Claims Handling Dispute

Jill Kronitz of California Casualty wrote:

Dear Mr. and Mrs. Stroot:

Per our conversation this morning, I have attached the current payment history for all payments made to date under your additional living expense limit. Your Coverage D-Additional Living Expense Limit is $129,300.00 to date we have issued payments in the amount of$120,835.48 the remaining limit balance is $8,464.52. Payments issued are thru March 31, 2025. We will be able to issue payment for the invoice for April once received and the balance remaining would be$1,510.52

Your policy states under D. Coverage D-Loss Of Use

The limit of liability for Coverage D is the total limit for the coverages in 1. Additional Living Expense, 2. Fair Rental Value and 3. Civil Authority Prohibits Use below.

1. Additional Living Expense

If a loss covered under Section I makes that part of the “residence premises” where you reside not fit to live in, we cover any necessary increase in living expenses incurred by you so that your household can maintain its normal standard of living.

Payment will be for the shortest time required to repair or replace the damage or, if you permanently relocate, the shortest time required for your household to settle elsewhere.

2. Fair Rental Value

If a covered loss under Section I makes that part of the “residence premises” rented to others or held for rental by you not fit to live in, we cover the fair rental value of such premises less any expenses that do not continue while it is not fit to live in.

Payment will be for the shortest time required to repair or replace such premises.

3. Civil Authority Prohibits Use

If a civil authority prohibits you from use of the “residence premises” as a result of direct damage to neighboring premises by a Peril Insured Against, we cover the loss as provided in 1. Additional Living Expenses and 2. Fair Rental Value above for no more than two weeks.

4. Loss Or Expense Not Covered

We do not cover loss or expense due to cancellation of a lease or agreement.

The periods of time under 1. Additional Living Expense, 2. Fair Rental Value and 3. Civil Authority Prohibits Use above are not limited by expiration of this policy.

Please call me to discuss further. Thank you.

We responded:

Stephen & Alison Stroot
1900 Susan Ln
Pleasant Hill, CA 94523
March 20, 2025
Jill Krovitz
Property Field Adjuster
California Casualty Indemnity Exchange
Re: Ongoing Claim Concerns, ALE Coverage, and Claims Handling
Policy No.: 2A0 8155395
Claim #: 50000658141
Date of Loss: 01/05/2024
Dear Ms. Krovitz,
We write with serious concerns about California Casualty Indemnity Exchange’s handling of our claim. Nearly fourteen months have passed since our loss—far exceeding the typical six- to twelve-month
timeframe for similar property-damage claims. These extensive delays, combined with inconsistent
communication, have imposed undue hardship and stress on our family. Moving forward, please communicate through written communications to both Alison Stroot
([email protected]) and Steve Stroot ([email protected]). Telephone calls should be , recorded, and included in our Claims File. We request delivery, whether physical or electronic, of a
complete, updated copy of our Claims File (including call recordings) monthly while the claim remains
open. We also reserve the right to reference any additional governing documents that may be
relevant. I. EMPHASIS ON DAMAGE TO COLLECTIBLE POSTCARDS (A MINOR ISSUE)
We are concerned that during our March 18, 2025 telephone call, significant attention was given to
the condition of collectible postcards—a relatively minor part of our losses—rather than the more
critical issues of structural damage and ALE coverage. Policy Language
Our homeowners policy clearly states:
"The limit of liability for Coverage D is the total limit for the coverages in: (1) Additional Living
Expense, (2) Fair Rental Value, and (3) Civil Authority Prohibits Use." Regulatory Requirements
We draw your attention to key governing documents that mandate clear, timely, and fair claims
handling:
California Insurance Code § 790.03(h)(5):
"An insurer shall attempt in good faith to effectuate prompt, fair, and equitable settlements of claims
in which liability has become reasonably clear."

