2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 47 - WORKERS' COMPENSATION FRAUD ACT (§§ 56-47-101 — 56-47-112) › Section 56-47-102 - Chapter definitions

As used in this chapter, unless the context otherwise requires:
(1)
"Actual malice" means the knowledge that information is false, or reckless disregard of whether it is false;
(2)
"Conceal" means to take affirmative action to prevent others from discovering information. Mere failure to disclose information does not constitute concealment. Action by the holder of a legal privilege, or one who has a reasonable belief that a privilege exists, to prevent discovery of privileged information does not constitute concealment;
(3)
"Insurance policy" means the written instrument in which are set forth the terms of any binder of coverage or contract of insurance, including a binder or contract issued by a state-assigned risk plan, or other forms of workers' compensation insurance;
(4)
"Insurance professional" means sales agents, managing general agents, brokers, producers, adjusters and third party administrators;
(5)
"Insurance transaction" means a transaction by, between or among an:
(A)
Insurer or a person who acts on behalf of an insurer; and
(B)
Insured, claimant, applicant for insurance, public adjuster, insurance professional, practitioner or any person who acts on behalf of any of the insureds, claimants, applicants for insurance, public adjusters, insurance professionals and practitioners, for the purpose of obtaining insurance or reinsurance, calculating insurance premiums, submitting a claim, negotiating or adjusting a claim or otherwise obtaining insurance, self-insurance or reinsurance or obtaining the benefits of or from insurance, self-insurance or reinsurance;
(6)
"Insurer" means any person purporting to engage in the business of insurance or authorized to do business in this state or subject to regulation by the state, who undertakes to indemnify another against loss, damage or liability arising from a contingent or unknown event related to causes arising under title 50, chapter 6;
(7)
"Pattern or practice" means repeated, routine or generalized in nature, and not merely isolated or sporadic;
(8)
"Person" means a natural person, company, corporation, unincorporated association, partnership, professional corporation, agency of government or any other entity;
(9)
"Practitioner" means a licensee of this state authorized to practice medicine and surgery, psychology, chiropractic or law or any other licensee of state or person required to be licensed in this state whose services are compensated either in whole or in part, directly or indirectly, by insurance proceeds;
(10)
"Premium" means consideration paid or payable for coverage under an insurance policy. "Premium" includes any payments, whether due within the insurance policy term or otherwise, and deductible payments whether advanced by the insurer or insurance professional and subject to reimbursement by the insured or otherwise, any self-insured retention or payments, whether advanced by the insurer or insurance professionals and subject to reimbursement by the insured or otherwise, and any collateral or security to be provided to collateralize obligations to pay any of the above;
(11)
"Premium avoidance" means any intentional material misrepresentation by an employer of any or all of the four (4) premium determinants. The determinants are employee job classifications, amount of payroll in each classification, geographic location of insured operations, and history of past losses. Intentional misrepresentation of each of these items can affect the total premium charged by an insurer to a workers' compensation risk;
(12)
"Reckless" means without reasonable belief of the truth, or, for the purposes of §
56-47-104(a)(3)
, with a high degree of awareness of probable insolvency; and
(13)
"Withhold" means to fail to disclose facts or information that any law other than this chapter requires to be disclosed. Mere failure to disclose information does not constitute "withholding" if the one failing to disclose reasonably believes that there is no duty to disclose.
Acts 1996, ch. 944, § 48; 1998, ch. 1024, § 11.