- (1) "Authorized agent" means an individual, corporation, association, organization, partnership, or other legal entity authorized to represent an insurer with respect to a claim.
- (2) "Claim file" means a record either in its original form or as recorded by a process that can accurately and reliably reproducer the original material regarding a claim, its investigation, adjustment, and settlement.
(3)(a) "Claimant" means a first party claimant, a third party claimant, or both.
- (b) "Claimant" includes a claimant's designated legal representative and an immediate family member.
- (4) "Day" means calendar day.
- (5) "Documentation" means a physical or an electronic record related to a claim.
(6)(a) "First party claimant" means a person asserting a right to a benefit under a policy to which the person is a party.
- (b) "First party claimant" includes a person's designated legal representative and an immediate family member.
- (7) "General business practice" means a pattern of conduct in a business.
- (8) "Investigation" means an activity by or on behalf of an insurer related to determining a claim under a policy.
- (9) "Notice of loss" means a claimant's notice that reasonably informs an insurer of facts related to a claim.
- (10) "Proof of loss" means an insured's reasonable documentation in support of a claim.
- (11) "Third party claimant" means a person asserting a claim against an insured.
Terms used in this rule are defined in Section 31A-1-301. Additional terms are defined as follows:
KEY: insurance law
Date of Last Change: June 7, 2024
Notice of Continuation: April 3, 2024
Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-26-301; 31A-26-303; 31A-21-312; 31A-2-308