Pleasant Hill Municipal Code § 4.02:
"No business shall engage in practices that are misleading or fail to provide clear, timely, and accurate
information to consumers." Contra Costa County Consumer Protection Ordinance § 3.1:
"Consumers are entitled to receive complete and accurate disclosures regarding the goods and
services provided within the county." Case Law
California courts have emphasized that insurers must not trivialize significant losses. In Gruenberg v. Aetna Ins. Co., 9 Cal.3d 566 (1973), the Court held:
"An insurer must not minimize significant losses by focusing excessively on minor matters." Our Position
We contend that the disproportionate focus on postcard damage detracts from addressing our
primary issues—namely, severe structural damage and unresolved ALE coverage—and may be used as
a diversionary tactic contrary to good-faith obligations and consumer-protection standards. II. DELAYS IN CLAIMS PROCESSING AND ADJUSTER PERFORMANCE
We received repeated notices from your predecessor stating “additional time will be needed” without
substantive explanations. Despite repeatedly voicing valid concerns regarding communication
difficulties, supervisor David Isban did not replace the previous adjuster until January 2025. Policy Language
Although our policy does not prescribe a strict timeline, its intent requires prompt investigation and
payment of covered losses to support our household’s living needs. Regulatory Requirements
The following California regulation mandates timely responsiveness:
California Code of Regulations § 2695.5(e):
"Every insurer shall respond to communications from claimants within fifteen (15) calendar days. If
more time is required to make a determination, the insurer shall provide an explanation for the delay
and specify any additional information needed." Case Law
In Hangarter v. Provident Life & Accident Ins. Co., 373 F.3d 998 (9th Cir. 2004), the Court stated:
"Repeated delays and insufficient communication may be considered evidence of insurer bad faith." Our Position
Extensive delays—now spanning nearly fourteen months—and the failure to replace your predecessor
in a timely manner strongly suggest potential noncompliance with regulatory standards and a breach
of the insurer’s duty of good faith.

III. ADDITIONAL LIVING EXPENSES (ALE) COVERAGE AND SUBROGATION RIGHTS
Your correspondence indicates our ALE limit is $129,300, with$120,835.48 already paid, leaving
$8,464.52 remaining. You imply that upcoming ALE payments (for instance, in April) could exhaust this
balance, which we dispute given our home remains uninhabitable. Policy Language
Our policy explicitly provides:
"If a loss covered under Section I makes that part of the 'residence premises' where you reside not fit
to live in, we cover any necessary increase in living expenses incurred by you so that your household
can maintain its normal standard of living. Payment will be for the shortest time required to repair or
replace the damage or, if you permanently relocate, the shortest time required for your household to
settle elsewhere." Regulatory Requirements
The following governing documents protects our rights:
California Insurance Code §§ 2060 & 2071
"An insurer paying a loss under a policy shall be subrogated to all rights of recovery... The exercise of
subrogation shall not relieve the insurer of its obligations to the insured under the policy nor act to
diminish benefits prematurely." Contra Costa County Code, Consumer Protection Ordinance, Article 3, Section 3.1 requires:
"Insurers to provide complete and transparent disclosures regarding benefits, coverage limits, and
claim status." Case Law
In Gruenberg v. Aetna Ins. Co., 9 Cal.3d 566 (1973), the Court reaffirmed that insurers must not
unreasonably withhold or prematurely terminate benefits while the insured property remains
uninhabitable. Our Position
We note that the documents & judgements above provide that ALE benefits continue until our home
is fully repaired or until the ALE limit is legitimately reached. Any premature termination of these
benefits is unacceptable and contrary to both the policy language and governing law. V. IMPACT ON FAMILY AND EMOTIONAL DISTRESS
Cumulative delays, insufficient communication, and unresolved repair issues have caused significant
emotional distress to our family, including our pets, during our prolonged displacement. Family members & pets have also endured significant health impacts, particularly when housed in
transient lodging over a 3 month period at the outset of the claim. Case Law
In Gruenberg v. Aetna Ins. Co., 9 Cal.3d 566 (1973), the Court recognized that insurer delays and
failures to act in good faith can lead to substantial emotional distress for the insured.

