Md. Code Regs. 31.15.07.02

Current through Register Vol. 51, No. 9, May 3, 2024

Section 31.15.07.02 - Definitions

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

B. Terms Defined.

(1) "Application" means an initial application for the issuance of an insurance policy.

(2) "Claim" means a demand for payment or an inquiry regarding the possibility of payment for a loss incurred under one or more coverages provided by the policy.

(3) "Claimant" means either a first-party claimant or a third-party claimant and may include, in a particular case, the claimant's designated legal representative or a member of the claimant's immediate family designated by the claimant.

(4) "First-party claimant" means any person asserting a right to payment under an insurance policy pursuant to which the person is insured, which right arises out of the occurrence of a contingency or loss covered by the policy.

(5) "Investigation" means all activities of an insurer directly or indirectly related to the determination of the insurer's liabilities under coverages afforded by an insurance policy.

(6) "Licensed producer" means a person issued a license in accordance with the provisions of Insurance Article, Title 10, Subtitle 1, Annotated Code of Maryland.

(7) Notification of a claim means notification by a claimant, in writing or by other means acceptable under the terms of the insurance policy, which reasonably apprises the insurer of the facts pertinent to the claim and which is made:

(a) Directly to the insurer in the case of a title insurance policy;

(b) Directly to the Maryland Automobile Insurance Fund in the case of a policy issued by the Fund; or

(c) To an insurer or its producer who has an appointment from that insurer as defined in Insurance Article, § 1-101(f), Annotated Code of Maryland, in all other cases.

(8) "Policy" means an individual or group policy, contract, or certificate issued by an insurer.

(9) "Producer" means any person authorized to represent an insurer with respect to a claim, or a licensed producer.

(10) "Proof of loss" means the submission to an insurer of all factual information necessary for an insurer to determine the nature of the loss, the applicable coverage, and the amount due under that applicable coverage.

(11) "Third-party claimant" means any person asserting a claim against a person insured under an insurance policy.

(12) "Unreasonable delay" means, except with respect to claims for personal injury protection benefits made pursuant to Insurance Article, § 19-505, Annotated Code of Maryland, the failure to make payment to claimants of amounts properly due them within 15 working days after receipt of a properly completed claim form or other proof of loss unless a longer period of time is provided for in the insurance contract or unless otherwise provided for by law, when there is no significant dispute as to coverage, liability, and amount of damages.

Md. Code Regs. 31.15.07.02

Regulation .02B amended effective January 14, 2010 (37:1 Md. R. 17); Regulation .02 amended effective 43:2 Md. R. 129, eff.2/1/2016