West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-15 - Examiners And Examinations › Section 114-15-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
As used in this legislative rule:
2.1. "Accredited examiner" or "examiner" means a
				person who is an employee of the insurance commissioner whose principle duty is to
				conduct, supervise, or provide technical support for financial or market conduct
				examinations, including but not limited to the following division of personnel job
				classifications: insurance company examiner, or insurance company examiner
				supervisor, market conduct examiner, market conduct examiner supervisor, or computer
				audit specialist, pursuant to the classification plan of the West Virginia division
				of personnel or such other equivalent classification plan as the state of West
				Virginia may adopt.
2.2. "Additional
				examination assessment fee" means any additional or increased examination assessment
				fee levied by order of the commissioner in excess of the annual examination
				assessment fee as allowed by the provisions of W. Va. Code §
									33-2-9.
2.3. "Application and accompanying records" means
				any written or electronic application form, any enrollment form, any document or
				record thereof, used to add coverage under any existing policy, questionnaire,
				telephone interview form, paramedical interview form or any other document used to
				question or underwrite an applicant for any policy issued by an insurer or for any
				declination of coverage by an insurer.
2.4. "Claim file and accompanying records" means
				the file maintained so as to show clearly the inception, handling and disposition of
				each claim. The claim file shall be sufficiently clear and specific so that
				pertinent events and dates of these events can be reconstructed.
2.5. "Commissioner" means the insurance
				commissioner of the state of West Virginia.
2.6. "Complaint" means a written communication
				primarily expressing a grievance.
2.7.
				"Declination" or "declined underwriting file" means all written or electronic
				records concerning coverage for which an application has been completed and
				submitted to the insurer or its producer but the insurer has made a determination
				not to issue a policy or not to add additional coverage when requested.
2.8. "Examination assessment fee" means the annual
				fee due on or before the first day of July of every year, as specified in W. Va.
				Code §
									33-2-9.
2.9. "Governor's travel rules" means those rules
				promulgated by the governor pursuant to the authority granted by W. Va. Code §
									12-3-11.
2.10. "Grievance" for health insurance
				purposes, means a written complaint submitted by or on behalf of a covered person
				regarding the:
a. Availability, delivery or
				quality of health services, including a complaint regarding an adverse determination
				made pursuant to utilization review;
b.
				Claims payment, handling or reimbursement for health care services; or
c. Matters pertaining to the contractual
				relationship between a covered person and a health carrier.