Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 12 - Trade Practices and Frauds › Section 806 KAR 12:095 - Unfair claims settlement practices for property and casualty insurance

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.2-100,
				304.2-165,
				304.2-340,
				304.3-200(1)(e),
				304.12-010,
				304.12-220,
				304.12-230,
				304.12-235,
				304.14-400,
				304.20-070,
				304.20-150to304.20-180,
				342.325
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110 authorizes the Commissioner of
				Insurance to make reasonable administrative regulations necessary for, or as an
				aid to, the effectuation of any provision of the Kentucky Insurance Code. This
				administrative regulation establishes unfair property and casualty insurance
				claims settlement practices, effectuating
				KRS
				304.3-200(1)(e),
				304.12-010,
				and
				304.12-230.
Section 1. Definitions.
(1) "Agent" means any person authorized to
			 represent an insurer with respect to a claim;
(2) "Claimant" means either a first party
			 claimant, a third-party claimant, or both and includes:
(a) The claimant's designated legal
			 representative, including an administrator, executor, guardian, or similar
			 person, and
(b) A member of the
			 insured's immediate family designated by the claimant;
(3) "Claim file" means any retrievable
			 electronic file, paper file, or both;
(4) "Commissioner" is defined by
			 KRS
			 304.1-050(1);
(5) "Days" means any day, Monday through
			 Friday, except holidays;
(6)
			 "First-party claimant" means a person asserting a right to payment under an
			 insurance policy, certificate, or contract arising out of the occurrence of the
			 contingency or loss covered by the policy, certificate, or contract;
(7) "Insurer" is defined by
			 KRS
			 304.1-040;
(8) "Investigation" means all activities of
			 an insurer related to the determination of liabilities under coverages afforded
			 by a policy, certificate, or contract;
(9) "Local market area" means a reasonable
			 distance surrounding the area where a motor vehicle is principally garaged or
			 the usual location of the article covered by the policy. This area does not
			 mean limited to the geographic boundaries of the Commonwealth;
(10) "Notification of claim" means any
			 notification, whether in writing or by other means acceptable under the terms
			 of the policy, certificate, or contract, to an insurer or its agent, by a
			 claimant, which reasonably apprises the insurer of the facts pertinent to a
			 claim;
(11) "Policy",
			 "certificate", or "contract" means any contract of insurance or indemnity,
			 except for:
(a) Fidelity, suretyship, or
			 boiler and machinery insurance; or
(b) A contract of workers' compensation
			 insurance unless it satisfies the requirements of Section 2 of this
			 administrative regulation.
(12) "Replacement crash part" means sheet
			 metal or plastic parts which generally constitute the exterior of a motor
			 vehicle, including inner and outer panels; and
(13) "Third-party claimant" means any person
			 asserting a claim against any person under a policy, contract, or certificate
			 of an insurer.