Our Position
After approximately fourteen months of displacement and uncertainty, the emotional toll on our
household is considerable. We expect prompt resolution to mitigate further harm. REQUEST FOR CLARIFICATION AND ACTION
We respectfully request a detailed, written response addressing each of the following points:

1. Explain why minor postcard damage received disproportionate emphasis over the more
   significant structural and ALE issues. 2. Provide an itemized timeline and rationale for all delays in processing our claim, including why
   supervisor David Isban delayed replacing the adjuster until January 2025. 3. Confirm in writing that ALE benefits will remain in effect until our home is fully restored or
   until the policy limit is legitimately reached. 4. Acknowledge the hardship and emotional distress these delays have caused, and detail the
   measures California Casualty will implement to resolve our claim promptly and fairly. 5. Confirm that all future communications will be emailed to both Alison and Steve, that
   telephone calls will be recorded and included in our Claims File, and that an updated Claims
   File will be delivered monthly. 6. Provide a comprehensive written plan detailing the steps to finalize repairs, resolve
   outstanding ALE issues, and ensure compliance with subrogation principles and local
   consumer-protection ordinances. Supporting Documents & Judgements
   • California Insurance Code: §§790.03, 790.12, 2060, 2071
   • California Code of Regulations: §§2695.5, 2695.7
   • Pleasant Hill Municipal Code: §4.02
   • Contra Costa County Consumer Protection Ordinance: §3.1
   • Gruenberg v. Aetna Ins. Co., 9 Cal.3d 566 (1973) • Hangarter v. Provident Life & Accident Ins. Co., 373 F.3d 998 (9th Cir. 2004) • Brown v. Guarantee Ins. Co. (1977)
   We appreciate your immediate attention to these serious concerns and request that you provide a
   comprehensive, written response within a reasonable timeframe. If additional documentation is
   required, we remain prepared to cooperate fully, subject to the communication protocols detailed
   above. Respectfully,
   Stephen & Alison Stroot

Jill wrote back:

Dear Mr. and Mrs. Stroot:

We are in receipt of your email dated March 20,2025. We will continue to update you with written communication, as requested, to recap any phone conversations that are had, as well as each time a coverage decision or payment is made. You will continue to receive monthly updates, in the form of the State of California required unable to conclude letter.

You have requested recorded phone calls and a copy of our claim file. Unfortunately, the claim file itself, along with its notes and any recorded messages are considered our work product and we are therefore unable to share a copy of your claims file or any recorded messages with you currently. You are entitled to a list of checks that were paid to you or that were paid on your behalf, any engineering reports, and copies of any approved estimates which were used as a basis of payments for the settlement of your claim.

Regarding the handling of the claim itself, California Casualty maintains that we continue to handle your claim in a fair and equitable manner, according to your policy contract and the imposed California Department of Insurance regulations. We will continue to work with your chosen contractor and any other of your chosen professionals, in our effort to assist in the resolution of your claim.

As the investigation of the claim continues, we await answers, from the contractor to the email of March 7th in the effort to support the repair estimate. The ceiling is to be opened after an asbestos test is completed, to determine the damages to the trusses and confirm that the damage is related to the loss. Your contractor is working with California Casualty to provide the supporting documentation for the repairs to settle and resolve your claim in an accurate and efficient manner.

California Casualty maintains that all aspects of the claim are important. While the postcards, as you stated, are of a lesser value than the structural portion of your claim, we needed to discuss them to enable an accurate value and, as such, made a phone call to address this. Please be assured that this discussion did not delay any part of the remaining portions of the claim.

