West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-14 - Unfair Trade Practices › Section 114-14-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
For the purposes of this regulation, the following definitions
				  shall apply:
2.1. "Agent" means any
				individual, corporation, association, partnership or other legal entity authorized
				to represent an insurer with respect to a claim.
2.2. "Claimant" means either a first-party
				claimant, a third-party claimant, or both.
2.3. "First-party claimant" or "Insured" means an
				individual, corporation, association, partnership or other legal entity asserting a
				right to payment under an insurance policy or insurance contract arising out of the
				occurrence of the contingency or loss covered by such policy or contract.
2.4. "Person" includes any individual, company,
				insurer, association, organization, society, reciprocal, business trust, corporation
				or any other legal entity, including agents, adjusters and brokers.
2.5. "Insurer" means a person licensed to issue or
				who issues any insurance policy or insurance contract covering risks resident,
				located or to be performed in this state.
2.6. "Investigation" means all activities of an
				insurer or agent directly or indirectly related to the determination of liabilities
				under coverages afforded by an insurance policy or insurance contract.
2.7. "Notification of claim" means any
				notification, whether in writing or other means acceptable under the terms of an
				insurance policy or insurance contract, to an insurer or its agents, by a claimant,
				which reasonably apprises the insurer or agent of the existence of an occurrence
				which might give rise to liability under a policy or contract of
				insurance.
2.8. "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 an
				insurer.
2.9. "Settlement of claims"
				means all activities of the insurer or its agent which are related directly or
				indirectly to the determination of the compensation that is due under coverage
				afforded by the insurance policy or insurance contract. This includes, but is not
				limited to, the requiring or preparing of repair estimates.
2.10. "Insurance policy" or "Insurance contract"
				means the contract effecting insurance, or the certificate thereof, by whatever name
				called, and includes all clauses, riders, endorsements and papers issued under the
				terms of the policy or contract.
2.11.
				"Claim" means any communication by a claimant to an insurer or its agent which
				reasonably apprises the insurer or agent of an occurrence which might give rise to
				liability under a policy or contract of insurance.
2.12. "Commissioner" means the West Virginia
				Insurance Commissioner.
2.13. "Licensee"
				means any person that holds a license or certificate of authority from the
				Commissioner, or any other entity for whom the Commissioner's consent is required
				before transacting business in the State of West Virginia or with residents of West
				Virginia.