Section 2274.54 - Reinstatement and Continuation of Coverage(a) For purposes of this article and Insurance Code section 10273.7, whenever an insurer is required to continue to provide coverage, to reinstate coverage or to reinstate a policyholder, certificate holder or other insured, the insurer must process and pay claims, and provide any required prior authorization of covered services, with respect to that coverage, policyholder, certificate holder or other insured, all in accordance with the terms of the policy or certificate as in the ordinary course of business.(b) The insurer shall provide coverage to the policyholder, certificate holder, or other insured pursuant to subdivision (d) of Insurance Code section 10273.7 if, on the date of the request for review by the commissioner, any of the following are true: (1) The policyholder's, certificate holder's or other insured's coverage is in effect;(2) No more than 30 days have passed since the date the insurer sent to the policyholder, certificate holder or other insured the notice of the right to request a review required by Section 2274.50; or(3) The insurer has not sent to the policyholder, certificate holder or other insured the notice of the right to request a review required by Section 2274.50.(c) The insurer shall provide coverage to its policyholder, certificate holder or other insured pursuant to subdivision (b) of this Section 2274.54 as of the date of the request for review. The insurer must comply with the preceding sentence at the time the insurer receives notice pursuant to subdivision (b) of Section 2274.52 that the policyholder, certificate holder or other insured has requested a review by the commissioner. The insurer shall continue to provide coverage until such time as the commissioner determines that:(1) Not all of the requirements applicable to the complaint that are set forth in Section 2274.52 were satisfied; or(2) The rescission, cancellation or failure to renew was lawful.(d) Subdivision (b) of this Section 2274.54 shall not apply if the insurer cancels the policy or coverage for nonpayment of premiums.Cal. Code Regs. Tit. 10, § 2274.54
1. New section filed 11-20-2013; operative 1-1-2014 (Register 2013, No. 47). Note: Authority cited: Sections 10273.7 and 12926, Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989) and 20th Century Ins. Co. v. Garamendi, 8 Cal. 4th 216 (1994). Reference: Sections 10273.4, 10273.6, 10273.7, 10384, 10384.17 and 10713, Insurance Code.
1. New section filed 11-20-2013; operative 1-1-2014 (Register 2013, No. 47).