Your Coverage D- Additional Living Expense will remain, as it has, until the limit is reached as stated in my prior email and our discussions. Your limit of coverage is $129,300.00. To date, we have paid$120,835.48. This leaves $8,464.52 left to use for payments of covered additional living expenses. If the expected cost of the additional living expenses continue as expected, we will be able to issue a payment for the April rental invoice, once it is received, leaving the remaining amount of the limit, in the amount of$1,510.52, as final payment to be applied to any remaining, covered additional living expenses. This final payment would exhaust your additional living expense coverage.

Please note that the subrogation department and the claims department operate mostly independently. However, please know that Farmers Insurance has been placed on notice of our intent to subrogate for the property damage. Upon completion of the claim, the required supporting documents will be sent to Farmers Insurance for their review. Should you have any questions regarding that portion of the claim please contact Farmers Insurance. You will need to reference claim number 5027499080 or policy number 529363493 through their handling adjuster Dominique Oree.

Thank you for your continued patience as we attempt to resolve your claim.

We responded:

Hi Jill,

Thanks for your response.

We have some concerns but are not yet able to address them as I have the flu. Please expect a response next week.

In the meantime, please provide California code, case law, regulations, or other governing documents that verify your claims as well as a detailed privilege log.

Please also provide evidence verifying the 24 hours of continuing education you have completed within the last 2 years including the 3 hours of ethics training.

Respectfully,

Steve & Alison Stroot

Jill responded:

Dear Mr. and Mrs. Stroot,

We have received and reviewed your email of March 27,2025. We do not understand what you are requesting from us. Please provide clarification on this request to enable us to review. We do not provide license or continuing education information to anyone outside of the company.

Your additional living expense has been extended with a move out date of May 1st, 2025. A 30 day move out notice is required. CRS temporary housing will be giving notice of move out on Monday March 31st. If you intend to stay past May 1st, 2025, you will need to make arrangements with the landlord. We will issue the payment for invoice MH792917 for the following dates April 1-30 in the amount of $6,954.00. The remaining balance of$1,510.52 will be issued to you directly.

After reviewing the payments that have been issued, we noticed that the payment that was issued on March 25th,2025 as an electronic transfer of funds payment in the amount of $7,959.88 remains in issued status, Alison have you received this payment? Please advise.

I did not call to discuss this email, since you are sick with the flu. I hope you feel better soon. Should you feel well enough to speak with me regarding any questions or concerns please do not hesitate to contact me. Thank you.

I asked:

What stands out to you regarding my arguments & Jill's?

How can I refute her claims?

I believe I asked her to includes in her response but that she did not produce any. Please confirm.

Did she violate any governing documents in her last message? One thing I'm concerned about is that she states that California Casualty (her employer & our insurer) doesn't know what I'm asking in her last message.

You wrote the following letter:

Stephen & Alison Stroot
1900 Susan Lane
Pleasant Hill, CA 94523
[email protected]
[email protected]

March 31, 2025

Jill Krovitz
Property Field Adjuster
California Casualty Indemnity Exchange

Subject: Reiteration of Legal Obligations, Clarification of Requests, and Notice of Ongoing Violations in Claims Handling — Policy No. 2A0 8155395 / Claim No. 50000658141

Dear Ms. Krovitz,

We write to you once again regarding ongoing concerns about the handling of our property claim. We are deeply concerned by California Casualty's continued failure to comply with multiple governing legal, regulatory, ethical, and contractual obligations. Your recent responses not only ignore the spirit and letter of our previous correspondence but also give rise to serious issues that may warrant administrative complaints and litigation if not immediately addressed.

I. Failure to Respond to Specific and Lawful Requests

On March 27, 2025, we requested:

1. The California and/or Federal codes, case law, regulations, and other governing documents relied upon by you and California Casualty to deny our request for:
   • A complete and updated claims file;
   • All related internal notes;
   • Recorded telephone calls;
2. A detailed privilege log indicating the legal basis for each refusal to disclose information from the claim file;
3. Documentation verifying your completion of at least 24 hours of continuing education over the last two years, including the mandatory three (3) hours of ethics training as required by California law and Department of Insurance regulations.

