Md. Code Regs. 31.01.02.03 - Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) All Other Lines.

(a) "All other lines " means any line of business or coverage that is not included in any of the line/coverage definitions under this chapter for which claims attributable to a disaster subject to a data call were reported.

(b) "All other lines" does not include mortgage/financial guaranty, title, fidelity, surety, medical malpractice, or professional liability insurance lines of business.

(2) "Business interruption insurance" means insurance that covers the loss of income, continuing fixed expenses, or extra expenses a business suffers after a disaster while its facility is either closed because of the disaster or in the process of being rebuilt after the disaster.

(3) Case Incurred Loss.

(a) "Case incurred loss" means indemnity case reserves plus payments to date.

(b) "Case incurred loss" does not include estimates of incurred but not reported (IBNR) losses.

(4) "Casualty insurance" has the meaning stated in Insurance Article, § 1-101, Annotated Code of Maryland.

(5) Claims Closed with Payment.

(a) "Claims closed with payment" means all claims closed where a loss payment was made regardless of the date of loss or when the claim was received.

(b) "Claims closed with payment" does not include claims closed where loss adjustment expense was incurred but no payment to the insured was made.

(6) Claims Closed without Payment.

(a) "Claims closed without payment" means all claims closed where no loss payment was made regardless of the date of loss or when the claim was received.

(b) "Claims closed without payment" includes claims closed where loss adjustment expense was incurred but no payment to the insured was made.

(7) "Claims reported" means all claims reported regardless of whether a payment was made.

(8) "Closed claim" means a claim:

(a) That has been settled and the claimant has received a payment even if the claimant may receive additional payment or payments from the insurer if the claimant provides additional information to the insurer regarding replacement or other costs as they are incurred;

(b) For which the claimant has not received a payment because the amount is less than the deductible;

(c) That has been withdrawn by the insured; or

(d) That has been denied.

(9) "Commercial auto insurance" means liability and physical damage insurance that covers vehicles used for commercial purposes.

(10) "Commercial property" means all property not categorized as residential property.

(11) Copayment means a specified charge that a covered person pays each time services of a particular type or in a designated setting are received.

(12) Deductible means the amount of allowable charges that are incurred by an individual or family per year before a carrier begins payment.

(13) Eligible individual means an individual who:

(a) Enrolled in Medicare Part B while enrolled in the Maryland Medical Assistance Program;

(b) Remained in the Maryland Medical Assistance Program due to a suspension of terminations by the Maryland Medical Assistance Program during a state of emergency, and was not disenrolled until or terminated until at least 6 months following the effective date of enrollment in Part B of Medicare;

(c) Seeks to enroll in a Medicare supplement policy during the 63-day period following the later of notice of termination or disenrollment or the date of termination from the Maryland Medical Assistance Program; and

(d) Submits evidence of the date of termination or disenrollment from the Maryland Medical Assistance Program with the application for a Medicare supplement policy.

(14) Farm owners insurance means insurance that provides liability coverage and coverage for damage to physical structures and other property located on a farm.

(15) Health benefits means a policy or certificate that includes benefits for hospital or medical services issued by a carrier.

(16) Health carrier means:

(a) An insurer;

(b) A nonprofit health service plan;

(c) A health maintenance organization; and

(d) A dental plan organization.

(17) Health insurance has the meaning stated in Insurance Article, § 1-101, Annotated Code of Maryland.

(18) Homeowners insurance means insurance for residential property provided under:

(a) A homeowners policy;

(b) A condominium owners policy;

(c) A mobile homeowners policy;

(d) A renters policy; or

(e) A noncommercial farm owners policy.

(19) Life insurance has the meaning stated in Insurance Article, § 1-101, Annotated Code of Maryland.

(20) Loss payment means the portion of an incurred loss that is paid by the insurer.

(21) Percentage of claims closed means a percentage calculated as (claims closed with payment + claims closed without payment)/(claims reported).

(22) Premium finance company has the meaning stated in Insurance Article, § 23-101, Annotated Code of Maryland.

(23) Private Passenger Auto Insurance.

(a) Private passenger auto insurance means liability and physical damage insurance that covers a vehicle driven for personal use.

(b) Private passenger auto insurance includes automobiles, motorcycles, and recreational vehicles.

(24) Privately issued flood insurance means specific insurance coverage against property loss from flooding under any policy or endorsement, issued by any entity other than the National Flood Insurance Program (NFIP).

(25) Property insurance has the meaning stated in Insurance Article, § 1-101, Annotated Code of Maryland.

(26) "Specified illness" means an illness, disease, virus, or infection for which:

(a) The Governor has declared or has renewed a declaration of a state of emergency for the State or an area within the State under Public Safety Article, § 14-107, Annotated Code of Maryland;

(b) The President of the United States has issued a major disaster or emergency declaration for the State or an area within the State under the federal Stafford Act; or

(c) A national or public health emergency that within the Commissioner's discretion affects the State and is:

(i) Issued by the President of the United States under §201, 202(d), or 301 of the Federal National Emergencies Act or by the Secretary of Health and Human Services under the Federal Public Health Service Act; and

(ii) Based on a serious threat to health resulting from the existence of a deadly agent as defined in Public Safety Article, § 14-3A-01, Annotated Code of Maryland.

(27) Workers Compensation Insurance.

(a) Workers compensation insurance means insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employees right to sue the employees employer for the tort of negligence.

(b) Workers compensation insurance includes associated employers liability coverage.

Notes

Md. Code Regs. 31.01.02.03

Regulation .03 amended effective 43:5 Md. R. 387, eff.7/1/2016; amended effective 49:25 Md. R.1041-1070, eff. 12/12/2022