple insurance policies that may provide coverage for the loss described herein. This notice is sent simultaneously to all potentially applicable carriers.

Policies Noticed

Description of Loss

[Incorporate by reference or repeat the loss description from Document 1.]

"Other Insurance" Clauses

The Insured is aware that some or all of the above policies may contain "other insurance" clauses. This simultaneous notice to all carriers does not constitute:

• An election as to which policy is primary, contributing, or excess
• An acknowledgment that any "other insurance" clause controls
• A waiver of the Insured's right to full indemnification under any or all applicable policies
• A concession regarding allocation among carriers

Under California law, the insured is entitled to select the policy or policies under which it seeks indemnity and may seek full indemnification from any insurer whose policy covers the loss. See Dart Industries, Inc. v. Commercial Union Ins. Co., 28 Cal. 4th 1059 (2002).

Requests to Each Carrier

Each carrier receiving this notice is requested to:

1. Acknowledge receipt of this notice within 15 calendar days
2. Assign a claim number and adjuster
3. Provide a complete copy of the applicable policy
4. Provide a written coverage position within 40 calendar days
5. Identify any "other insurance" clause in the policy and its position on priority of coverage
6. Coordinate with co-carriers on coverage and defense as appropriate

The Insured reserves all rights under each policy and under California law.

Sincerely,

________________________________________
[________________________________] (Name / Title)
[________________________________] (Insured Entity)

cc: All carriers listed above; coverage counsel

DOCUMENT 6: CLAIMS DIARY / TIMELINE TEMPLATE

California Regulatory Deadlines Reference

Claims Activity Log

Bad Faith Documentation Tracker

Record each instance of carrier conduct that may constitute bad faith under Cal. Ins. Code § 790.03(h):

Key § 790.03(h) Violations to Track:

• (h)(2): Failing to acknowledge and act reasonably promptly on communications
• (h)(3): Failing to adopt reasonable standards for prompt investigation
• (h)(4): Refusing to pay claims without conducting a reasonable investigation
• (h)(5): Not attempting good faith settlement when liability is reasonably clear
• (h)(11): Delaying investigation or payment by requiring duplicative documentation
• (h)(13): Failing to provide a reasonable explanation for denial

DOCUMENT 7: COMMON CLAIM TYPES ADDENDA

Addendum A — Property Damage Claims Checklist

☐ Date and cause of damage identified
☐ Emergency mitigation measures documented (photos before and after)
☐ Building and contents inventoried with pre-loss values
☐ At least two repair/replacement estimates from licensed California contractors
☐ Proof of ownership for high-value items (receipts, appraisals, photos)
☐ Code upgrade costs estimated (if applicable under ordinance or law coverage)
☐ Debris removal costs documented
☐ ALE / loss of use expenses tracked with receipts
☐ Scope of loss reviewed against policy coverages (dwelling, other structures, personal property, ALE)
☐ Proof of loss submitted within policy deadline (typically 60 days of insurer request)
☐ Cal. Code Regs. tit. 10, § 2695.9 requirements reviewed (residential and commercial property standards)

Addendum B — Liability / Third-Party Claims Checklist

☐ Complaint, demand letter, or claim documentation attached to notice
☐ Tender of defense clearly stated
☐ All potentially applicable policies identified and noticed
☐ Conflict of interest evaluated — Cumis counsel may be required (Cal. Civ. Code § 2860)
☐ Reservation of rights letter requested from insurer
☐ Cooperation obligations reviewed and complied with
☐ Settlement authority and consent requirements identified in policy
☐ Excess carrier notified if claim may exceed primary limits
☐ Litigation hold implemented to preserve evidence

Addendum C — Auto / Vehicle Claims Checklist

☐ Police report obtained (Report No.: [________________])
☐ Photos of all vehicles and scene taken
☐ Other driver's insurance information obtained
☐ Witness statements collected
☐ Medical treatment documented (if BI claim)
☐ Vehicle damage estimate / total loss valuation obtained
☐ Rental car / transportation expenses tracked
☐ UM/UIM coverage evaluated
☐ Med-Pay coverage evaluated
☐ Diminished value claim considered