Your response simply stated: “We do not understand what you are requesting,” and claimed that you “do not provide license or continuing education information to anyone outside the company.”

This reply is problematic and potentially violates multiple regulatory mandates.

II. Required Disclosures Under California Law

As a licensed insurer operating in California, California Casualty is bound by the following codes and regulations:

• California Insurance Code §791.08(a): Requires insurers to provide individuals with access to recorded personal information upon written request.

  • The statute does not exempt call recordings unless they fall under specific legal privilege, which you have not cited or proven.

• California Code of Regulations, Title 10, §2695.3(a): Requires every insurer to maintain claim files that are accessible, retrievable, and contain all documents, notes, and work papers that pertain to the claim.

  • Your refusal to provide our claim file, notes, and recorded calls is therefore directly contrary to this mandate.

• California Code of Regulations, Title 10, §2695.5(e): Requires that insurers respond to communications within fifteen (15) calendar days and clearly identify the reasons for any inability to respond fully.

  • Your failure to provide any legal basis and instead stating that you “do not understand” our request does not satisfy the regulatory burden.

• California Insurance Code §790.03(h)(1)–(5): Lists unfair claims practices, including:

  • Failing to adopt and implement reasonable standards for prompt investigation and processing;
  • Refusing to pay claims without conducting a reasonable investigation;
  • Not attempting in good faith to effectuate prompt and equitable settlements;
  • Failing to affirm or deny coverage within a reasonable time;
  • Failing to provide a reasonable explanation of the basis in the insurance policy, in relation to facts or applicable law, for denial or offer of compromise.

Your blanket refusal to release key records and denial of your own education record violates the above.

III. Ethics Training and Required Qualifications

You are required under California Insurance Code §166.5 and California Code of Regulations §2695.6(a) to be adequately trained and qualified to carry out claims adjusting functions.

• Adjusters must complete 24 hours of continuing education every two years, including 3 hours of ethics training.
• As a party handling our claim, you are obligated to conduct yourself in accordance with the highest ethical standards and must demonstrate:
  • Transparent conduct
  • A willingness to disclose training records if requested

Your refusal to provide proof of qualifications in response to a consumer inquiry regarding competency and ethics is not only alarming—it may constitute evidence of bad faith, especially when viewed alongside ongoing delays and incomplete disclosures.

IV. Mischaracterization of Our Requests

You stated that you “do not understand” what we are requesting. We find this assertion disingenuous for the following reasons:

• Our request was written clearly and listed:

  • Codes
  • Case law
  • Regulations
  • Privilege log
  • Training documentation

• Your failure to ask for clarification while refusing the request directly contradicts Cal. Code Regs. §2695.5(e).

• It is especially troubling given that you are a licensed claims professional with a duty to comprehend standard policyholder inquiries regarding their rights and your obligations.

We believe this is a deliberate tactic to delay or obscure your responsibilities—a practice explicitly prohibited by Insurance Code §790.03(h)(3) and §790.03(h)(5).

V. Incomplete and Contradictory Statements Regarding the Claims File and Recorded Calls

You stated that the claim file and recordings are considered “work product” and therefore not shareable. Yet you provide no citation to any statute or case law justifying this.

Your assertion is legally flawed:

• The “work product” doctrine under California Code of Civil Procedure §2018.030 applies to documents prepared in anticipation of litigation and does not broadly cover entire claim files or communications with the insured.
• Call recordings involving the insured about their own claim are not privileged merely because they are stored in an internal system.

Furthermore:

• Cal. Ins. Code §791.08(a) specifically obligates insurers to provide individuals with access to recorded personal information, which explicitly includes any information collected to determine eligibility, benefits, or claim handling.

This obligation is ongoing and cannot be avoided by invoking overbroad or blanket confidentiality labels.

