Utah Admin. Code 590-192-4

Current through Bulletin 2024-12, June 15, 2024

Section R590-192-4 - File and Record Documentation

(1) An insurer's claim file is subject to examination by the commissioner.

(2) To aid in an examination, an insurer shall maintain:

(a) claim data that is accessible and retrievable for examination, including:

(i) the policy number;

(ii) the certificate number, if any;

(iii) a duplicate of the policy, as issued;

(iv) the claim number;

(v) the date of loss;

(vi) the date the notice of loss was received, if required;

(vii) the date the proof of loss was received;

(viii) the date an investigation began and was complete;

(ix) the date of a benefit determination;

(x) the date of the settlement of the claim;

(xi) the type of settlement, indicated as:

(A) payment, including the amount paid;

(B) settled without payment; or

(C) denied;

(xii) documentation supporting how the claim was settled and how any payments were calculated; and

(xiii) other documentation relied upon for claim settlement;

(b) detailed documentation in each claim file permitting the reconstruction of the insurer's activities related to the claim; and

(c) the claim file record in a hard copy or other format that has the capability of duplication to hard copy.

(3) The data in Subsection (2) shall:

(a) be available for all open and closed files for at least the most recent three-year period; or

(b) for a Utah domiciled insurer, be available from the date of the previous examination by the commissioner.

Utah Admin. Code R590-192-4

Amended by Utah State Bulletin Number 2023-17, effective 8/22/2023