All definitions contained in the Unfair Insurance Claims
Settlement Practices Act are hereby incorporated by reference. As otherwise
used in this regulation:
003.01 Agent
"Agent" means any individual, corporation, association,
partnership or other legal entity authorized to represent an insurer with
respect to a claim;
003.02
Automobile
"Automobile" means a four wheel motor vehicle of the private
passenger, station wagon, pickup, panel or delivery type;
003.03 Claim file
"Claim file" means any retrievable electronic file,
microfilm/microfiche file, paper file, or any combination
thereof;
003.04 Claimant
"Claimant" means either a first party claimant, a third party
claimant, or both and includes the claimant's designation legal representative
or a member of the claimant's immediate family designated by the
claimant;
003.05 Days
"Days" means working days;
003.06 Documentation
"Documentation" includes, but is not limited to, all
pertinent communications, transactions, notes, work papers, claim forms, bills
and explanation of benefits forms relative to the claim;
003.07 First party claimant
"First party claimant" means an individual, corporation,
association, partnership or other legal entity asserting a right to payment
under an insurance policy or insurance contract arising out of the occurrence
of the contingency or loss covered by the policy or contract;
003.08 Investigation
"Investigation" means all activities of an insurer directly
or indirectly related to the determination of liabilities under coverages
afforded by an insurance policy or insurance contract;
003.09 Notification of claim
"Notification of claim" means any notification by a claimant,
whether in writing or by other means acceptable under the terms of an insurance
policy, business custom or statute, to an insurer or its agent which reasonably
apprises the insurer of the facts pertinent to a claim;
003.10 Third party claimant
"Third party claimant" means any person asserting a claim
against any person under a policy or certificate of an insurer;
and
003.11 Written
communications
"Written communications" includes all correspondence,
regardless of source or type, that is related to the handling of the claim.
Written communications shall be effectively communicated when placed in the
mail with adequate first class postage.