VI. ALE Coverage Termination and Related Obligations

We dispute your assertion that ALE benefits must end upon exhaustion of the stated policy limit.

• Our policy states that coverage will continue until the home is repaired or we permanently relocate.
• You have not resolved the claim.
• Subrogation against Farmers is ongoing and does not resolve our right to full benefits.

We draw your attention to:

• California Insurance Code §2060–2071:

  • Requires that subrogation not diminish the benefits to the insured.

• Gruenberg v. Aetna Ins. Co., 9 Cal.3d 566 (1973):

  • An insurer may not prioritize its own legal strategy or internal processes over timely payment and resolution of a claim.

• Hangarter v. Provident Life & Acc. Ins. Co., 373 F.3d 998 (9th Cir. 2004):

  • Held that extended delays and poor communication can be grounds for bad faith claims.

You have not demonstrated that you are fulfilling your obligations under these principles.

VII. Summary of Violations

We hereby record the following alleged violations for ongoing review:

• Failure to produce claims file and call recordings:

  • Violates Ins. Code §791.08, Cal. Code Regs §2695.3, §2695.5.

• Failure to acknowledge clear, valid request:

  • Violates §2695.5(e) and general claims handling obligations.

• Failure to verify your education and ethical qualifications:

  • Raises doubt about compliance with §2695.6(a).

• False representation of work product exemption:

  • Not supported by statute or case law.

• Premature limitation of ALE coverage:

  • Conflicts with policy language and legal obligations under §2060, §2071, and Gruenberg.

• Failure to cite codes or laws when requested:

  • Avoidance of regulatory transparency, as required under §2695.5 and §790.03(h)(1-5).

• Mischaracterization of “not understanding” clear language:

  • Appears calculated and obstructive.

VIII. Actions Requested Immediately

1. Provide a full copy of the claims file, including internal notes and call recordings.
2. Provide all California and Federal code, regulation, or case law citations used to justify withholding that material.
3. Provide a privilege log outlining any documents you believe you are legally barred from disclosing and under what exact authority.
4. Provide documentation confirming that you have completed at least 24 hours of continuing education, including 3 hours of ethics, within the last two years, as required by California Department of Insurance.
5. Cease all attempts to terminate ALE coverage until our home is fully repaired or we permanently relocate.
6. Confirm that monthly claims file updates will be provided in writing until the claim is resolved.
7. Acknowledge all statutory, regulatory, and ethical obligations cited herein.

IX. Final Statement

This letter is intended to document the deficiencies in California Casualty’s claims handling to date, and to provide you and your supervisors with an opportunity to correct them in good faith.

We are prepared to escalate these matters to:

• The California Department of Insurance
• The California State Auditor
• Legal counsel or file a complaint in court if necessary

If your reply fails to respond in full to each request above, we will interpret that as further noncompliance and proceed accordingly.

Sincerely,
Stephen & Alison Stroot

Verify then write a final, professional draft.

Does this look good?:

Stephen & Alison Stroot
1900 Susan Lane
Pleasant Hill, CA 94523
[email protected]
[email protected]

March 31, 2025

Jill Krovitz
Property Field Adjuster
California Casualty Indemnity Exchange

Subject: Reiteration of Legal Obligations, Clarification of Requests, and Notice of Ongoing Violations in Claims Handling
Policy No. 2A0 8155395 / Claim No. 50000658141

Dear Ms. Krovitz,

We write again to address serious and continuing concerns regarding California Casualty’s handling of our property claim. Despite multiple efforts to secure clarity, compliance, and respectful resolution, your responses have disregarded not only the spirit and substance of our communications, but also violated numerous governing codes, regulations, ethical obligations, and contractual duties. These actions—and in some cases, omissions—now compel us to formally reiterate our position, expand on legal obligations, and provide a final opportunity to correct and clarify before escalation.

