Jones

Pacificare Life & Health Ins. Co. v. Jones

Good Law
238 Cal. Rptr. 3d 150·27 Cal. App. 5th 391
Court of Appeal of CaliforniaSeptember 20, 2018G053914California12,505 words

Opinion

lead Opinion

Goethals, J.

*397 INTRODUCTION

Dave Jones, in his capacity as Insurance Commissioner of the State of California (the Commissioner), appeals from an order enjoining him from enforcing three regulations, adopted in 1992, to implement the unfair claims settlement practices provision of the Unfair Insurance Practices Act (UIPA) ( Ins. Code, § 790, et seq. ) 1 The injunction was issued at the conclusion of the first phase of a trial in which PacifiCare *154 Life and Health Insurance Company is challenging the Commissioner's finding that it had committed over 900,000 acts and practices in violation of the Insurance Code.

The first of the three enjoined regulations states that, for purposes of the statute defining unfair claims settlement practices (§ 790.03, subd. (h) 790.03(h) ), a violation occurs when the prohibited settlement practice is either "knowingly committed on a single occasion," or "performed with such frequency as to indicate a general business practice." ( Cal. Code Regs., tit. 10, § 2695.1(a).) 2 The second regulation defines the word " '[k]nowingly' " to include implied and constructive knowledge (Reg. 2695.2(l) ). The third regulation defines the word " '[w]illful' " without…

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