Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 16 - MISCELLANEOUS › Chapter 31.16.10 - Complaint Investigation and Determination Process › Section 31.16.10.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Administration" has the meaning stated in Insurance Article, §
										1-101, Annotated Code of Maryland.
(2) "Carrier" means:
(a) An insurer;
(b) A nonprofit health service plan;
(c) A dental plan organization;
(d) A fraternal benefit society;
(e) A health maintenance organization; or
(f) The Maryland Automobile Insurance Fund (MAIF).
(3) "Commissioner" means the Insurance Commissioner of Maryland or the Insurance Commissioner's designee.
(4) "Complainant" means a person who files a complaint with the Commissioner.
(5) Complaint.
(a) "Complaint" means any written communication received by the Commissioner that expresses dissatisfaction with a carrier.
(b) "Complaint" includes an oral communication received by the Commissioner, which is subsequently converted to a written form.
(c) "Complaint" does not include a dispute regarding a claim that is resolved by the Consumer Education and Advocacy Unit through the Rapid Response Program.
(d) "Complaint" includes a dispute that is initially handled by the Consumer Education and Advocacy Unit that is not resolved and is referred for a complaint investigation.
(e) "Complaint" does not include actions taken under Insurance Article, §
											27-1001, Annotated Code of Maryland.
(f) "Complaint" does not include a dispute that is subject to the authority of the Workers' Compensation Commission.
(6) "Complaint investigation" means the process used by the Commissioner to determine if a carrier has violated a State statute, regulation, or order in its dealings or interactions with the complainant, to the extent the Commissioner has the authority to enforce that statute, regulation, or order.
(7) Determination.
(a) "Determination" means a decision by the Commissioner that requires the Commissioner to provide the opportunity for a hearing to a person aggrieved by the decision under Insurance Article, §
											2-210, Annotated Code of Maryland.
(b) "Determination" includes:
(i) A decision as to whether a carrier against whom a complaint has been received violated a law, regulation, or order; and
(ii) An order or notice issued under Insurance Article, §
												2-204, Annotated Code of Maryland.
(8) "Health care provider" means:
(a) A hospital, as defined in Health-General Article, §19-301, Annotated Code of Maryland; or
(b) A person who is:
(i) Licensed under Health Occupations Article, Annotated Code of Maryland, or similar laws of another state, to render health care services; and
(ii) The treating provider of the individual who is entitled to coverage under a contract issued or delivered in Maryland by a carrier.
(9) "Market conduct action" has the meaning stated in COMAR 31.04.20.03A.
(10) "Person" has the meaning stated in Insurance Article, §
										1-101, Annotated Code of Maryland.
(11) "Premium" has the meaning stated in Insurance Article, §
										1-101, Annotated Code of Maryland.
(12) "Rapid Response Program" means the process designed by the Administration to help Maryland residents resolve personal property and casualty insurance claims directly with the individual's insurer.