Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 26 - Trade Practices › Article 1 - Unfair Claims Settlement Acts or Practices › 3 AAC 26.300 - Definitions

Current through May 31, 2024
In this chapter,
(1) "claim" means notice that an event, act
				  or omission has occurred which may result in injury or damage for which an
				  insured may be legally obligated to pay;
(2) "claimant" means a first-party claimant,
				  a third-party claimant, or both, and includes the claimant's legal
				  representative and includes a member of the claimant's immediate family if
				  authorized by the claimant;
(3)
				  repealed 8/20/2016;
(4)
				  "destination or delivery charges" means the charges for shipping a motor
				  vehicle to a primary residence of the claimant or to where the motor vehicle is
				  primarily operated;
(5)
				  "first-party claimant" means a person asserting a right to payment under his or
				  her own coverage;
(6) "frequency as
				  to indicate a general business practice" means violation of any one standard
				  committed on one or more percent of claims handled within a 12-month period, or
				  the repeated violation of a single standard without reasonable
				  explanation;
(7) "local market
				  area" means the geographical area, in the closest proximity to the claimant's
				  residence, in which two or more licensed dealers are located;
(8) "outside attorney" means an attorney who
				  is in private practice and not an employee of a person transacting a business
				  of insurance under AS 21;
(9)
				  repealed 8/20/2016;
(10)
				  "third-party claimant" means any person asserting a claim against any other
				  person;
(11) repealed
				  9/15/2004;
(12) "working days"
				  means all calendar days except Saturdays, Sundays, all official federal
				  holidays, and all official Alaska holidays.
(13) "comparable motor vehicle" means a motor
				  vehicle by the same manufacturer, of the same or newer model year, and with
				  similar body style, similar options, and similar mileage as the loss vehicle,
				  and in as good or better condition;
(14) "licensed," when used with reference to
				  a dealer, supplier, or contractor, means in possession of a current business
				  license under AS 43.70 and 12 AAC 12;
(15) "similar mileage" means having mileage
				  that does not exceed the mileage of the loss vehicle on the date of loss by
				  more than 4,000 miles or 10 percent of the mileage of the loss vehicle,
				  whichever is greater.
(16) "clean
				  claim" has the meaning given in
				  AS
				  21.36.495;
(17) "electronic funds transfer" means a
				  paperless or cardless transfer of funds initiated by an insurer to authorize a
				  financial institution to credit a claimant's account using the insurer's funds
				  in order to pay a judgment or settlement of a claim;
(18) "emergency medical condition" means a
				  medical condition manifesting itself by acute symptoms of sufficient severity,
				  including severe pain, that a prudent person who possesses an average knowledge
				  of health and medicine could reasonably expect that the absence of immediate
				  medical attention would result in serious impairment of bodily functions,
				  serious dysfunction of a bodily organ or part, or would place the person's
				  health or, with respect to a pregnant woman, the health of the woman or her
				  unborn child, in serious jeopardy.
(19) "emergency services" means medical care
				  services or items furnished or required to evaluate and treat an emergency
				  medical condition;
(20) "health
				  care insurance" has the meaning given in
				  AS
				  21.12.050;
(21) "prepaid card product" means a
				  reloadable card issued by a financial institution in the name of the claimant
				  that is loaded with funds from an insurer to pay a judgment or settlement of a
				  claim;
(22) "procedure code" means
				  a universal code used by a health care provider to identify the services or
				  supplies provided to an insured under a health care insurance policy.
In 2010 the revisor of statutes, acting under
						AS
						01.05.031, redesignated former
						AS
						21.36.350 as
						AS
						21.36.125(c). As of Register
						196 (January 2011), the regulations attorney made a conforming technical
						revision under
						AS
						44.62.125(b)(6), to the
						authority citation that follows
						3 AAC 26.300, deleting the citation to former
						AS
						21.36.350 to reflect that the authority
						citation already includes a citation to
						AS
						21.36.125, the section where material
						formerly in
						AS
						21.36.350 was
						relocated.
Authority:
AS
						21.06.090
AS 21.12.050
AS 21.36.125
AS
						21.36.495