I. Failure to Respond to Specific and Lawful Requests
In our March 27, 2025 correspondence, we lawfully and unambiguously requested:

Identification of the specific California and/or federal statutes, regulations, and/or case law upon which you or California Casualty rely to justify denial of:

Our complete and updated claim file

All related internal claim notes

All recorded telephone calls made or received regarding this claim

A privilege log justifying any and all withheld items.

Verification of your compliance with required continuing education under California law, including 24 hours total and 3 hours dedicated to ethics training.

Your reply did not meet these requests in any capacity and instead claimed a lack of understanding and categorically denied provision of education records. This failure to engage, explain, or produce clearly violates legal mandates and is inconsistent with principles of ethical claims handling.

II. Required Disclosures Under California Law
Your responses to date conflict with multiple state requirements governing insurer duties to the insured, specifically:

California Insurance Code § 791.08(a):

“An insurance institution shall permit the individual to obtain a copy of recorded personal information about the individual maintained by the institution.”

This includes notes, communications, and recorded calls pertaining to a policyholder's claim. The statute is clear: if the information is maintained by the insurer and pertains to the insured, it must be disclosed on request.

CCR Title 10 § 2695.3(a):

“Every licensee shall maintain a claim file... to permit the Department to readily ascertain the licensee's actions and handling with respect to each claim.”

This mandates not only the creation of a retrievable file, but the accessibility of it to the Department and—by implication and longstanding interpretation—also to the claimant requesting it for legitimate reasons.

CCR Title 10 § 2695.5(e):

“Every insurer shall respond in writing to communications from a claimant that reasonably suggest a response is expected, within 15 calendar days.”

Your response failed to cite any statute, explain your basis for denial, or request clarification. This omission constitutes regulatory noncompliance.

California Insurance Code § 790.03(h)(1)–(5):

This section defines unfair claims practices, including:

(1) Misrepresenting facts or policy provisions

(3) Failing to adopt and implement reasonable standards for prompt investigations

(4) Refusing to pay claims without conducting a reasonable investigation

(5) Not attempting in good faith to effectuate prompt, fair, and equitable settlements

Your actions fit squarely within this framework of prohibited conduct.

These legal obligations were established to protect insureds from arbitrary denials, non-responsiveness, and document withholding during the claims process.

III. Ethics Training and Qualifications — Expanded Obligations
Per California Insurance Code §166.5 and CCR §2695.6(a), all claims adjusters operating in California are required to complete:

24 hours of continuing education every two years

Including 3 hours dedicated to ethics training

This requirement exists to ensure that all adjusters remain current on applicable laws and uphold the ethical standards that prevent abuse or mistreatment of policyholders.

Refusing to provide verification of your compliance with these requirements is deeply concerning. While license records may not be generally disclosed publicly, you are operating in a regulatory role and your conduct is already in question. A denial in the face of a formal, justified request implies:

Either a failure to comply with mandatory training requirements,

Or a refusal to demonstrate professional accountability.

Either raises further questions about your capacity to fairly and lawfully adjust claims and may necessitate referral to the California Department of Insurance for license compliance review.

IV. Mischaracterization of Clear Requests
Your claim that you “do not understand” our March 27 request is problematic on multiple levels:

The request was written in plain, specific legal language

You did not attempt to clarify; instead, you dismissed it entirely

This response appears to be a deliberate obstruction in violation of:

CCR §2695.5(e): Requires a full and clear response within 15 days

Insurance Code §790.03(h)(3): Prohibits failing to conduct a reasonable investigation

You are licensed to handle regulated insurance matters and are presumed competent in interpreting basic statutory and regulatory terminology. A claim of “not understanding” suggests either:

A lack of qualifications, or

A strategic evasion of accountability.

Both possibilities violate the ethical foundation of insurance adjusting.

