Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-30 - Trade practices › THE UNFAIR CLAIMS SETTLEMENT PRACTICES REGULATION › Section 284-30-320 - Definitions

Current through Register Vol. 24-14, July 15, 2024
When used in this regulation, WAC
				  284-30-300
				  through
				  284-30-400:
(1) "Actual cash value" means the fair market
				value of the loss vehicle immediately prior to the loss.
(2) "Claimant" means, depending upon the
				circumstance, either a first party claimant, a third-party claimant, or both
				and includes a claimant's designated legal representative and a member of the
				claimant's immediate family designated by the claimant.
(3) "Comparable motor vehicle" means a
				vehicle that is the same make and model, of the same or newer model year,
				similar body style, with similar options and mileage as the loss vehicle and in
				similar overall condition, as established by current data. To achieve
				comparability, deductions or additions for options, mileage or condition may be
				made if they are itemized and appropriate in dollar amount.
(4) "Current data" means data within ninety
				days prior to or after the date of loss.
(5) "Documented expenses" means specific
				incurred expenses which are either paid by the group policyholder or paid on
				behalf of the group policyholder and for which documentation is obtained by the
				insurer. Such documented expenses include, but are not limited to, training,
				marketing, consumer awareness, information technology and computer programming
				and operations and administration. Such expenses must be specifically disbursed
				and actually incurred within the limits set forth in the policy or policy
				addendum.
(6) "File" means a record
				in any retrievable format, and unless otherwise specified, includes paper and
				electronic formats.
(7) "First
				party claimant" means an individual, corporation, association, partnership or
				other legal entity asserting a right as a covered person to payment under an
				insurance policy or insurance contract arising out of the occurrence of the
				contingency or loss covered by a policy or contract.
(8) "Group policyholder" means a policy owner
				under a group policy which provides coverage to an entire group of fifty-one or
				more individuals.
(9) "Insurance
				policy" or "insurance contract" mean any contract of insurance, indemnity,
				suretyship, or annuity issued, proposed for issuance, or intended for issuance
				by any insurer.
(10) "Insurer"
				means any individual, corporation, association, partnership, reciprocal
				exchange, interinsurer, fraternal mutual insurer, fraternal mutual life
				insurer, and any other legal entity engaged in the business of insurance,
				authorized or licensed to issue or who issues any insurance policy or insurance
				contract in this state. "Insurer" does not include health care service
				contractors, as defined in
				RCW
				 48.44.010, and health maintenance
				organizations, as defined in
				RCW
				 48.46.020.
(11) "Investigation" means all activities of
				the insurer directly or indirectly related to the determination of liabilities
				under coverages afforded by an insurance policy or insurance
				contract.
(12) "Loss vehicle" means
				the damaged motor vehicle or a motor vehicle that the insurer determines is a
				"total loss."
(13) "Motor vehicle"
				means any vehicle subject to registration under chapter 46.16 RCW.
(14) "Notification of claim" means any
				notification, whether in writing or other means acceptable under the terms of
				an insurance policy or insurance contract, to the insurer or its agent, by a
				claimant, which reasonably apprises the insurer of the facts pertinent to a
				claim.
(15) "Principally garaged
				area" means the place where the loss vehicle is normally kept, consistent with
				the applicable policy of insurance.
(16) "Shall describe any such payment" means
				the specific expenses that are described in the group policy-holder's contract
				or subsequent contract addendum with the insurer and which establish the limits
				of acceptable expenses under the contract.
(17) "Third-party claimant" means any
				individual, corporation, association, partnership or other legal entity
				asserting a claim against any individual, corporation, association, partnership
				or other legal entity insured under an insurance policy or insurance contract
				of the insurer.
(18) "Total loss"
				means that the insurer has determined that the cost of parts and labor, plus
				the salvage value, meets or exceeds, or is likely to meet or exceed, the
				"actual cash value" of the loss vehicle. Other factors may be considered in
				reaching the total loss determination, such as the existence of a biohazard or
				a death in the vehicle resulting from the loss.
(19) "Written" or "in writing" means any
				retrievable method of recording an agreement or document, and, unless otherwise
				specified, includes paper and electronic formats.