Md. Code Regs. 31.15.12.02

Current through Register Vol. 51, No. 12, June 14, 2024

Section 31.15.12.02 - Definitions

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

B. Terms Defined.

(1) "Business day" means a day other than Saturday, Sunday, a federal holiday, or a State holiday as designated by State Personnel and Pensions Article, § 9-201, Annotated Code of Maryland.

(2) "Claim" means a demand for payment or reimbursement for a loss incurred under one or more coverages provided by an insurance policy.

(3) "Claimant" includes a first-party claimant and a third-party claimant.

(4) "First-party claimant" means a person asserting a right to payment:

(a) Under an insurance policy pursuant to which the person is insured; and

(b) That arises out of a loss that is covered by the insurance policy.

(5) "Motor vehicle" has the meaning stated in Insurance Article, § 19-501(b), Annotated Code of Maryland.

(6) "Notification of a claim" means notification by a claimant that:

(a) Is made in writing or by other means acceptable under the terms of an insurance policy;

(b) Reasonably informs the insurer of the facts pertinent to the claim; and

(c) Is made:

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

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

(7) "Substantially similar motor vehicle" means a motor vehicle that, in comparison to a damaged motor vehicle:

(a) Is the same make and model as the damaged motor vehicle;

(b) Is the same year as, or a more recent year than, the damaged motor vehicle;

(c) Contains at least the same major options as the damaged motor vehicle;

(d) Is in a condition substantially similar to or better than the condition of the damaged motor vehicle immediately before the damage occurred; and

(e) Has mileage that is within the greater of 4,000 miles or 10 percent of the mileage on the damaged motor vehicle at the time that the damage occurred unless the vehicle is limited in production, specialty in nature, or older than 10 model years at the time of total loss.

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

(9) "Total loss" means the condition of a motor vehicle for which:

(a) The cost of repairs equals or exceeds:

(i) The actual cash value of the motor vehicle as calculated in accordance with Regulation .04 of this chapter; or

(ii) A percentage of the actual cash value of the motor vehicle established by the insurer and calculated in accordance with Regulation .04 of this chapter; or

(b) The total cost to repair the motor vehicle, plus the estimated cost of potential repairs from hidden damage, plus any anticipated rental coverage, may equal or exceed:

(i) The actual cash value of the motor vehicle as calculated in accordance with Regulation .04 of this chapter; or

(ii) A percentage of the actual cash value of the motor vehicle established by the insurer and calculated in accordance with Regulation .04 of this chapter.

Md. Code Regs. 31.15.12.02