V. Improper Use of the “Work Product” Doctrine
You cited “work product” as a reason to deny access to call recordings and the claim file. This is legally incorrect:

California Code of Civil Procedure §2018.030 defines work product narrowly:

Only material “prepared in anticipation of litigation” by counsel or their agents is protected.

Routine communications (e.g., recorded calls with insureds, internal claim notes) are not protected unless litigation is ongoing and the specific document was created for that purpose.

Further, Insurance Code §791.08(a) specifically overrides this assertion by requiring disclosure of personal information collected by the insurer about the insured.

Blanket claims of “work product” to deny insureds access to their own records violate public policy and may rise to the level of an unfair claims practice.

VI. ALE Coverage Limits and Misinterpretation of Policy
Your communication suggests that ALE benefits will terminate when the policy limit is exhausted—without consideration of California law or the policy language itself, which states:

“Payment will be for the shortest time required to repair or replace the damage or, if you permanently relocate, the shortest time required for your household to settle elsewhere.”

You failed to address:

That we have not permanently relocated

That our home remains uninhabitable

That repairs are incomplete and actively delayed

Moreover, California Insurance Code §§2060 & 2071 are clear:

Subrogation activity does not reduce or eliminate benefits owed

ALE must be provided for the actual duration required under policy terms—not prematurely terminated due to internal budget limits or forecasts

VII. Case Law Supporting Our Position (Expanded)
Gruenberg v. Aetna Ins. Co., 9 Cal.3d 566 (1973)

Held that an insurer owes an affirmative duty of good faith and fair dealing in claims handling. Focusing on insignificant issues (e.g., postcards) while delaying ALE payments violates this duty.

Hangarter v. Provident Life & Acc. Ins. Co., 373 F.3d 998 (9th Cir. 2004)

Established that persistent delays and evasive conduct can amount to bad faith, even where some benefits are eventually paid.

Egan v. Mutual of Omaha Ins. Co., 24 Cal.3d 809 (1979)

Insurers cannot use bureaucratic procedures to delay or avoid their obligations.

Wilson v. 21st Century Ins. Co., 42 Cal.4th 713 (2007)

A technical justification for delay or denial will not shield an insurer from liability where the claim is otherwise clearly owed.

VIII. Timeline of Delays & Violations
January 5, 2024: Date of loss

February–June 2024: First 6 months with incomplete inspections & repair plan

July–December 2024: Multiple invoices paid, but no resolution of long-term displacement

January 2025: Adjuster finally replaced after numerous complaints

March 2025: Still no full damage confirmation, ceiling remains unopened

March 27, 2025: Our detailed request denied, no governing law cited, no education compliance confirmed

We are now at Month 15 of a claim that is expected to resolve in 6–12 months under typical circumstances. This gross delay, combined with evasive behavior, is presumptively unreasonable.

IX. Summary of Violations
Failure to provide the full claim file & recordings: §791.08(a), §2695.3(a)

Failure to substantively respond to a valid request: §2695.5(e)

Refusal to verify adjuster training compliance: §2695.6(a)

Improper “work product” denial: §2018.030 misused

Premature termination of ALE: §2060, §2071, policy language

Mischaracterization of requests: §790.03(h)(1)–(5)

X. Demands and Next Steps
We again demand:

Full claim file including internal notes and all call recordings

Statutory and legal basis for denial of each withheld item

Privilege log per §2018.030

Confirmation of compliance with CE and ethics training

Monthly updates of claim documentation until claim is closed

Written confirmation that ALE will not end prematurely

Acknowledgment of duties under each cited code, regulation, and policy provision

XI. Escalation & Oversight
If California Casualty continues to:

Delay

Deny access to claim documents

Misuse legal protections

Fail to cite governing authority

…we will escalate this matter immediately to:

California Department of Insurance

State Auditor’s Office

Civil legal counsel

Press and media outlets if necessary

Respectfully,

Stephen & Alison Stroot

Do all the governing documents check out? Are there any other recommendations?

Go ahead & rewrite with the adjustments.