2023 Laws of Puerto Rico › TITLE TWENTY-SIX - Insurance (§§ 101 — 10377) › Subtitle 1 - Insurance Generally (§§ 101 — 4513) › Chapter 38 - Miscellaneous Insurance Guaranty Association (§§ 3801 — 3819) › § 3805 - Definitions

As used in this chapter:
(1) Account.— Means any of the two accounts created by § 3806 of this title.
(2) Affiliate.— Means a person who, directly or indirectly, through one or more intermediaries, controls, is controlled by, or is under the common control of an insolvent insurer as of December 31 of the year immediately preceding the date on which the insurer becomes an insolvent insurer.
(3) Claimant.— Means any insured who files a first party claim or any person who files a public liability claim. No person affiliated with the insolvent insurer shall be a claimant.
(4) Association.— Means the Puerto Rico Miscellaneous Insurance Guaranty Association created pursuant to § 3806 of this title.
(5) Control.— Means the direct or indirect possession of the power to direct or induce the direction of the management and public policy of a person, whether through the control of voting stock, or through a contract that is not commercial in nature, for properties or services that are not managerial, or otherwise. The power that results from the position of an official or a corporate office held in that capacity by the individual, shall not be deemed as control. It shall be presumed that there is control of a person, directly or indirectly, owns, controls, holds with a right to vote or holds proxies representing five percent (5%) or more of the voting stock belonging to any person. This presumption may be rebutted with proof that said control does not, in fact, exist.
(6) Covered claim.— Means an unpaid claim, including one for unearned premiums which arises from and is within the coverage, and which is subject to the applicable limits of a insurance policy to which this chapter is applicable, which has been issued by an insurer pursuant to the provisions of this title, if said insurer becomes an insolvent insurer after the effective date of this act, and when:
(a) The claimant or insured is a resident of Puerto Rico at the time in which the event against which he is insured occurs. For entities that are not an individual, the residence of the claimant or of the insured is the state where his main place of business is located at the time the insured event occurs, or
(b) the property from which the claim arises is permanently located in Puerto Rico.
Covered claim.— Shall not include any sum awarded as punitive or exemplary damages; nor procured as a premium return under a retrospective rating plan; nor that is owed to a reinsurer, insurer, insurance pool or underwriting association, as recoveries by subrogation or otherwise.
(7) Insolvent insurer.— Means an insurer authorized to transact insurance in Puerto Rico, whether on the date the policy was issued or when the insured event occurred, and against whom a court of competent jurisdiction has issued a final order of liquidation in the state of domicile of the insurer or in Puerto Rico, based on his insolvency and pursuant to § 4015 of this title, and the same has not been stayed nor been subject to a supersedeas or other comparable order.
(8) Member insurer.— Means any insurer authorized to transact insurance in Puerto Rico, and who subscribes the kinds of insurance to which this chapter is applicable, including the exchange of reciprocal or mutual contracts. This definition shall not include insurers which are exclusively engaged in reinsuring.
Nor shall this definition include the Fire and Allied Lines Joint Insurance Underwriting Association, the Medical-Hospital Professional Liability Insurers Syndicate for Joint Underwriting Insurance, the Assigned Risks Automobile Insurance Plan of Puerto Rico, nor any other association which could be created by law in the future to insure one of the kinds of insurance to which this chapter applies and which is mandatorily composed of the insurers authorized to underwrite this kind of insurance.
Any member insurer who ceases to contract new insurance business in Puerto Rico, but continues to collect premiums on policies which are still in effect with regard to residents of Puerto Rico, or risks located in Puerto Rico, shall continue to be a member insurer while said policies are in effect.
(9) Net direct written premiums.— Means the direct gross premiums written in Puerto Rico on insurance policies to which this chapter is applicable, less return premiums and dividends paid or accredited to the policyholders on said direct businesses. “Net direct written premiums” does not include premiums on contracts between insurers or reinsurers.
History —Ins. Code, added as § 38.050 on Aug. 17, 1991, No. 72, § 1.