Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-125 - STANDARDS FOR PROPERTY/CASUALTY INSURANCE CLAIMS › Section 482-1-125-.03 - Definitions

Current through Register Vol. 42, No. 9, June 28, 2024
In addition to the definitions contained in the Trade Practices
				Act and Section
				27-1-2,
Code of Ala.
				1975
, which are hereby incorporated by reference, the following
				definitions shall apply for purposes of this chapter:
(a) Claimant. A first party claimant, a third
			 party claimant, or both and includes the claimant's designated legal
			 representative and includes an adult member of the claimant's immediate family
			 designated in writing by the claimant.
(b) Claim file. Any retrievable electronic
			 file, paper file or combination of both relative to the claim that may contain:
The notice of claim, claims forms, proof of loss or other form
				of claim submission, settlement demands, accident reports, police reports,
				adjusters logs, claim investigation documentation, inspection reports,
				supporting bills, estimates and valuation worksheets, medical records,
				correspondence to and from insureds and claimants or their representatives,
				notes, contracts, declaration pages, certificates evidencing coverage under a
				group contract, endorsements or riders, work papers, any written communication,
				any documented or recorded telephone communication related to the handling of a
				claim, including the investigation, payment or denial of the claim, copies of
				claim checks or drafts, or check numbers and amounts, releases, all applicable
				notices, correspondence used for determining and concluding claim payments or
				denials, subrogation and salvage documentation, any other documentation,
				maintained in a paper or electronic format, necessary to support claim handling
				activity, and any claim manuals or other information necessary for reviewing
				the claim.
(c) Days.
			 Calendar days calculated as set forth in the Alabama Rules of Civil
			 Procedure.
(d) Documentation. All
			 pertinent communications, transactions, notes, work papers, claim forms,
			 photographs, bills and explanation of benefits forms and all other records
			 relative to the claims.
(e) First
			 party claimant. An individual, corporation, association, partnership or other
			 legal entity asserting a policy coverage as applicable as a named insured,
			 policyholder, or a person insured by definition under an insurance policy or
			 insurance contract arising out of the occurrence of a loss or a loss
			 contingency covered by the policy or contract.
(f) INSURER. As set forth in Section
			 27-1-2,
Code of Ala.
			 1975
.
(g)
			 Investigation. All activities of an insurer directly or indirectly related to
			 the determination of liabilities under coverages afforded by an insurance
			 policy or insurance contract.
(h)
			 NOTICE OR Notification of A claim. Any notice or notification, whether in
			 writing, verbal or other means acceptable under the terms of an insurance
			 policy to an insurer or its producer, by a claimant, which reasonably apprises
			 the insurer of the facts pertinent to a claim.
(i) Producer. As defined in Section
			 27-7-1,
Code of Ala.
			 1975
.
(j) RECEIPT
			 DATE. The date received which could be confirmed either by facsimile,
			 electronic or other recognized confirmation or signed certified return mail
			 receipt.
(k) Replacement Crash
			 Part. For purposes of this chapter, means non-mechanical sheet metal or plastic
			 parts which generally constitute the exterior of a motor vehicle, including
			 inner and outer panels as set forth in Section
			 32-17A-1
et
seq
.,
Code of
			 Ala. 1975
.
(l) Service
			 Representative. As defined in Section
			 27-7-1.
(m) Third party claimant. Any person other
			 than a first party claimant asserting a claim against any person under a policy
			 or certificate of an insurer.
(n)
			 Written communications. All correspondence, regardless of source or type, that
			 is materially related to the handling of the claim.
Author:
Commissioner of Insurance
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-1-17,
				  27-1-19,
				  27-12-21,
				  27-12-24,
				  27-14-8,
				  27-14-11,
				  27-14-9.