1. (1) An insurer's claim file is subject to examination by the commissioner.

2. (2) To aid in an examination, an insurer shall maintain:

   1. (a) claim data that is accessible and retrievable for examination, including:

      1. (i) the policy number;
      2. (ii) the certificate number, if any;
      3. (iii) a duplicate of the policy, as issued;
      4. (iv) the claim number;
      5. (v) the date of loss;
      6. (vi) the date the notice of loss was received, if required;
      7. (vii) the date the proof of loss was received;
      8. (viii) the date an investigation began and was complete;
      9. (ix) the date of a benefit determination;
      10. (x) the date of the settlement of the claim;

      11. (xi) the type of settlement, indicated as:

          1. (A) payment, including the amount paid;
          2. (B) settled without payment; or
          3. (C) denied;
      12. (xii) documentation supporting how the claim was settled and how any payments were calculated; and
      13. (xiii) other documentation relied upon for claim settlement;
   2. (b) detailed documentation in each claim file permitting the reconstruction of the insurer's activities related to the claim; and
   3. (c) the claim file record in a hard copy or other format that has the capability of duplication to hard copy.

3. (3) The data in Subsection (2) shall:

   1. (a) be available for all open and closed files for at least the most recent three-year period; or
   2. (b) for a Utah domiciled insurer, be available from the date of the previous examination by the commissioner.

KEY: insurance law

Date of Last Change: October 29, 2025

Notice of Continuation: June 10, 2024

Authorizing, and Implemented or Interpreted Law: 31A-1-301; 31A-2-201; 31A-2-204; 31A-2-308; 31A-21-312; 31A-26-303