Section 2274.60 - Affirmative Defense(a) A policyholder, certificate holder or other insured shall be barred from requesting a review by the commissioner if the date of his or her request for review is more than 180 calendar days after the date the insurer sent the notice required by Section 2274.50, or the date coverage was terminated (if coverage was terminated), whichever is later in time. The running of this 180-day period shall be tolled, however, during such period as the policyholder, certificate holder or other insured is unable, due to substantial health reasons or other incapacity, to understand or appreciate the significance of such notice, or termination of coverage, and act upon it.(b) The insurer shall have the burden to establish that the 180-day period had run, and had not been tolled, at the time of the policyholder's, certificate holder's or other insured's request for review by the commissioner. The insurer must assert the affirmative defense described in this Section 2274.60, and include all evidence available to the insurer in support of that assertion, in the submittal required pursuant to Paragraph (c)(1) of Section 2274.55 and in any submittal required pursuant to subdivision (a) of Section 2274.59. In the event the insurer has not sent the notice required by Section 2274.50, the affirmative defense described in this section shall not obtain.Cal. Code Regs. Tit. 10, § 2274.60
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).