Ala. Admin. Code r. 482-1-125-.03

Current through Register Vol. 42, No. 7, April 30, 2024

Section 482-1-125-.03 - Definitions

In addition to the definitions contained in the Trade Practices Act and Section 27-1-2, Code of Ala. 1975, which are hereby incorporated by reference, the following definitions shall apply for purposes of this chapter:

(a) Claimant. A first party claimant, a third party claimant, or both and includes the claimant's designated legal representative and includes an adult member of the claimant's immediate family designated in writing by the claimant.

(b) Claim file. Any retrievable electronic file, paper file or combination of both relative to the claim that may contain:

The notice of claim, claims forms, proof of loss or other form of claim submission, settlement demands, accident reports, police reports, adjusters logs, claim investigation documentation, inspection reports, supporting bills, estimates and valuation worksheets, medical records, correspondence to and from insureds and claimants or their representatives, notes, contracts, declaration pages, certificates evidencing coverage under a group contract, endorsements or riders, work papers, any written communication, any documented or recorded telephone communication related to the handling of a claim, including the investigation, payment or denial of the claim, copies of claim checks or drafts, or check numbers and amounts, releases, all applicable notices, correspondence used for determining and concluding claim payments or denials, subrogation and salvage documentation, any other documentation, maintained in a paper or electronic format, necessary to support claim handling activity, and any claim manuals or other information necessary for reviewing the claim.

(c) Days. Calendar days calculated as set forth in the Alabama Rules of Civil Procedure.

(d) Documentation. All pertinent communications, transactions, notes, work papers, claim forms, photographs, bills and explanation of benefits forms and all other records relative to the claims.

(e) First party claimant. An individual, corporation, association, partnership or other legal entity asserting a policy coverage as applicable as a named insured, policyholder, or a person insured by definition under an insurance policy or insurance contract arising out of the occurrence of a loss or a loss contingency covered by the policy or contract.

(f) INSURER. As set forth in Section 27-1-2, Code of Ala. 1975.

(g) Investigation. All activities of an insurer directly or indirectly related to the determination of liabilities under coverages afforded by an insurance policy or insurance contract.

(h) NOTICE OR Notification of A claim. Any notice or notification, whether in writing, verbal or other means acceptable under the terms of an insurance policy to an insurer or its producer, by a claimant, which reasonably apprises the insurer of the facts pertinent to a claim.

(i) Producer. As defined in Section 27-7-1, Code of Ala. 1975.

(j) RECEIPT DATE. The date received which could be confirmed either by facsimile, electronic or other recognized confirmation or signed certified return mail receipt.

(k) Replacement Crash Part. For purposes of this chapter, means non-mechanical sheet metal or plastic parts which generally constitute the exterior of a motor vehicle, including inner and outer panels as set forth in Section 32-17A-1etseq., Code of Ala. 1975.

(l) Service Representative. As defined in Section 27-7-1.

(m) Third party claimant. Any person other than a first party claimant asserting a claim against any person under a policy or certificate of an insurer.

(n) Written communications. All correspondence, regardless of source or type, that is materially related to the handling of the claim.

Author: Commissioner of Insurance

Ala. Admin. Code r. 482-1-125-.03

New Rule: May 27, 2003; effective June 9, 2003. Filed with LRS May 30, 2003. Rule is not subject to the Alabama Administrative Procedure Act.

Statutory Authority:Code of Ala. 1975, §§ 27-2-17, 27-1-17, 27-1-19, 27-12-21, 27-12-24, 27-14-8, 27-14-11, 27-14-9.