The California Division of Insurance coverage has taken an aggressive step to guard wildfire survivors, submitting an Order to Present Trigger towards the California FAIR Plan Affiliation for systematically denying and limiting smoke harm claims. 1 Commissioner Ricardo Lara introduced the motion in a press launch following a surge of client complaints from residents affected by the Palisades and Eaton Fires earlier this yr, who reported that their claims for smoke harm have been both denied or inadequately dealt with. On the coronary heart of the difficulty is the FAIR Plan’s insistence that smoke harm should lead to “everlasting bodily harm” to be coated. It is a normal the Division has deemed illegal.
The Division’s investigation paints a troubling image of the FAIR Plan’s practices. Starting in 2017, the FAIR Plan quietly altered its coverage language to redefine “direct bodily loss” as requiring “everlasting bodily modifications” to insured property. This transformation had the impact of limiting protection for smoke claims that didn’t go away seen, lasting marks on a construction. In line with the Division, this restrictive language not solely undermined the protections of California’s normal hearth insurance coverage coverage but additionally led to tons of of improper denials. The just lately filed Order to Present Trigger accuses the FAIR Plan of committing at the very least 418 violations of California’s client safety legal guidelines, together with misrepresenting coverage phrases, failing to conduct truthful investigations, and denying reliable claims with out affordable justification.
Shopper tales outlined within the authorized submitting are each irritating and alarming. Householders described properties crammed with poisonous smoke and ash, uninhabitable circumstances, and denied remediation companies regardless of clear proof of smoke intrusion. In a number of circumstances, discipline inspectors for the Honest Plan allegedly carried out cursory inspections and instructed owners to scrub their properties themselves with primary family instruments, resembling mops and vacuums, moderately than arranging skilled remediation. The Division argues that these actions reveal not simply remoted errors, however a scientific enterprise observe of unfair claims dealing with.
This enforcement motion is a part of Commissioner Lara’s broader marketing campaign to carry insurance coverage corporations accountable for his or her claims practices within the wake of California’s worsening wildfire crises. The Division can be conducting market conduct examinations of different insurers, together with State Farm, to make sure that wildfire claims are dealt with in compliance with state legislation. Commissioner Lara emphasised that the FAIR Plan, though an insurer of final resort, is just not exempt from client safety statutes and should meet the identical claims-handling requirements as non-public carriers. His workplace has additionally launched the Smoke Claims & Remediation Activity Drive to develop statewide requirements for evaluating and cleansing smoke harm, aiming to shut a long-standing hole within the insurance coverage panorama.
The stakes are excessive for each customers and the FAIR Plan. The Division is searching for cease-and-desist orders, financial penalties of as much as $10,000 per willful violation, and sweeping corrective measures. For owners, this motion alerts a renewed dedication by regulators to make sure that insurance coverage protection fulfills its promise in instances of disaster. Commissioner Lara’s message is evident that policyholders deserve truthful therapy, and insurance coverage corporations that use illegal claims techniques to keep away from paying smoke harm claims will face vital penalties.
Thought For The Day
“We is not going to tolerate insurance coverage corporations breaking the legislation and denying Californians the protection they deserve, together with the FAIR Plan.”
—Richard Lara
1 Within the Matter of California FAIR Plan Affiliation, No. DISP-2025-00281 (Cal. Dep’t Ins. July 31, 2025).