Addendum D — Business Interruption Claims Checklist

☐ Period of restoration defined and documented
☐ Pre-loss financial records compiled (12–24 months recommended)
☐ Lost revenue calculated with supporting methodology
☐ Continuing expenses documented
☐ Extra expense documentation maintained
☐ Mitigation efforts to reduce loss documented
☐ CPA or forensic accountant engaged (if warranted)
☐ Extended period of indemnity reviewed (if applicable)
☐ Civil authority coverage evaluated (if applicable)
☐ Contingent business interruption assessed (if supply chain disruption)

Addendum E — Professional Liability / E&O Claims Checklist

☐ Claim or potential claim reported within policy's reporting period
☐ Claims-made trigger date confirmed (date claim first made)
☐ Retroactive date verified — alleged act must post-date retro date
☐ Prior knowledge/prior acts exclusion reviewed
☐ Related claims analysis completed (earlier notice may control)
☐ Consent to settle provision identified in policy
☐ Defense costs within or outside limits — structure identified
☐ Tail / extended reporting period options reviewed (if policy expiring)
☐ Regulatory investigation or proceeding coverage evaluated

DOCUMENT 8: CALIFORNIA PRACTICE NOTES

Key Statutes and Regulations

Key Case Law

Notice-Prejudice Rule — California Summary

California's notice-prejudice rule provides significant protection to policyholders:

1. Default Rule: An insurer may not deny coverage based on late notice unless it proves actual and substantial prejudice from the delay. Shell Oil Co. v. Winterthur, 12 Cal. App. 4th 715 (1993).
2. Burden on Insurer: The insurer bears the burden of proving prejudice. Speculative or theoretical prejudice is insufficient. Pitzer College v. Indian Harbor Ins. Co., 8 Cal. 5th 93 (2019).
3. Claims-Made Exception: The notice-prejudice rule generally does not apply to the reporting requirement in claims-made-and-reported policies where the reporting deadline is a fundamental term of the coverage grant. However, California courts have shown willingness to examine this issue case by case.
4. Notice to Agent: Notice to an authorized agent of the insurer may constitute notice to the insurer itself.

California Department of Insurance — Contact Information

California Department of Insurance
Consumer Services Division
300 South Spring Street, South Tower
Los Angeles, CA 90013

Consumer Hotline: 1-800-927-4357 (1-800-927-HELP)
Sacramento Office: 300 Capitol Mall, Suite 1600, Sacramento, CA 95814
Online Complaint Portal: https://cdiapps.insurance.ca.gov/CP/login/
Website: https://www.insurance.ca.gov

California-Specific Timeline Summary

SOURCES AND REFERENCES

1. California Insurance Code § 790.03 — https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=INS&division=1.&part=2.&chapter=1.&article=6.5.
2. Cal. Code Regs. tit. 10, § 2695.5 — https://www.law.cornell.edu/regulations/california/10-CCR-2695.5
3. Cal. Code Regs. tit. 10, § 2695.7 — https://www.law.cornell.edu/regulations/california/10-CCR-2695.7
4. Cal. Code Regs. tit. 10, § 2695.9 — https://www.law.cornell.edu/regulations/california/10-CCR-2695.9
5. California Department of Insurance — File a Complaint — https://www.insurance.ca.gov/01-consumers/101-help/
6. Shell Oil Co. v. Winterthur Swiss Ins. Co., 12 Cal. App. 4th 715 (1993) — https://law.justia.com/cases/california/court-of-appeal/4th/12/715.html
7. Pitzer College v. Indian Harbor Ins. Co., 8 Cal. 5th 93 (2019) — https://www4.courts.ca.gov/opinions/archive/S239510.PDF
8. California Fair Claims Settlement Practices Guide — https://www.propertyinsurancecoveragelaw.com/blog/california-claims-handling-requirements/

This template is provided for informational purposes only and does not constitute legal advice. It is intended for use by licensed attorneys representing policyholders in California insurance claims. Each claim requires professional evaluation of the specific facts, policy language, and applicable law. Users should verify all statutory citations and regulatory references, as laws and regulations are subject to change. This template was last updated on 2026-02-26.

Prepared for use on the ezel.ai platform.