2023 Oklahoma Statutes › Title 36. Insurance › §36-2004. Definitions.

As used in the Oklahoma Property and Casualty Insurance Guaranty Association Act:
1. "Affiliate" means a person who directly or indirectly, through one or more intermediaries, controls, is controlled by, or is under common control with another person on December 31 of the year next preceding the date the insurer becomes an insolvent insurer;
2. "Association" means the Oklahoma Property and Casualty Insurance Guaranty Association as created in Section 2005 of this title;
3. "Assumed claims transaction" means:
a.
policy obligations that have been assumed by the insolvent insurer, prior to the entry of a final order of liquidation, pursuant to a plan, approved by a domestic commissioner of the assuming insurer, which transfers the direct policy obligations and future policy renewals from one insurer to another insurer, or
b.
an assumption reinsurance transaction in which all of the following have occurred:
(1)
the insolvent insurer assumed, prior to the entry of a final order of liquidation, the claim or policy obligations of another insurer under the claims or policies,
(2)
the assumption of the claim or policy obligations has been approved, if an approval is required, by the appropriate regulatory authorities, and
(3)
as a result of the assumption, the claim or policy obligations became the direct obligations of the insolvent insurer through novation of the claims or policies;
4. "Claimant" means any person instituting a covered claim; provided that no person who is an affiliate of the insolvent insurer may be a claimant;
5. "Commissioner" means the Insurance Commissioner of Oklahoma;
6. "Control" means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. Control shall be presumed to exist if a person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing ten percent (10%) or more of the voting securities of any other person. This presumption may be rebutted by a showing that control does not exist in fact;
7. "Covered claim" means:
a.
an unpaid claim, including one of unearned premiums, submitted by a claimant, which arises out of and is within the coverage and is subject to the applicable limits of an insurance policy to which this act applies, if the insurer becomes an insolvent insurer after the effective date of this act and the policy was issued by the insurer, and:
(1)
the claimant or insured is a resident of this state at the time of the insured event, provided that for entities other than an individual, the residence of a claimant or insured is the state in which its principal place of business is located at the time of the insured event, or
(2)
the property from which the claim arises is permanently located in this state,
b.
"Covered claim" shall not include:
(1)
any amount awarded as punitive or exemplary damages,
(2)
any amount sought as a return of premium under any retrospective rating plan,
(3)
any amount due any reinsurer, insurer, insurance pool, or underwriting association, health maintenance organization, hospital plan corporation, professional health service corporation or self-insurer as subrogation recoveries, reinsurance recoveries, contribution, indemnification or otherwise. No claim for any amount due any reinsurer, insurer, insurance pool, or underwriting association, health maintenance organization, hospital plan corporation, professional health service corporation or self-insurer may be asserted against a person insured under a policy issued by an insolvent insurer other than to the extent the claim exceeds the association obligation limitations set for in Section 2007 of this title,
(4)
any claims excluded pursuant to Section 15 of this act due to the high net worth of an insured,
(5)
any first party claims by an insured that is an affiliate of the insolvent company,
(6)
any fee or other amount relating to goods or services sought by or on behalf of any attorney or other provider of goods and services retained by the insolvent insurer or an insured prior to the date it was determined to be insolvent,
(7)
any fee or other amount sought by or on behalf of any attorney or other provider of goods and services retained by any insured or claimant in connection with the assertion or prosecution of any claim, covered or otherwise, against the Association,
(8)
any claims for interest,
(9)
any claim filed with the association or a liquidator for protection afforded under the policy of the insured for incurred-but-not-reported losses, or
(10)
notwithstanding any other provision of this act or any other law to the contrary, a claim that is filed with the association on a date that is later than eighteen (18) months after the date of the order of liquidation or that is unknown and unreported as of said date; provided, however, that this shall not include any claim for workers' compensation benefits pursuant to Title 85A of the Oklahoma Statutes and the applicable rules of OAC Title 810;
8. "Insolvent insurer" means an insurer that is licensed to transact insurance in this state either at the time the policy was issued, when the obligation with respect to the covered claim was assumed under an assumed claims transaction, or when the insured event occurred and against whom a final order of liquidation has been entered after the effective date of this act with a finding of insolvency by a court of competent jurisdiction in the state of domicile of the insurer;
9. "Insured" means any named insured, any additional insured, any vendor, lessor or any other party identified as an insured under the policy;
10. a.
"Member insurer" means any person who:
(1)
writes any kind of insurance to which the Oklahoma Property and Casualty Insurance Guaranty Association Act applies pursuant to Section 2003 of this title, including the exchange of reciprocal or inter-insurance contracts, and
(2)
is licensed to transact insurance in this state, except those insurers enumerated in Section 110 of this title or those insurers that are otherwise exempted by law or order of the Commissioner.
b.
An insurer shall cease to be a member insurer effective on the day following the termination or expiration of its license to transact the kinds of insurance to which the Oklahoma Property and Casualty Insurance Guaranty Association Act applies; however, the insurer shall be liable as a member insurer for any and all obligations, including but not limited to obligations for assessments levied after the termination or expiration, which relate to any insurer that becomes an insolvent insurer prior to the termination or expiration of the license of the insurer;
11. "Net direct written premiums" means direct gross premiums written in this state on insurance policies to which this act applies, including but not limited to policy and membership fees, less the following amounts:
a.
return premiums,
b.
premiums on policies not taken, and
c.
dividends paid or credited to policyholders on direct business. "Net direct written premiums" does not include premiums on contracts between insurers or reinsurers;
12. "Novation" means that the assumed claim or policy obligations became the direct obligations of the insolvent insurer through consent of the policyholder and that thereafter the ceding insurer or entity initially obligated under the claims or policies is released by the policyholder from performing its claim or policy obligations. Consent shall be express and an implied novation shall not be allowed for the purposes, implementation and application of the Oklahoma Property and Casualty Insurance Guaranty Association Act;
13. "Person" means the individual or other entities as defined in Section 104 of this title;
14. "Receiver" means liquidator, rehabilitator, conservator or ancillary receiver, as the context requires; and
15. "Self-insurer" means a person who covers its liability through a qualified individual or group self-insurance program or any other formal program created for the specific purpose of covering liabilities typically covered by insurance.
Added by Laws 1980, c. 362, § 4, emerg. eff. June 27, 1980. Amended by Laws 1986, c. 251, § 30, emerg. eff. June 13, 1986; Laws 1988, c. 252, § 3, eff. Nov. 1, 1988; Laws 2010, c. 159, § 3, eff. Nov. 1, 2010; Laws 2021, c. 478, § 13, emerg. eff. May 12, 2021.