Insurer Fraud Investigation
Cal. INS § 1875.24
California Statutes
(
a) If after examination, or upon the basis of other information, the commissioner has good cause to believe that an insurer to whom the provisions of this
article apply does not comply with the requirements of this article, or with the regulations set forth in
Article 2 (commencing with
Section 2698.30) of Subchapter of
Chapter of Title of the California Code of Regulations, the commissioner shall notify the insurer of its noncompliance. The notice shall state in what manner and to what extent the noncompliance is alleged to exist, shall specify a reasonable time, not less than days thereafter, in which the noncompliance may be corrected, and shall set forth the amount of any penalty that may be due under subdivision (b). (
b) Any insurer that fails to comply with the provisions of this
article or with the regulations described in subdivision (
a) shall be liable to the state for a civil penalty not to exceed five thousand dollars ($5,000) for each act, or, if the act was willful, a civil penalty not to exceed ten thousand dollars ($10,000) for each act. The commissioner shall have the discretion to determine what constitutes
an act. However, when violations relative to the maintenance and operation of the unit or division are inadvertent, the violations shall be considered a single act for the purpose of this section. Any penalty imposed by the commissioner pursuant to this
section shall be determined as provided in subdivision (
d) of this
section and
Article 19 (commencing with
Section 2591) of Subchapter of
Chapter of Title of the California Code of Regulations. Notwithstanding subdivision (
c) of
Section 2591.1 of Title of the California Code of Regulations, enforcement of any provision of this
section shall be deemed an enforcement action pursuant to
Article 19 (commencing with
Section 2591) of Subchapter of
Chapter of that title. (
c) An insurer served with a notice of noncompliance described herein shall, within the time specified therein, do one or more of the following:
(1) Establish to the satisfaction of the commissioner that the noncompliance does not exist.
(2) Request a hearing, notice of which must be given at least days prior to the date set for a hearing.
(3) Enter into a consent order with the commissioner to correct the specified noncompliance within the time period specified in the consent order. (
d) If, after hearing, the commissioner finds that the facts alleged in the notice of noncompliance are true, he or she shall issue an order requiring compliance with the provisions of this
article within a reasonable time. An insurer that fails to comply with an order issued by the commissioner, including a consent order, shall be liable to the state for a civil penalty not to exceed ten thousand dollars ($10,000) for each day the insurer fails to comply with the provisions of the order. Any order, including any consent order, issued pursuant to this
section shall specify the amount of the penalty due under subdivision (b), and shall indicate that an additional penalty shall be imposed for each day the insurer fails to comply with the order within the time specified therein. In addition to any other remedy provided by statute, regulation, or otherwise, the commissioner may direct the insurer to take any other corrective action that he or she may deem necessary and proper. (
e) The commissioner shall adopt regulations necessary to implement this
section in accordance with the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with